Aseptic Meningitis Linked to <i>Borrelia afzelii</i> Seroconversion in Northeastern Greece: An Emerging Infectious Disease Contested in the Region

Borreliosis (Lyme disease) is a zoonosis, mediated to humans and small mammals through specific vectors (ticks), with increasing global incidence. It is associated with a variety of clinical manifestations and can, if not promptly recognized and left untreated, lead to significant disability. In Europe, the main <i>Borrelia</i> species causing disease in humans are <i>Borrelia burgdorferi s.s.</i>, <i>Borrelia afzelii</i>, <i>Borrelia garinii</i>, and <i>Borrelia spielmanii</i>. The <i>Ixodes ricinus</i> tick is their principal vector. Although Lyme disease is considered endemic in the Balkan region and Turkey, and all three main Lyme pathogens have been detected in ticks collected in these countries, autochthonous Lyme disease remains controversial in Greece. We report a case of aseptic meningitis associated with antibody seroconversion against <i>Borrelia afzelii</i> in a young female patient from the prefecture of Thasos without any relevant travel history. The patient presented with fever and severe headache, and the cerebrospinal fluid examination showed lymphocytic pleocytosis. Serum analysis was positive for specific IgG antibodies against <i>Borrelia afzelii</i>. In the absence of typical erythema migrans, serological evidence of infection is required for diagnosis. Although atypical in terms of clinical presentation, the seasonality and geographical location of potential disease transmission in the reported patient should raise awareness among clinicians for a still controversial and potentially underreported emerging infectious disease in Greece.