{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T20:52:53Z","timestamp":1765486373327,"version":"3.44.0"},"reference-count":20,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,10,22]]},"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:p>\n                  <jats:italic>Ixodes scapularis<\/jats:italic> is responsible for transmission of <jats:italic>Borrelia burgdorferi, B. miyamotoi, Babesia microti, Anaplasma phagocytophilum<\/jats:italic> and Powassan virus to humans. We present a case of an 87-year-old man who presented with fever and altered mental status. Initial workup revealed haemolytic anaemia, thrombocytopenia, mild hepatitis and acute kidney injury. Patient tested positive for <jats:italic>B. burgdorferi<\/jats:italic> and <jats:italic>Babesia microti<\/jats:italic>, and was started on doxycycline, atovaquone and azithromycin. He also underwent exchange transfusion twice. After some initial improvement, patient had acute deterioration of mental status and appearance of neurological findings like myoclonus and tremors. Therefore, testing for arboviruses was done and results were positive for Powassan virus. During a protracted course of hospitalisation, patient required intubation for respiratory failure and temporary pacemaker for unstable arrythmias from Lyme carditis. Patient developed permanent neurological deficits even after recovery from the acute illness.<\/jats:p>","DOI":"10.1136\/bcr-2019-231645","type":"journal-article","created":{"date-parts":[[2019,11,11]],"date-time":"2019-11-11T06:15:47Z","timestamp":1573452947000},"page":"e231645","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Powassan virus encephalitis, severe babesiosis and lyme carditis in a single patient"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0724-0766","authenticated-orcid":false,"given":"Abdul Moiz","family":"Khan","sequence":"first","affiliation":[{"name":"Internal Medicine, Albany Medical Center Hospital, Albany, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sheikh Raza","family":"Shahzad","sequence":"additional","affiliation":[{"name":"Internal Medicine, Albany Medical Center Hospital, Albany, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammad Farhan","family":"Ashraf","sequence":"additional","affiliation":[{"name":"Internal Medicine, Albany Medical Center Hospital, Albany, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Usman","family":"Naseer","sequence":"additional","affiliation":[{"name":"Internal Medicine, Albany Medical Center Hospital, Albany, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,11,10]]},"reference":[{"key":"2025082703291973000_12.11.e231645.1","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1016\/j.cll.2015.07.006","article-title":"Lyme disease coinfections in the United States","volume":"35","author":"Caulfield","year":"2015","journal-title":"Clin Lab Med"},{"key":"2025082703291973000_12.11.e231645.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pt.2015.09.008"},{"key":"2025082703291973000_12.11.e231645.3","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00011-06"},{"key":"2025082703291973000_12.11.e231645.4","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.2884"},{"key":"2025082703291973000_12.11.e231645.5","doi-asserted-by":"crossref","unstructured":"Kemenesi G , Banyai K , Flaviviruses T-B . With a focus on Powassan virus. Clinical microbiology reviews 2019;32.","DOI":"10.1128\/CMR.00106-17"},{"key":"2025082703291973000_12.11.e231645.6","unstructured":"Powassan virus- Statistics & Maps, 2018. Available: https:\/\/www.cdc.gov\/powassan\/statistics.html"},{"key":"2025082703291973000_12.11.e231645.7","doi-asserted-by":"publisher","DOI":"10.1089\/vbz.2017.2110"},{"key":"2025082703291973000_12.11.e231645.8","doi-asserted-by":"publisher","DOI":"10.3201\/eid1912.130903"},{"key":"2025082703291973000_12.11.e231645.9","doi-asserted-by":"crossref","DOI":"10.1186\/1756-0500-5-594","article-title":"Powassan virus infection: case series and literature review from a single institution","volume":"5","author":"Raval","year":"2012","journal-title":"BMC Res Notes"},{"key":"2025082703291973000_12.11.e231645.10","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-ento-112408-085446"},{"key":"2025082703291973000_12.11.e231645.11","first-page":"1419","article-title":"Powassan encephalitis: a case report with neuropathology and literature review","volume":"161","author":"Gholam","year":"1999","journal-title":"CMAJ"},{"key":"2025082703291973000_12.11.e231645.12","unstructured":"CDC . Arboviral diseases, Neuroinvasive and Non-neuroinvasive 2015 case definition, 2015. Available: https:\/\/wwwn.cdc.gov\/nndss\/conditions\/powassan-virus-disease\/case-definition\/2015\/"},{"key":"2025082703291973000_12.11.e231645.13","unstructured":"CoDCaP . Tickborne diseases of the US: a reference manual for health care providers. 5th edn, 2018. https:\/\/www.cdc.gov\/ticks\/tickbornediseases\/TickborneDiseases-P.pdf"},{"key":"2025082703291973000_12.11.e231645.14","doi-asserted-by":"publisher","DOI":"10.3201\/eid2308.161971"},{"key":"2025082703291973000_12.11.e231645.15","doi-asserted-by":"publisher","DOI":"10.1086\/508667"},{"key":"2025082703291973000_12.11.e231645.16","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1202018"},{"key":"2025082703291973000_12.11.e231645.17","doi-asserted-by":"crossref","DOI":"10.1186\/s12941-017-0198-9","article-title":"Babesiosis in long island: review of 62 cases focusing on treatment with azithromycin and atovaquone","volume":"16","author":"Kletsova","year":"2017","journal-title":"Ann Clin Microbiol Antimicrob"},{"key":"2025082703291973000_12.11.e231645.18","doi-asserted-by":"crossref","DOI":"10.15585\/mmwr.mm6832a4","article-title":"Updated CDC recommendation for serologic diagnosis of Lyme disease","volume":"68","author":"Mead","year":"2019","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2025082703291973000_12.11.e231645.19","first-page":"202","article-title":"Treatment and prognosis","volume":"112","author":"Scheffold","year":"2015","journal-title":"Deutsches Arzteblatt international"},{"key":"2025082703291973000_12.11.e231645.20","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.ijcard.2016.12.169","article-title":"Manifestations of Lyme carditis","volume":"232","author":"Kosti\u0107","year":"2017","journal-title":"Int J Cardiol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2019-231645","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T10:29:31Z","timestamp":1756290571000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2019-231645"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11]]},"references-count":20,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2019,11,10]]},"published-print":{"date-parts":[[2019,11]]}},"alternative-id":["10.1136\/bcr-2019-231645"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2019-231645","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2019,11]]}}}