Lyme Disease Causes Encephalopathy — Inflammation of the Brain
One of the findings noted by many physicians treating Lyme disease that was never treated, or Babesia or Bartonella, is serious personality and neurology troubles. This is no surprise when you realize the emotional centers and relational skills centers of the brain are infected with these infections in some people and this makes them into very sad hateful eccentric people. It is amazing to listen to respected physicians who treat people with tick infections. They seem to typically report the following tick infection personality changes or neurology changes:
Narcissism—they believe they have the answers, despite prolonged and failed treatment. They think they know areas they have no training in such as costs to be educated for NP, PA, DO, ND or MD. They act as if they know the costs to be an MD each year, costs to research or attend conferences, costs for any book, costs to do a blind study, costs to have lawyers, costs for malpractice insurance, costs for staffing, etc.
Entitlement—massive demands for time and huge expectations
Short term memory is decreased—so patients forget instructions
Rage—evidence of huge amounts of time not helping people, but attacking.
Weird posts on the motives of respected clinicians.
Black and White Thinking—past or current healers are the devil or great.
Slowed Learning—they read a book and do not seem to absorb large sections.
Criminal actions, e.g., stealing PDF books which has possible five year jail term, stealing identities, making extreme bizarre accusations, posting home addresses to provoke some attack or _________ on a physician, local politician or insurance staff who is not approving a treatment. I assume the writer or poster also wants harm to come to the family of these individuals.
Hate over fees—they do not appreciate offering treatment for a possibly fatal illness has massive risks. They have no knowledge of expenses just to run an office or lost income just publishing a small journal article. They suffer from a regressed primitive personality that wants the physician to be a mother and offer free unconditional love.
Trivia Complaints—small matters are made into matters worthy of immense time and hateful accusations which are amplified 20x from the brain pathology. Some actually hate some physicians, and instead of moving on and finding a good fit and getting well, they attack someone who is not meeting their perfection standards, which usually include taking insurance, very low rates and mother-like care with free emergency access and free email medicine.
Rape of Physician Boundaries—they want to take five physicians and rip them apart, and take the things they like in each one, to make a perfect MD that meets their standards.
1. Klin Mikrobiol Infekc Lek. 2009 Oct;15(5):160-165.
[Detection of spirochaetal DNA from patients with neuroborreliosis and erythema migrans.]
[Article in Czech]
Moravcov� L, P�cha D, Va�ousov� D, Hercogov� J.
Department of Infectious Diseases, 1st Medical Faculty, Charles University Prague, Czech Republic,
Lenka.moravcova@fnb.cz.
Aim: Assessment of PCR procedure for proving of the Borrelia burgdorferi sensu lato DNA in nerve and skin forms of Lyme borreliosis. Methods: DNA from plasma, urine and CSF was isolated by QIAamp DNA mini kit. PCR was deigned as two-step amplification (nested-PCR). Each sample was tested in PCR for five target sequences: two were specific for plasmide genes encoding OspA and OspC proteins and three correlated with genes for 16SrDNA, flagellin and p66 protein. Results: Borrelial DNA was proved in 41 patients suffering from neuroborreliosis out of 56 (77.4 %), among 48 patients with erythema migrans (EM) were found 26 positive (54.2 %). After treatment the specific DNA was detected in 22 patients with neuroborreliosis (41.5 %) and 16 patients with EM (38.1 %). Three months after the treatment 23 patients were positive in both of groups (28.7 %) and next 3 months later the specific DNA was found in 6 (9.5 %). The highest rate of positive results was manifested by 16SrDNA target, lower and comparable results were obtained by OspA, C and flagellin primers, the lowest rate was in p66 system. Conclusion: The tested PCR proved specific DNA in all tested biological fluids in both of the clinical forms of Lyme borreliosis with a relatively high sensitivity. The proving of DNA can not be used for the assessment of the effect of treatment due to the long persistence of PCR positivity after antibiotic treatment. To achieve a sufficient diagnostic sensitivity of PCR it is desirable to use minimally two amplification systems in parallel.
