CONCOMITANT INFECTION WITH TICK-BORNE ENCEPHALITIS-VIRUS AND BORRELIA-BURGDORFERI SENSU-LATO IN PATIENTS WITH ACUTE MENINGITIS OR MENINGOENCEPHALITIS

From September 1992 to August 1993, 338 patients over the age of 15 ye ars presented to the Department of Infectious Diseases, University Med ical Centre Ljubljana, with acute lymphocytic meningitis, In 89 of the se patients (26.3%) serum IgM and IgG antibodies against tick-borne en cephalitis (TBE) virus were detected, and in 59 patients (17.5%) a bor relial etiology of disease was demonstrated by one or more of the foll owing: presence of intrathecal antibody production, seroconversion to borrelial antigens, presence of erythema migrans, and/or isolation of Borrelia burgdoferi sensu Into from skin or cerebrospinal fluid. Of th e 148 patients who fulfilled criteria for TEE or borrelial infection, concomitant infection with TEE virus and B, burgdorferi sensu late was demonstrated in 12 patients (3.6% of all patients presenting with acu te lymphocytic meningitis). In the majority of patients with concomita nt infection the clinical features at presentation were characteristic of, or consistent with, TEE. In addition, during follow-up studies, e ight of the 12 patients subsequently developed signs and symptoms comp atible with minor and/or major manifestations of Lyme borreliosis. Six patients were diagnosed with neuroborreliosis based on signs or sympt oms and/or laboratory tests. These findings show that in patients with acute lymphocytic meningitis or meningoencephalitis, originating in T EE and Lyme borreliosis endemic regions, the possibility of concomitan t infection should be considered.