Borrelia miyamotoi is a relapsing-fever spirochete that conventional tick-borne testing does not detect. We report a case notable for two findings not emphasized in prior series: creatine kinase elevation to 1464 U/L and glucose concentrations above 500 mg/dL without ketoacidosis in a pump-treated patient with type 1 diabetes mellitus. A 36-year-old man with frequent wooded exposure presented with fever, headache, myalgias, and rash, along with leukopenia, thrombocytopenia, and mild transaminitis. Lyme serology, Babesia smear, Anaplasma and Ehrlichia PCR, spotted-fever group Rickettsia serology, and blood cultures were negative; blood real-time PCR identified B. miyamotoi after discharge. The hyperglycemia was attributable to infection-related insulin resistance and interruption of pump delivery. Seventeen days of doxycycline produced full clinical and laboratory recovery. Exercise and dehydration may have contributed to the hyperCKemia. This case supports early blood PCR during the febrile illness in culture-negative tick-borne disease and illustrates that insulin requirements may rise sharply when infection coincides with failure of insulin-delivery technology.

SUMMARYBrucella spp. are highly adapted intracellular bacterial pathogens that remain a substantial global cause of zoonotic disease. The globally distributed species Brucella melitensis, Brucella abortus, Brucella suis, and Brucella canis account for the majority of human infections, reflecting their efficient transmission across animal hosts, and their exceptional capacity to survive and replicate within the intracellular niche. Although animal infections are often clinically silent, human brucellosis can exhibit persistent intracellular infection and relapsing fever. Growing genomic data highlight expanding species diversity, including B. canis and marine Brucella. Progress in elucidating the intracellular life cycle of Brucella, including the maturation of Brucella-containing vacuoles, immune evasion strategies, and the role of the type IV secretion system, has refined our understanding of disease pathogenesis across hosts. At the same time, expanding molecular surveillance, global minimum-spanning-tree analyses, and One Health epidemiology have clarified transmission pathways among livestock, dogs, wildlife, and humans, revealing both cross-species connectivity and geographical hotspots of emergence. Given the limitations of existing livestock vaccines and the absence of human or canine vaccines, diverse next-generation platforms are now advancing toward translational evaluation. Unlike prior reviews focused primarily on livestock brucellosis or classical species, this review integrates emerging canine and marine Brucella lineages with advances in genomics, intracellular pathogenesis, and next-generation vaccine strategies within a unified One Health framework. In this review, we synthesize global trends in Brucella species diversity, zoonotic emergence, mechanisms of intracellular pathogenesis, and the status of current and experimental vaccines, while highlighting the One Health interventions needed to disrupt transmission and advance toward comprehensive brucellosis control.

Ornithodoros zumpti is a soft tick species in eastern South Africa. In 1961, Zumpt and Organ described the transmission of a relapsing fever Borrelia species from O. zumpti to laboratory mice. The Borrelia species showed phenotypic differences to Borrelia duttonii and was designated Borrelia tillae Zumpt and Organ 1961 (Approved Lists 1980). At the German National Reference Center for Borrelia (NRZ), Oberschleissheim, a sample containing blood of an infected laboratory mouse labelled 'Borrelia tillae', was cultured. We sequenced PCR products of the 16S rRNA locus, flaB and MLST loci and generated whole-genome sequences using Pacific Biosciences technologies. The Borrelia 16S rRNA amplification product from DNA of an O. zumpti colony was sequenced and compared to the 16S rRNA gene sequence from the culture at the NRZ. No identical matches to 16S rRNA gene, flaB or MLST sequences were found in BLASTn searches of the NCBI nucleotide database. In phylogenies of those sequences, B. tillae sequences clustered on their own branches. However, borrelial 16S rRNA gene sequences from an O. zumpti colony were identical to the sequence obtained from the cultured isolate. The genome of B. tillae consists of a linear chromosome, 5 linear and 11 circular plasmids (including the megaplasmid). Sequence comparison provides evidence that the recovered isolate (named 'Krampitz') differs from all Borrelia spp. for which sequence data exist. Identical 16S rRNA gene sequences from an O. zumpti colony to the cultured isolate strongly support the notion that we recovered B. tillae. Because there was no type strain available for B. tillae, we propose strain 'Krampitz' to be recognized as the type strain for the species according to rule 18f of the International Code of Nomenclature of Prokaryotes. The type strain, Krampitz[T], has been deposited in two culture collections, DSMZ (=DSM 121361) and NCCB (=101126).

