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Case Reports in Infectious Diseases
Volume 2011 (2011), Article ID 469194, 5 pages
http://dx.doi.org/10.1155/2011/469194
Case Report

Coinfection with Rickettsia helvetica and Herpes Simplex Virus 2 in a Young Woman with Meningoencephalitis

1Section of Clinical Microbiology, Department of Medical Sciences, Uppsala University, 751 85 Uppsala, Sweden
2Section of Infectious Diseases, Department of Medical Sciences, Uppsala University, 751 85 Uppsala, Sweden
3Centre for Clinical Research, Falu Hospital, 791 82 Falun, Sweden

Received 6 July 2011; Accepted 15 August 2011

Academic Editors: M. Caira, A. Marangoni, and S. Richardson

Copyright © 2011 Kenneth Nilsson et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Herpes virus type 2 DNA was detected by PCR in the cerebrospinal fluid in a young woman presenting with headache, stiff neck and pleocytosis, and serological findings consistent with reactivation. Since she was exposed to ticks, Lyme disease and tick-borne encephalitis were excluded. Further investigation in an ongoing project, using PCR and sequencing of the amplified products, showed the presence of Rickettsia helvetica in the cerebrospinal fluid. The bacteria were also isolated in Vero cell culture, and microimmunofluorescence confirmed the development of antibodies against Rickettsia spp. with predominance of IgM reactivity consistent with recent infection. She was treated with antibiotics and improved rapidly. The patient could easily have been judged to have isolated herpes meningitis. Because Sweden and other European countries are endemic areas for rickettsioses, the paper reaffirms the importance of investigating for the presence of rickettsial infections in endemic areas in cases of meningitis of uncertain aetiology.