PMID: 19916154 [PubMed - as supplied by publisher]
2. PLoS Pathog. 2009 Nov;5(11):e1000659. Epub 2009 Nov 13.
Microglia are mediators of Borrelia burgdorferi-induced apoptosis in SH-SY5Y neuronal cells.
Myers TA, Kaushal D, Philipp MT.
Division of Bacteriology & Parasitology, Tulane National Primate Research Center, Tulane University Health Sciences Center, Louisiana, United States of America.
Inflammation has long been implicated as a contributor to pathogenesis in many CNS illnesses, including Lyme neuroborreliosis. Borrelia burgdorferi is the spirochete that causes Lyme disease and it is known to potently induce the production of inflammatory mediators in a variety of cells. In experiments where B. burgdorferi was co-cultured in vitro with primary microglia, we observed robust expression and release of IL-6 and IL-8, CCL2 (MCP-1), CCL3 (MIP-1alpha), CCL4 (MIP-1beta) and CCL5 (RANTES), but we detected no induction of microglial apoptosis. In contrast, SH-SY5Y (SY) neuroblastoma cells co-cultured with B. burgdorferi expressed negligible amounts of inflammatory mediators and also remained resistant to apoptosis. When SY cells were co-cultured with microglia and B. burgdorferi, significant neuronal apoptosis consistently occurred. Confocal microscopy imaging of these cell cultures stained for apoptosis and with cell type-specific markers confirmed that it was predominantly the SY cells that were dying. Microarray analysis demonstrated an intense microglia-mediated inflammatory response to B. burgdorferi including up-regulation in gene transcripts for TLR-2 and NFkappabeta. Surprisingly, a pathway that exhibited profound changes in regard to inflammatory signaling was triggering receptor expressed on myeloid cells-1 (TREM1). Significant transcript alterations in essential p53 pathway genes also occurred in SY cells cultured in the presence of microglia and B. burgdorferi, which indicated a shift from cell survival to preparation for apoptosis when compared to SY cells cultured in the presence of B. burgdorferi alone. Taken together, these findings indicate that B. burgdorferi is not directly toxic to SY cells; rather, these cells become distressed and die in the inflammatory surroundings generated by microglia through a bystander effect. If, as we hypothesized, neuronal apoptosis is the key pathogenic event in Lyme neuroborreliosis, then targeting microglial responses may be a significant therapeutic approach for the treatment of this form of Lyme disease.
PMCID: 2771360 PMID: 19911057 [PubMed - in process]
3. Tidsskr Nor Laegeforen. 2009 Oct 22;129(20):2132-4.
[Laboratory diagnosis of Lyme borreliosis]
[Article in Norwegian]
Kristiansen BE, Grude N, Tveten Y, Emmert A.
Unilabs Telelab, Postboks 1868 Gulset, 3703 Skien, Norway.
bjorn.erik.kristiansen@unilabs.comPMID: 19855455 [PubMed - indexed for MEDLINE]
4. MMW Fortschr Med. 2009 Apr 30;151(18):8.
[New biomarker discovered. Will the diagnosis of neuroborreliosis soon be easier (interview by Maria Weiss)?]
[Article in German]
Rupprecht T.
PMID: 19769063 [PubMed - indexed for MEDLINE]
5. Eur J Paediatr Neurol. 2009 Sep 11. [Epub ahead of print]
Uncommon manifestations of neuroborreliosis in children.
Baumann M, Birnbacher R, Koch J, Strobl R, Rost�sy K.
Department of Pediatrics, Division of Pediatric Neurology and Inherited Metabolic Disorders, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria.
Lyme borreliosis is a tick-borne spirochetal infection which affects the skin, joints, heart and nervous system. Children with a neuroborreliosis usually present with a facial nerve palsy or aseptic meningitis, but the spectrum also includes other rare manifestations. We report four unusual cases of childhood neuroborreliosis and show that seizures with regional leptomeningeal enhancement, acute transverse myelitis, meningoradiculitis with pain and paraesthesia and cranial nerve palsies other than facial nerve palsy can be the leading symptoms of children with neuroborreliosis. All children had serological evidence of an acute infection with Borrelia burgdorferi, a pleocytosis in the cerebrospinal fluid and a complete response to antibiotic treatment. An intrathecal synthesis of IgG antibodies was detected in three children. Thus, diagnostic work up in children with unusual neurological symptoms should include cerebrospinal fluid studies with determination of the white blood cell count and calculation of the antibody index against B. burgdorferi.