The carbonyl stress pathway in bacteria is mediated by the enigmatic metabolite methylglyoxal and is thought to be activated in response to cellular carbohydrate and phosphate imbalance. Methylglyoxal, produced from dihydroxyacetone phosphate by methylglyoxal synthase, covalently modifies nucleophilic groups of amino acid residues, such as lysine, arginine and cysteine, to yield advanced glycation end products. In this work, we have identified several environmental signals, including glycerol and peptides, which activate carbonyl stress in the Lyme disease spirochete Borrelia (Borreliella) burgdorferi. We establish that methylglyoxal production and protein glycation is dependent on the mgsA gene (bb0364) product and show that this pathway is active in Lyme disease spirochetes, but not relapsing fever Borrelia or in B. mayonii. Furthermore, we have investigated the role of carbonyl stress in the tick-mouse model of Lyme disease and provide evidence that production of methylglyoxal and glycation of proteins is not necessarily lethal, as previously believed, at least in Lyme disease spirochetes. Finally, we show that expression of the B. burgdorferi mgsA and carbonyl stress pathway in the relapsing fever spirochete B. hermsii significantly reduces the peak level of spirochetemia during the relapse phase of murine infection. Together, our results identify a new post-translation modification system in Lyme disease spirochetes that appears to be important in governing the lifestyle of this pathogen and seems to be selected against in spirochetes that reach high numbers in the blood.

Melioidosis, caused by Burkholderia pseudomallei, produces a wide range of clinical manifestations and may be difficult to diagnose in the pediatric population. We describe the case of a 12-year-old girl with poorly controlled type 1 diabetes mellitus that posed diagnostic challenges. Over 4 months, she experienced relapsing fever, multiple splenic abscesses with a 'target sign' on ultrasonography, right-sided preseptal cellulitis, and a left thigh ulcer. Repeated cultures of superficial swabs and blood yielded no growth of bacteria. Radiological mimicry and culture-negative results raised concerns regarding a fungal etiology, leading to empiric amphotericin B therapy. The definitive diagnosis was made after incision and drainage of a 4 × 6 cm[2] frontal abscess. Pus culture isolated Burkholderia pseudomallei, identified by matrix‑assisted laser desorption/ionization time‑of‑flight mass spectrometry (MALDI‑ToF MS). Patient was treated with intravenous meropenem for 4 weeks followed by oral cotrimoxazole for a planned 3‑month eradication course. The patient recovered with no relapse on follow‑up. This case highlights the need to consider melioidosis in diabetic patients presenting with recurrent, culture-negative abscesses that display a target sign in endemic regions. Deep tissue culture remains essential for diagnosis, as superficial swabs may be misleading. Source control, coupled with dual-phase antimicrobial therapy, remain the cornerstones of effective management.

Crohn's disease (CD) and ulcerative colitis are chronic inflammatory bowel diseases (IBDs) characterized by relapsing exacerbations related to a dysregulated immune response, resulting primarily in gastrointestinal symptoms and also frequently in signs of chronic systemic inflammation. Malnutrition is a possible complication of IBD with a prevalence ranging from 20 to 85%, varying with disease activity, location, and age, and is recognized as having a multifactorial pathogenesis. Malnutrition in patients with IBD should be diagnosed early and treated appropriately because it can heavily affect patient prognosis, including complications, hospitalization rates, mortality, and overall quality of life. Therefore, patients with IBD should be screened for malnutrition at diagnosis and regularly thereafter. Moreover, assessing micronutrient deficiencies in patients with IBD is recommended ideally during clinical and biochemical remission. We reported the case of a 56-year-old female patient admitted to our department who reported chronic diarrhea for several months, along with recurrent abdominal pain, low-grade evening fever, nausea, hyporexia, and significant involuntary weight loss, with probable sarcopenia. Iron-deficiency anemia, an elevated platelet count, elevated inflammatory markers, and some oligoelement deficiencies were observed on blood tests. A diagnosis of extensive ileo-colonic CD (A3, L3, B1 according to the Montreal classification) complicated by a perianal abscess and simple intrasphincteric fistula, requiring surgery, was made during the hospitalization. As agreed with our nutritional team, given the severe malnutrition observed in patients at risk of refeeding syndrome, the patient received thiamine supplementation, minimal enteral feeding with oral nutritional supplements (ONS), and simultaneous parenteral nutrition with a ternary emulsion supplemented with vitamins and trace elements. Parenteral nutritional supplementation and ONS were continued for 2 months after discharge to improve the patient's nutritional status. Subsequently, the patient was able to eat only natural foods, as advised by our hospital's nutrition team. Finally, we briefly reviewed recommendations on malnutrition screening and enteral or parenteral nutrition in patients with IBD to reduce morbidity and mortality due to malnutrition.

