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Diagnosis of Louse-Borne Relapsing Fever despite Negative Microscopy in Two Asylum Seekers from Eastern Africa
We report two cases of louse-borne relapsing fever observed at our Institution in June 2016. Both patients were young asylum seekers from Africa who had recently arrived in Milan, Italy. Notably, direct microscopic examination of peripheral blood smears was repeatedly negative for the presence of spirochetes and the diagnosis, supported by clinical and epidemiologic evidence, required molecular confirmation by polymerase chain reaction amplification of DNA extracted from blood and sequencing of the amplified products.
Author Notes
Authors’ addresses: Spinello Antinori and David Ricaboni, Department of Biomedical and Clinical Sciences Luigi Sacco, Luigi Sacco Hospital, University of Milano, Milano, Italy, E-mails: spinello.antinori@unimi.it and davide.ricaboni@unimi.it. Cristina Tonello and Carlo Parravicini, Department of Diagnostics, Pathology Unit, Luigi Sacco Hospital, University of Milano, Milano, Italy, E-mails: cristina.tonello@asst-fbf-sacco.it and carlo.288@gmail.com. Sophie Edouard and Didier Raoult, Aix Marseille Université, URMITE UMR 6236, IRD 198, Marseille, France, E-mails: soph.edouard@gmail.com and didier.raoult@gmail.com. Daniela Gastaldi, Centro Accoglienza immigrati, Milano, Italy, E-mail: raiot41@gmail.com. Romualdo Grande, Departments of Diagnostics, Clinical Microbiology, Virology and Bioemergence Diagnostics, Luigi Sacco Hospital, University of Milano, Milano, Italy, E-mail: romualdo.grande@asst-fbf-sacco.it. Laura Milazzo and Mario Corbellino, Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, University of Milano, Milano, Italy, E-mails: laura.milazzo@unimi.it and mario.corbellino@unimi.it. Florence Fenollar, Faculté de Médecine, Unité des Rickettsies, Marseille, France, E-mail: florence.fenollar@univ-amu.fr. Oleg Mediannikov, Aix Marseille Université, URMITE UMR 6236, IRD 198, Marseille, France and IRD, URMITE UMR198, Campus communs IRD/UCAD Hann Maristes, Dakar, Senegal, E-mail: olegusss1@gmail.com.