Table 12 Rare infectious/parasitic diseases
Disease | Etiology | Transmission | Clinical features | Laboratory tests | Treatment |
|---|---|---|---|---|---|
Whipple disease | T. whipplei | Exposure to contaminated soil | Weight loss, diarrhea, fever, lymphadenopathy, skin hyperpigmentation, arthritis, heart failure, CNS involvement (oculomasticatory myorhythmia or oculo-facio-skeletal myorhythmia) | PAS test from duodenal/jejunal biopsy tissue; Positive T. whipplei PCR in stools, CSF, or saliva | Ceftriaxone or Meropenem 2 weeks, co-trimoxazole or doxycycline with hydroxychloroquine for 1 year. Corticosteroids with IRIS present |
Lyme disease | B. burgdorferi | Tick-borne (I. scapularis or I. pacificus) in USA, Europe, and Asia | Erythema migrans (bull- eye pattern), arthritis, myocarditis, peripheral nervous system, facial palsy, meningoencephalitis, chronic fatigue syndrome; Autoimmune and allergic diseases development | ELISA IgM and IgG for B. burgdorferi, western blot IgM and IgG for B. burgdorferi | Ceftriaxone intravenously for severe features. Doxycycline or amoxicillin for mild features |
Baggio-Yoshinari syndrome¶ | B. burgdorferi sensu stricto spirochetes | Tick-borne (A. cajennense or R. sanguineus or D. nitens) in Brazil | Erythema migrans (bull-eye pattern), arthritis, myocarditis, peripheral nervous system, facial palsy, meningoencephalitis, chronic fatigue syndrome; Autoimmune and allergic diseases development | ELISA IgM and IgG, western blot IgM and IgG for B. burgdorferi adopted in LIM-17 HCFMUSP standardization | Ceftriaxone intravenously for severe features. Doxycycline or amoxicillin for mild features |
Garin-Bujadoux-Bannwarth syndrome | B. garinii | Tick-borne (I. scapularis) in Europe. | Painful radiculitis, peripheral motor deficits, lymphocytic meningoencephalitis, and facial palsy | Increase of lymphocytes and protein in CSF. ELISA IgM and IgG for B. burgdoferi, western blot IgM and IgG for B. burgdorferi (lack of standardization) | Ceftriaxone intravenously |
Acrodermatitis chronica atrophicans | B. afzelii | Tick-borne (I. scapularis) in Europe | Extensive skin atrophy with a shiny appearance or “cigarette paper skin”; Peripheral neuropathy and/or arthropathy | ELISA IgM and IgG for B. burgdorferi, western blot IgM and IgG for B. burgdorferi (lack of standardization) | Doxycycline or amoxicillin or ceftriaxone. |