{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T10:07:43Z","timestamp":1772878063358,"version":"3.50.1"},"reference-count":63,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,1,14]],"date-time":"2025-01-14T00:00:00Z","timestamp":1736812800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Departments of Medicine at the University of Toronto and University Health Network"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["TropicalMed"],"abstract":"<jats:p>The causative agent of Lyme disease, Borrelia burgdorferi, is endemic to Canada, the northeastern United States, northern California, and temperate European regions. It is rarely associated with a travel-related exposure. In this report, we describe a resident of southern Ontario, Canada who developed rash, fever, and cranial nerve VII and XII palsies following a 12 day trip to Ecuador and the Galapagos islands approximately four weeks prior to referral to our center. Comprehensive microbiological work-up was notable for reactive Borrelia burgdorferi serology by modified two-tier testing (MTTT), confirming a diagnosis of Lyme disease. This case highlights important teaching points, including the classic clinical presentation of acute Lyme disease with compatible exposure pre-travel in a Lyme-endemic region of Ontario, initial manifestations during travel following acquisition of arthropod bites in Ecuador, and more severe manifestations post-travel. Given the travel history to a South American country in which Lyme disease is exceedingly uncommon, consideration of infections acquired in Ecuador necessitated a broad differential diagnosis and more comprehensive microbiological testing than would have been required in the absence of tropical travel. Additionally, cranial nerve XII involvement is an uncommon feature of Lyme neuroborreliosis, and therefore warranted consideration of an alternative, non-infectious etiology such as stroke or a mass lesion, both of which were excluded in this patient through neuroimaging.<\/jats:p>","DOI":"10.3390\/tropicalmed10010021","type":"journal-article","created":{"date-parts":[[2025,1,14]],"date-time":"2025-01-14T03:29:43Z","timestamp":1736825383000},"page":"21","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Acute Febrile Illness Accompanied by 7th and 12th Cranial Nerve Palsy Due to Lyme Disease Following Travel to Rural Ecuador: A Case Report and Mini-Review"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4041-426X","authenticated-orcid":false,"given":"Teslin S.","family":"Sandstrom","sequence":"first","affiliation":[{"name":"Division of Medical Microbiology, Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kumudhavalli","family":"Kavanoor Sridhar","sequence":"additional","affiliation":[{"name":"Division of Medical Microbiology, Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7888-5406","authenticated-orcid":false,"given":"Judith","family":"Joshi","sequence":"additional","affiliation":[{"name":"Faculty of Arts and Science, University of Toronto, Toronto, ON M5S 3G3, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali","family":"Aunas","sequence":"additional","affiliation":[{"name":"Faculty of Arts and Science, University of Toronto, Toronto, ON M5S 3G3, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sheliza","family":"Halani","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, ON M5S 3H2, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea K.","family":"Boggild","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, ON M5S 3H2, Canada"},{"name":"Tropical Disease Unit, Toronto General Hospital, Toronto, ON M5G 2C4, Canada"},{"name":"Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 3K3, Canada"},{"name":"Office of Access and Outreach, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,14]]},"reference":[{"key":"ref_1","unstructured":"(2024, December 01). 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