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Table 1 Characteristics of four patients suffering from louse-borne relapsing fever (Borrelia recurrentis) diagnosed in Switzerland from June to December 2015

From: Louse-borne relapsing fever – report of four cases in Switzerland, June-December 2015

Case

Sex, age

Origin

Travel route

Location of first febrile episode

Symptoms

Platelet count (on admission, nadir; × 109)

CRP (on admission, peak; mg/L)

Other laboratory features

Treatment

1

M, 25 y

Eritrea

ER, SU, LB, IT, CH

Libya

Fever, abdominal pain, epistaxis

56, 30

312, 312

Mild anemia, hyponatremia and hypokalemia

Ceftriaxone for 2 days followed by doxycycline for 7 days

2

M, 29 y

Somalia

SO, KE, SU, LB, IT, CH

Italy (infestation with body lice in Libya)

Fever, abdominal pain, headache, muscle aches

141, 54

245, 245

Mild anemia, leukocytosis and hyponatremia

Ceftriaxone for 1 day followed by doxycycline for 7 days plus

HRZEb

3

F, 21 y

Somalia

SO, KE, UG, SU, LB, IT, CH

Italy

Fever, pollakisuria, swollen/painful cervical/axillary lymphadenopathy

45, 27

367, 367

Mild anemia, leukocytosis and hyponatremia, elevated creatinine (mild), bilirubin and LDH (both moderate)

Doxycycline for 5 days

4

M, 17y

Somalia

SO, ET, SU, LB, IT, CH

Libya

Fever, chills, cough, urinary incontinence

167, 62

127, 235

Moderate anemia, mild hyponatremia, hypokalemia, elevated creatinine and LDH (both mild)

Doxycycline for 3 days plus Artemether/lumefantrinea

  1. Abbreviations: F female, M male, Y year, CRP C-reactive protein, HRZE antimycobacterial treatment with isoniazid (H), rifampicin (R), pyrazinamide (Z) and ethambutol (E)
  2. Travel route: CH Switzerland, ER Eritrea, ET Ethiopia, IT Italy, LB Libya, SU Sudan, SO Somalia, UG Uganda
  3. Platelet count, norm: 150–450 × 109/L; C-reactive protein, norm: <10 mg/L
  4. aArtemether/lumefantrine treatment was administered for concurrent Plasmodium falciparum malaria infection
  5. bAntimycobacterial treatment consisting of HRZE for two months followed by HR for four months was administered for concurrent M. tuberculosis lymphadenitis