PMID: 19748808 [PubMed - as supplied by publisher]
6. J Laryngol Otol. 2009 Sep 10:1-3. [Epub ahead of print]
Recurrent laryngeal nerve paralysis due to subclinical Lyme borreliosis.
Karosi T, R�cz T, Szekanecz E, T�th A, Sziklai I.
Department of Otolaryngology Head and Neck Surgery, University Medical School of Debrecen, Debrecen, Hungary.
Objective:We report an extremely rare case of recurrent laryngeal nerve paralysis due to subclinical Lyme borreliosis.Method:Case report presenting a 15-year-old girl referred with hoarseness and soft voice.Results:Right-sided recurrent laryngeal nerve paralysis was observed using videolaryngoscopy. Imaging was used to exclude intracranial, cervical and intrathoracic embryological lesions, vascular malformations and tumours. Laboratory and electrophysiological investigations were used to exclude inflammatory and paraneoplastic processes, endocrinopathy and metabolic disorders. Serological testing was positive for Lyme disease. Parenteral ceftriaxone therapy was commenced. The patient's nerve paralysis showed complete recovery on the seventh day of antibiotic treatment; this was confirmed by videolaryngoscopy.Conclusion:Recurrent laryngeal nerve paralysis is an extremely rare complication of neuroborreliosis associated with Lyme disease. In patients with recurrent laryngeal nerve paralysis in whom the clinical history is uncertain and the usual diagnostic methods give negative results, screening with anti-borrelia immunoglobulin M is suggested.
PMID: 19740453 [PubMed - as supplied by publisher]
7. J Neuroinflammation. 2009 Aug 25;6:23.
Possible role of glial cells in the onset and progression of Lyme neuroborreliosis.
Ramesh G, Borda JT, Gill A, Ribka EP, Morici LA, Mottram P, Martin DS, Jacobs MB, Didier PJ, Philipp MT.
Division of Bacteriology and Parasitology, Tulane National Primate Research Center, Covington, LA, USA.
gramesh@tulane.eduBACKGROUND: Lyme neuroborreliosis (LNB) may present as meningitis, cranial neuropathy, acute radiculoneuropathy or, rarely, as encephalomyelitis. We hypothesized that glia, upon exposure to Borrelia burgdorferi, the Lyme disease agent, produce inflammatory mediators that promote the acute cellular infiltration of early LNB. This inflammatory context could potentiate glial and neuronal apoptosis. METHODS: We inoculated live B. burgdorferi into the cisterna magna of rhesus macaques and examined the inflammatory changes induced in the central nervous system (CNS), and dorsal root nerves and ganglia (DRG). RESULTS: ELISA of the cerebrospinal fluid (CSF) showed elevated IL-6, IL-8, CCL2, and CXCL13 as early as one week post-inoculation, accompanied by primarily lymphocytic and monocytic pleocytosis. In contrast, onset of the acquired immune response, evidenced by anti-B. burgdorferi C6 serum antibodies, was first detectable after 3 weeks post-inoculation. CSF cell pellets and CNS tissues were culture-positive for B. burgdorferi. Histopathology revealed signs of acute LNB: severe multifocal leptomeningitis, radiculitis, and DRG inflammatory lesions. Immunofluorescence staining and confocal microscopy detected B. burgdorferi antigen in the CNS and DRG. IL-6 was observed in astrocytes and neurons in the spinal cord, and in neurons in the DRG of infected animals. CCL2 and CXCL13 were found in microglia as well as in endothelial cells, macrophages and T cells. Importantly, the DRG of infected animals showed significant satellite cell and neuronal apoptosis. CONCLUSION: Our results support the notion that innate responses of glia to B. burgdorferi initiate/mediate the inflammation seen in acute LNB, and show that neuronal apoptosis occurs in this context.
