194. Utility of Borrelia miyamotoi PCR in Rhode Island: A Case Series.
Session: Poster Abstract Session: Diagnostics: Bacteriology, Sequencing, and Resistance
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • BMIYAMOTOIPOSTER.png (94.9 kB)
  • Background: Borrelia miyamotoi is a newer cause of ixodid (hard-bodied) tick-borne relapsing fever. Symptoms are generally non-specific, and pathognomonic clinical features lacking, thus whole blood PCR may be useful for confirming a diagnosis. At South County hospital in Rhode Island, in an endemic region for many tick-borne illnesses, a bundled panel which includes B. miyamotoi PCR was often sent on symptomatic patients with a suspicion of tick-borne disease during 2014-2015.

    Methods: A retrospective chart review was performed to establish a case series of patients with PCR positive for B. miyamotoi in an attempt to further characterize demographics, clinical presentations, co-infections, laboratory abnormalities and treatment courses for B. miyamotoi disease.

    Results: 2592 patients had a bundled tick-borne illness panel sent for unexplained fever and other symptoms. 18 tested positive for B. miyamotoi PCR (0.7% positivity rate). 1 was co-infected with Babesia microti; an additional 6 had positive Lyme serology.  11 patients were prescribed doxycycline, and 1 was prescribed amoxicillin-clavulanate.

    Conclusion: B. miyamotoi testing was bundled to a pre-existing tick-borne illness panel to potentially account for unexplained fevers and other symptoms in high-risk patients. Treatment recommendations for B. miyamotoi are based on case reports of successful treatments in other causes of relapsing fever, thus similar antibiotics regimens are used for both. The cost for this additional test is $25/test in our setting. Despite the endemic nature of B. miyamotoi in RI, the utility of Borrelia PCR in first-line screening for patients with unexplained fever may be minimal from a cost-benefit perspective.

    Theresa Fiorito, MD, Pediatric Infectious Diseases, Brown University/Hasbro ChildrenĀ“s Hospital, Providence, RI, Mark Godding, MS1, Warren Alpert Medical School of Brown University, Providence, RI, Rebecca Reece, MD, Infectious Diseases, Alpert Medical School of Brown University, Providence, RI, Timothy Flanigan, MD, FIDSA, Department of Infectious Diseases, The Miriam Hospital, Providence, RI and Fred Silverblatt, MD, Infectious Diseases, South County Hospital, East Greenwich, RI

    Disclosures:

    T. Fiorito, None

    M. Godding, None

    R. Reece, None

    T. Flanigan, None

    F. Silverblatt, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.