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This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Dittman, W. A. Search for Related Content PubMed Articles by Dittman, W. A. Related Collections Hemostasis, Thrombosis, and Vascular Biology Plenary Papers Clinical Trials and Observations Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  Blood, 15 November 2000, Vol. 96, No. 10, pp. 3333-3333 FEATURED MICROGRAPH View larger version (132K): [in this window] [in a new window]   Congenital relapsing fever (Borrelia hermsii). William A. Dittman Sr, Sacred Heart Medical Center, Spokane, WA. A 35-week infant was delivered by cesarean section because of fetal distress. Her mother presented to Sacred Heart Medical Center early because of decreased fetal movement. At delivery, the child demonstrated respiratory depression requiring intubation and manual resuscitation. Apgar scores were 1 at one minute and 5 at five minutes. The "admitting" diagnosis was sepsis with shock. Cord blood counts revealed a white blood cell count at 8.2/µL, hemoglobin level at 16.4g/dL, hematocrit level at 48.8%, and platelet count at 8/µL. Nucleated red blood cells were 88 per 100 white blood cells. During verification of the platelet count with the blood film, multiple spirochetes were seen (A), many in clumps (B). These spirochetes were further classified and confirmed by immunofluorescent antibody staining as Borrelia hermsii.   No organisms were seen on multiple blood films of the mother. Although the placenta was grossly and microscopically normal, silver stains demonstrated spirochetes.   A review of the prenatal history identified an episode of fever, chills, aching, headache, and fatigue which occurred at week 16 of the pregnancy. The mother recalled a similar one-day illness at week 19. There were no other untoward events until presentation.   The child was treated with fluids for the septic shock. Ampicillin and cefotaxime were given initially, and erythromycin was added when the spirochetes were found. Dexamethasone was administered for the septic shock and thrombocytopenia. Improvement was progressive until day 9 when hypotension, pallor, and abdominal distension occurred. Autopsy revealed bleeding into a liver abscess with subsequent rupture of a subcapsular hematoma. No organisms were found in the abscesses at autopsy.   Relapsing fever (tick-borne borrelia hermsii) is endemic to the western United States. It is transmitted by the Ornithodoros hermsii tick. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Dittman, W. A. Search for Related Content PubMed Articles by Dittman, W. A. Related Collections Hemostasis, Thrombosis, and Vascular Biology Plenary Papers Clinical Trials and Observations Social Bookmarking                   What's this?

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