PMCID: 2748066 PMID: 19706181 [PubMed - indexed for MEDLINE]
8. Acta Clin Belg. 2009 May-Jun;64(3):225-7.
Motor neuron disease features in a patient with neuroborreliosis and a cervical anterior horn lesion.
De Cauwer H, Declerck S, De Smet J, Matthyssen P, Pelzers E, Eykens L, Lagrou K.
Department of Neurology, Klina Regional Hospital, Brasschaat, Belgium.
harald.de.cauwer@klina.beA variety of neurological syndromes has been described in neuroborreliosis: cranial nerve palsies, radiculopathy, axonal neuropathy, stroke, parkinsonism, transverse myelitis, supranuclear palsy, Guillain-Barr� syndrome, ... We report a case of neuroborreliosis with cervical myelitis presenting clinically as a lower motor neuron syndrome of the upper and lower limbs with proximal and distal pareses and atrophies as well as bulbar dysarthria and dysphagia. During the course of the disease the patient developed the clinical picture of a meningoencephalitis. After initiating ceftriaxone treatment the patient showed a complete recovery. In endemic regions for Lyme disease, in all neurological syndromes neuroborreliosis has to be excluded.
PMID: 19670562 [PubMed - indexed for MEDLINE]
9. Eur J Neurol. 2009 Jul 23. [Epub ahead of print]
Remaining complaints 1 year after treatment for acute Lyme neuroborreliosis; frequency, pattern and risk factors.
Lj�stad U, Mygland A.
Department of Neurology, S�rlandet Hospital HF, Kristiansand, Norway.
Background and purpose: To chart remaining complaints 1 year after treatment for neuroborreliosis, and to identify risk factors for a non-favorable outcome. Methods: We followed patients treated for neuroborreliosis prospectively, and assessed outcome by a composite clinical score. The impact on outcome of clinical, demographic and laboratory factors were analyzed by univariate analyses and logistic regression. Results: Out of 85 patients 41 (48%) had remaining complaints; 14 had objective findings and 27 subjective symptoms. Remaining complaints were associated with pre-treatment symptom duration >/=6 weeks (OR = 4.062, P = 0.044), high pre-treatment cerebrospinal fluid (CSF) cell count (OR = 1.005, P = 0.001), and female gender (OR = 3.218, P = 0.025). Presence of CSF oligoclonal bands (OCBs) was not analyzed in the logistic regression model due to many missing observations, but was found to be more frequent both pre-treatment (P = 0.004) and after 12 months (P = 0.015) among patients with remaining complaints as compared to patients with complete recovery. Further evaluation showed that objective remaining findings, and not subjective symptoms, were associated with pre-treatment symptom duration >/=6 weeks. No difference in outcome was observed between patients treated with IV ceftriaxone and patients treated with oral doxycycline. Conclusion: Remaining complaints are common after neuroborreliosis. The majority of the complaints are subjective. Pre-treatment symptom duration >/=6 weeks, high pre-treatment CSF cell count, and female gender seem to be risk factors for remaining complaints. Presence of CSF OCBs may also predict a non-favorable outcome, but this should be further studied. Whether subjective and objective complaints are associated with different risk factors is also an issue for future studies.
PMID: 19645771 [PubMed - as supplied by publisher]
10. Neurology. 2009 Jul 28;73(4):326.
Diffuse hyperintense brainstem lesions in neuroborreliosis.
Haene A, Tr�ger M.
Department of Neurology, Cantonal Hospital Aarau, Tellstrasse, 5001 Aarau, Switzerland.
adrian.haene@swissonline.chPMID: 19636055 [PubMed - indexed for MEDLINE]
11. Scand J Immunol. 2009 Aug;70(2):141-8.
T-cell epitope mapping of the Borrelia garinii outer surface protein A in lyme neuroborreliosis.
Widhe M, Ekerfelt C, Jarefors S, Skogman BH, Peterson EM, Bergstr�m S, Forsberg P, Ernerudh J.
Division of Clinical Immunology, Department of Clinical and Experimental Medicine, Link�ping University, Link�ping, Sweden.