Ornithodoros ticks, a genus of soft ticks in the family Argasidae, occur worldwide including throughout deserts in the Southwestern United States. In the Mojave Desert, Ornithodoros parkeri and O. turicata are common ectoparasites of Mojave desert tortoises (Gopherus agassizii). These two tick species are vectors of Borrelia spp. that cause tick-borne relapsing fever (TBRF) in people. However, the distribution of O. parkeri and O. turicata and TBRF group Borrelia infection prevalence remain poorly known in the Mojave Desert. These ticks are commonly found in desert tortoise burrows. In this study, 1165 ticks were collected in the Mojave Desert, 1164 of those ticks were identified as belonging to the genus Ornithodoros, while the remaining tick was an Otobius species. We used morphologic characteristics and molecular genetic analysis to identify ticks as O. parkeri and O. turicata. Twenty-two of the 1165 tick samples tested positive for TBRF group Borrelia, five of which could be sequenced and were identified as Borrelia turicatae. This study sheds light on the distributions of tick species and pathogens in an understudied ecosystem, the Mojave Desert, and identifies group Borrelia as a potential risk factor in Mojave desert tortoise habitat.

Why revisit our understanding of relapsing fever and their causative spirochaetes? We have seen many existing paradigms of relapsing fever borreliosis challenged over recent years, largely facilitated through technological molecular biological improvements. Concepts that were believed for many years are now being questioned; from the origins of B. recurrentis, the epidemic form of relapsing fever, through to the one-tick-one Borrelia model. Furthermore, the description of relapsing fever borreliae such as B. miyamotoi transmitted by hard tick species and increasing reports of new borrelial species have prompted a re-evaluation of existing knowledge. Within this narrative review, we overview existing knowledge of relapsing fever ecology, epidemiology, diagnostics, disease and prevention, and explore several research gaps worthy of further research.

Kleine–Levin syndrome (KLS), also known as "Sleeping beauty syndrome," is a rare yet devastating parasomnia that includes recurrent episodes of hypersomnia, along with behavioral or cognitive abnormalities, coupled with compulsive eating and hypersexuality.[1] In 1862, Brierre de Boismont reported the first apparent case of Kleine–Levin syndrome. The condition is named after Willi Kleine, who documented several cases of periodic hypersomnia in 1925, and Max Levin, who, in 1930, noted a case of periodic hypersomnia paired with hyperphagia.[2]  Critchley and Hoffman actually defined the syndrome in 1942 and gave it its name after the publication of the classic paper, “The Syndrome of Periodic Somnolence and Morbid Hunger (Kleine–Levin syndrome)."[3]  It predominantly affects adolescent males with episodes usually lasting up to a few weeks and result in complete recovery.[2] Those who are affected are asymptomatic between these episodes; however, multiple relapses may occur.[1] Each episode can last from a week to 1 to 2 months.[3] The duration of Kleine–Levin syndrome can vary based on the clinical manifestation of the syndrome.

The hard tick Ixodes ricinus serves as vector for life-threatening tick-borne diseases (TBDs) such as Lyme borreliosis, relapsing fever, and tick-borne encephalitis. Due to the ticks` ability to adjust to climate changes, their habitat is expanding quickly across Europe, and the incidences of TBD´s are increasing. Therefore, to better understand and control TBDs it is essential to expand the knowledge about the ticks´ microbiome, particularly the spatiotemporal and tissue-specific dynamics of I. ricinus bacterial community. This study was designed to investigate the differences in the detected bacterial communities according to the locations, where ticks had been collected, according to ticks´ tissue types and to seasonal impacts.

ATP1A3-related disorders comprise an expanding group of ultra-rare neurologic conditions, classically including rapid-onset dystonia-parkinsonism (RDP), alternating hemiplegia of childhood (AHC), and cerebellar ataxia, areflexia, pes cavus, optic atrophy, and sensorineural hearing loss (CAPOS) syndrome. However, accumulating reports suggest a broader and overlapping phenotypic spectrum. In this context, we established the ATP1A3 Study Group to comprehensively characterize the phenotypic and genotypic spectrum of ATP1A3-related disorders in a Brazilian cohort.