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The purpose of this study is to explore whether a correlation exists between the bacterial load of Borrelia persica in tick-borne relapsing fever (TBRF), established by quantitative real-time PCR, and the development of Jarisch-Herxheimer reaction (JHR) after the initiation of antibiotic treatment. Forty-two blood samples were included in our study. The mean bacterial load, as established by real-time PCR, in patients who developed JHR was significantly greater than in those patients who did not develop JHR (443,293 copies vs. 140,598, p = 0.035). Accordingly, real-time PCR may assist clinicians in identifying patients at higher risk of JHR.

BACKGROUND: Acute schistosomiasis (AS) is a systemic hypersensitivity reaction that has been recognized mostly in nonimmune travelers. Although the condition is self-limited, it can be severe. We describe an outbreak of AS in a group of travelers returning from Tanzania and estimate the disease burden. METHODS: After we identified the index case, we initiated an epidemiological investigation of the entire group. Diagnosis was established on the basis of symptoms, serologic data, and ova detection. Relevant clinical information was documented with use of a structured questionnaire, and the patient's economic burden was recorded. Health-related quality of life was assessed during the illness and 3 months later. RESULTS: Of 34 group members, 27 had a single exposure to a fresh water pond, 22 (81%) of whom were infected. AS developed in 19 (86%) of the 22 infected travelers. Cough (78% of patients), fever (68%), and fatigue (58%) were the most common symptoms, with mean durations (+/- standard deviation) of 22 +/- 11, 11 +/- 7, and 37 +/- 16 days, respectively. The total number of medical encounters was 258 (mean no. of encounters per patient, 11), and 152 work and school days were missed (mean, 8 days per patient). During the acute phase of illness, there was a significant decline in health-related quality of life that returned to expected norms after 3 months. CONCLUSIONS: A single, short exposure of travelers to an infected pond led to a high infection rate. The illness had a significant impact on the patients' daily functions, and patients extensively used medical resources. Education to avoid exposure to fresh water remains the most effective method of schistosomiasis prevention.

Blood samples from 18 tickborne relapsing fever (TBRF) patients and Ornithodoros tholozani specimens were tested with a Borrelia flaB-PCR. Results were positive for all patients and 2%–40% of ticks. A 7–amino acid gap characterized all 9 sequenced flagellin gene amplicons. By phylogenetic analysis, Israel TBRF Borrelia sequences clustered separately from American and African groups.

To the Editor: Tickborne relapsing fever (TBRF) is caused by several Borrelia species and transmitted by argasid soft ticks of the genus Ornithodoros. The disease is endemic to many parts of the world, especially Africa (B. duttonii and B. crocidurae most prevalent), and the Mediterranean basin (B. hispanica most prevalent). In Eurasia, TBRF is mainly caused by B. persica (1–3). We report a patient who returned to France with B. persica infection after visiting Uzbekistan and Tajikistan. In September 2008, a 32-year-old man sought care at the Saint Louis Hospital in Paris, France, for a fifth relapsing episode of fever. Three weeks earlier (July 31–August 18), he had trekked through Uzbekistan and Tajikistan and spent 7 nights in a tent in Uzbekistan. The day before his return to France, he had fever (39.5°C) that lasted 5 days without other symptoms. After a 4-day interval, fever recurred for 1 day, then relapsed 3 other times (every 2 days with fever for 12 hours). Laboratory investigations performed earlier by his general physician on August 19 and 20 showed lymphopenia (0.76 × 109 cells/L and 0.44 × 109 cells/L), thrombocytopenia (94 ×109 cells/L and 80 ×109 cells/L), and C-reactive protein level 300 mg/L (reference level

It is not entirely clear when and how steroids should be used to treat trichinellosis.To describe the course of consecutive patients with trichinellosis treated with antihelminthic drugs with and without the addition of prednisone.We extracted data from the hospital records of 30 patients hospitalized for trichinellosis contracted after eating poorly cooked pork that came from two wild pigs killed in the Golan Heights, and contacted them for follow-up 5-6 weeks and 6 months after hospital discharge.All the patients who attended a party and ingested the infected pork (100% attack rate) were hospitalized after 2-16 days (median 9 days); 29 were symptomatic and 1 patient without symptoms had creatine phosphokinase levels 17.9 times above the upper limit of normal. Twelve of 23 patients (52%) treated with antihelminthic drugs without prednisone were rehospitalized with worsening fever, increased peripheral blood eosinophil counts, but decreasing CPK values. These patients and another seven at the time of admission were treated with prednisone 40 mg/day for 5 days in addition to antihelminthic drugs for at least 14 days. All became asymptomatic within 24 hours and were asymptomatic 6 weeks and 6 months later.Worsening symptoms in patients treated with antihelminthic drugs alone is common. A short course of prednisone is safe and alleviates symptoms due to tissue larvae in patients with trichinellosis.

Schistosomiasis is increasingly encountered among travelers returning from the tropics; signs and symptoms of travelers may differ from those of local populations. During 1993-2005, schistosomiasis was diagnosed in 137 Israeli travelers, most of whom were infected while in sub-Saharan Africa. Clinical findings compatible with acute schistosomiasis were recorded for 75 (66.4%) patients and included fever (71.3%), respiratory symptoms (42.9%), and cutaneous symptoms (45.2%). At time of physical examination, 42 patients (37.1%) still had symptoms of acute schistosomiasis, chronic schistosomiasis had developed in 23 (20.4%), and 48 (42.5%) were asymptomatic. Of patients who were initially asymptomatic, chronic schistosomiasis developed in 26%. Diagnosis was confirmed by serologic testing for 87.6% of patients, but schistosome ova were found in only 25.6%. We conclude that acute schistosomiasis is a major clinical problem among travelers, diagnostic and therapeutic options for acute schistosomiasis are limited, and asymptomatic travelers returning from schistosomiasis-endemic areas should be screened and treated.

Serologic tests are essential for the diagnosis of syphilis. In symptomatic patients, serodiagnosis confirms the clinical diagnosis. During the asymptomatic stage, interpretation of serologic tests is more difficult, either because of low serologic titres or because of discrepant serologies. Questioning of the patient will help to find a history of syphilis within the previous months or years, an adequate therapy or no treatment at all. Another issue that must be mentioned is the impossibility to differentiate syphilis and non-sexually acquired treponemal infections.

Patients with early complicated forms of Lyme borreliosis had a low specific IgG avidity index and patients with late forms had a high avidity index. Naturally exposed individuals had intermediate values.