We studied the T-cell reactivity to overlapping peptides of B. garinii OspA, in order to locate possible immunodominant T-cell epitopes in neuroborreliosis. Cells from cerebrospinal fluid (CSF) and blood from 39 patients with neuroborreliosis and 31 controls were stimulated with 31 overlapping peptides, and interferon-gamma secreting cells were detected by ELISPOT. The peptides OspA(17-36), OspA(49-68), OspA(105-124), OspA(137-156), OspA(193-212) and OspA(233-252) showed the highest frequency of positive responses, being positive in CSF from 38% to 50% of patients with neuroborreliosis. These peptides also elicited higher responses in CSF compared with controls (P = 0.004). CSF cells more often showed positive responses to these peptides than blood cells (P = 0.001), in line with a compartmentalization to the central nervous system. Thus, a set of potential T-cell epitopes were identified in CSF cells from patients with neuroborreliosis. Further studies may reveal whether these epitopes can be used diagnostically and studies involving HLA interactions may show their possible pathogenetic importance.
PMID: 19630920 [PubMed - indexed for MEDLINE]
12. Radiology. 2009 Oct;253(1):167-73. Epub 2009 Jul 8.
Neuro-lyme disease: MR imaging findings.
Agarwal R, Sze G.
Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT 06520, USA.
PURPOSE: To describe the neuroimaging manifestations of Lyme disease at magnetic resonance (MR) imaging of the brain. MATERIALS AND METHODS: Institutional review board approval was obtained and HIPAA compliance was followed. This study retrospectively reviewed the MR imaging findings of all patients seen from 1993 to 2007 in whom neuro-Lyme disease was suspected and who were referred for MR imaging of the brain for the evaluation of neurologic symptoms. RESULTS: Of 392 patients suspected of having neuro-Lyme disease, 66 patients proved to have the disease on the basis of clinical criteria, serologic results, and response to treatment. Seven of these 66 patients showed foci of T2 prolongation in the cerebral white matter, one had an enhancing lesion with edema, and three demonstrated nerve-root or meningeal enhancement. Of the seven patients with foci of T2 prolongation in the white matter, three were an age at which white matter findings due to small-vessel disease are common. CONCLUSION: In cases of nerve-root or meningeal enhancement, Lyme disease should be considered in the differential diagnosis in the proper clinical setting.
PMID: 19587309 [PubMed - indexed for MEDLINE]
13. Curr Opin Infect Dis. 2009 Oct;22(5):450-4.
Lyme borreliosis: a European perspective on diagnosis and clinical management.
Stanek G, Strle F.
Department of Hygiene and Medical Microbiology, Medical University of Vienna, Vienna, Austria.
gerold.stanek@meduniwien.ac.atPURPOSE OF REVIEW: Lyme borreliosis has been widely recognized in Europe, but diagnostic and therapy concepts are still a matter for discussion. False-positive microbiologic results can lead to unnecessary antibiotic treatment, which even in genuine cases is sometimes unnecessarily prolonged. This review addresses new research on diagnosis, treatment, and eco-epidemiology. RECENT FINDINGS: Recent research work in Europe since the last annual review has mostly dealt with diagnostic concepts. Improvement of serology has been achieved by use of multiple recombinant or peptide antigens, or of just the most frequently targeted antigen for detection of specific immunoglobulin G or immunoglobulin M antibodies to Borrelia burgdorferi sensu lato, the causative agent of Lyme borreliosis. Concerning management of the disease, early work on the efficacy of oral treatment of Lyme neuroborreliosis has been confirmed. Studies on the ecology of the vectors and pathogens have elucidated aspects of epidemiology. SUMMARY: Widespread awareness of Lyme borreliosis in Europe continues to grow due to increasing numbers of medical publications, information on the Internet, and from the media and patient support groups. The emphasis in scientific and medical publications has been on improvements in laboratory diagnostics, confirmation of therapeutic protocols, and the ecology of the vectors and pathogens.
PMID: 19571749 [PubMed - in process]
14. Dtsch Arztebl Int. 2009 Jan;106(5):72-81; quiz 82, I. Epub 2009 Jan 30.
Lyme disease--current state of knowledge.
Nau R, Christen HJ, Eiffert H.
