In Reply.—The case of late-onset neonatal Borrelia sepsis reported by Lepage et al has many features in common with the two cases we described. However, the clinical course of their patient was benign, whereas the two neonates from Israel died. Although Borrelia species are sensitive to a variety of drugs including the penicillin group, the tetracyclines, and chloramphenicol,1 the overall mortality in the neonatal age group remains unusually high: of the six reported cases in neonates treated with antibiotics, three patients died. This poor outcome seems to be related to the severe metabolic disturbances, the coagulation defects, and the endotoxic shock observed in the affected neonates.
The two reports, one from Israel and the other from an African country, help us to remember that Borrelia infections are distributed worldwide. This possibility should therefore be considered in the differential diagnosis of sepsis in neonates in endemic areas.