Streptococcus suis Meningitis and Bacteremia in Man, French Guiana

performed as described in Stiasny et al. (6) showed a strongly positive titer of 1:320. We excluded hepatitis C virus; West Nile virus infection has not been reported in Poland. Because of his religious beliefs, the patient had not been vaccinated against TBE or yellow fever; he had not traveled abroad and had not been exposed to dengue virus. The differential diagnosis included Lyme disease, but the results of repeated serologic tests for B. burgdorferi were negative. Chorea arises deep in the basal ganglia; high-definition MRI demonstrates caudate atrophy (7). In patients with TBE, MRI may reveal unilateral or bilateral thalamus lesions, as well as lesions in the cerebellum, brainstem, and nucleus caudalis (8). One case study presented a case of simultaneous lesions in the thalamus, stem, and spinal cord (9). Chorea developed in the patient reported here because of inflammatory lesions in the region of the thalamus. Supportive care is standard for patients with chorea (10), but after treatment for TBE, the lesions in this patient resolved, and the chorea abated.