Geriatrisches Zentrum, Evangelisches Krankenhaus G�ttingen-Weende, Abteilung f�r Neurologie, Universit�tsklinikum G�ttingen, G�ttingen, Germany.
rnau@gwdg.deComment in: Dtsch Arztebl Int. 2009 Jul;106(31-32):524-5; author reply 525. Dtsch Arztebl Int. 2009 Jul;106(31-32):524; author reply 525. Dtsch Arztebl Int. 2009 Jul;106(31-32):524; author reply 525.
BACKGROUND: Lyme disease is the most frequent tick-borne infectious disease in Europe. The discovery of the causative pathogen Borrelia burgdorferi in 1982 opened the way for the firm diagnosis of diseases in several clinical disciplines and for causal antibiotic therapy. At the same time, speculation regarding links between Borrelia infection and a variety of nonspecific symptoms and disorders resulted in overdiagnosis and overtreatment of suspected Lyme disease. METHOD: The authors conducted a selective review of the literature, including various national and international guidelines. RESULTS: The spirochete Borrelia burgdorferi sensu lato is present in approximately 5% to 35% of sheep ticks (Ixodes ricinus) in Germany, depending on the region. In contrast to North America, different genospecies are found in Europe. The most frequent clinical manifestation of Borrelia infection is erythema migrans, followed by neuroborreliosis, arthritis, acrodermatitis chronica atrophicans, and lymphocytosis benigna cutis. Diagnosis is made on the basis of the clinical symptoms, and in stages II and III by detection of Borrelia-specific antibodies. In adults erythema migrans is treated with doxycycline, in children with amoxicillin. The standard treatment of neuroborreliosis is third-generation cephalosporins. CONCLUSIONS: After appropriate antibiotic therapy, the outcome is favorable. In approximately 95% of cases neuroborreliosis is cured without long-term sequelae. When chronic borreliosis is suspected, other potential causes of the clinical syndrome must be painstakingly excluded.
PMCID: 2695290 PMID: 19562015 [PubMed - indexed for MEDLINE]
15. Nervenarzt. 2009 Oct;80(10):1239-51.
[Neuroborreliosis]
[Article in German]
Kaiser R, Fingerle V.
Neurologische Klinik, Klinikum Pforzheim, Kanzlerstrasse 2-6, 75175, Pforzheim, Deutschland.
rkaiser@klinikum-pforzheim.deNeuroborreliosis is easily diagnosed by means of clinical symptoms and laboratory findings. Guiding symptoms are radicular pain and pareses of the extremities and the facial nerve. There is a great number of further less frequently occurring neurological symptoms, which can be attributed to a borrelial infection only by appropriate investigations of the CSF. Radiculitis is cured adequately by oral doxycycline while symptoms of the central nervous system are probably better treated intravenously by ceftriaxone, cefotaxime or penicillin G. Post-Lyme syndrome is a diffuse description of non-specific complaints, which are not the explicit result of a former infection with B. burgdorferi. As further antibiotics do not help and the CSF is unremarkable in most patients, a persistent infection with B. burgdorferi s.l. in all probability can be excluded.
PMID: 19536517 [PubMed - in process]
16. Clin Microbiol Infect. 2009 May;15(5):422-6.
Human brain microvascular endothelial cell traversal by Borrelia burgdorferi requires calcium signaling.
Grab DJ, Nyarko E, Nikolskaia OV, Kim YV, Dumler JS.
Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
dgrab1@jhmi.eduNeurological manifestations of Lyme disease (or neuroborreliosis) occur variably and while it is clear that Borrelia burgdorferi can invade the nervous system, how it does so is not well understood. Pathogen penetration through the blood brain barrier (BBB) is often influenced by calcium signaling in the endothelial cells triggered by extracellular host-pathogen interactions. We examined the traversal of B. burgdorferi across the human BBB using in vitro model systems constructed of human brain microvascular endothelial cells (HBMEC) grown on Costar Transwell inserts. Pretreatment of the cell monolayers with BAPTA-AM (an intracellular calcium chelator) or phospholipase C (PLC) inhibitor U73122 inhibited B. burgdorferi transmigration. By 5 h, BAPTA-AM significantly inhibited (82-99%; p <0.017) spirochete traversal of HBMEC compared to DMSO controls. Spirochete traversal was almost totally blocked (> or =99%; p <0.017) after pretreatment with the PLC-beta inhibitor U73122 as a result of barrier tightening based on electric cell-substrate impedance sensing (ECIS). The data suggest a role for calcium signaling in CNS spirochete invasion through endothelial cell barriers.
PMID: 19489925 [PubMed - indexed for MEDLINE]
17. Rev Neurol (Paris). 2009 Aug-Sep;165(8-9):694-701. Epub 2009 May 17.
[Epidemiology of Lyme borreliosis and neuroborreliosis in France]
[Article in French]
Blanc F.
D�partement de neurologie, CMRR, h�pitaux universitaires de Strasbourg, France.
Frederic.Blanc@chru-strasbourg.frLyme borreliosis (LB) is a systemic disease called neuroborreliosis (NB) when neurological symptoms are pre-eminent. LB is a zoonosis caused by Borrelia bacteria transmitted by Ixodes tick-bite. Because of the absence of a national registry, epidemiology of LB in France is not well known. Moreover, diagnosis of NB may be difficult because of the various clinical forms. Acute meningoradiculitis is the most common presentation, but pauci-symptomatic meningitis, encephalitis, myelitis, polyneuropathy, cerebrovascular involvement, and rarely chronic encephalomyelitis are also described. The vector Ixodes ricinus (I. ricinus) is found throughout metropolitan France excepting border areas of the Mediterranean seaside and in regions with an altitude above 1500 meters. In France, the Borrelia infestation rate of Ixodes is 7% with wide disparity between administrative districts. Prospective work in 1999-2000 by 875 general practitioners participating in the "Sentinel" network established the estimated incidence of BL (9.4/100 000) and of NB (0.6/100 000) in France. Incidence is higher in certain regions: in Alsace, prospective work by 419 general practitioners and specialists in cooperation with the national surveillance agency (Institut national de veille sanitaire), estimated BL incidence at 86 to 200/100 000 inhabitants and NB at 10/100 000. Thus, although globally France is a country with a moderate risk for LB, some regions such as Limousin, Auvergne, Lorraine and Alsace, have a high risk of LB, comparable to countries in the northeastern Europe such as Germany and Sweden.
PMID: 19447458 [PubMed - indexed for MEDLINE]
18. Muscle Nerve. 2009 Jun;39(6):851-4.
Perineuritis in acute lyme neuroborreliosis.
Elamin M, Alderazi Y, Mullins G, Farrell MA, O'Connell S, Counihan TJ.
Department of Neurology, University College Hospital, Galway, Ireland.
Perineuritis is an unusual cause of direct peripheral nerve injury. We describe the clinicopathologic features of a 56-year-old man with mononeuritis multiplex due to Lyme disease; sural nerve biopsy demonstrated florid perineuritis. Treatment with intravenous ceftriaxone resulted in marked neurologic improvement. This study supports the notion that perineuritis forms part of the pathogenesis in acute Lyme neuroborreliosis.
PMID: 19441045 [PubMed - indexed for MEDLINE]
19. Acta Paediatr. 2009 Aug;98(8):1300-6. Epub 2009 May 7.
Differential diagnosis of acute central nervous system infections in children using modern microbiological methods.
Huttunen P, Lappalainen M, Salo E, L�nnqvist T, Jokela P, Hyypi� T, Peltola H.
Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Hospital for Children and Adolescents, 00029 HUS, Helsinki, Finland.
pasihut@iki.fiAIM: Except bacterial meningitis, the agents causing acute central nervous system (CNS) infections in children are disclosed in only approximately half of the cases, and even less in encephalitis. We studied the potential of modern microbiological assays to improve this poor situation. METHODS: In a prospective study during 3 years, all children attending hospital with suspected CNS infection were examined using a wide collection of microbiological tests using samples from the cerebrospinal fluid, serum, nasal swabs and stool. RESULTS: Among 213 patients, 66 (31%) cases suggested CNS infection and specific aetiology was identified in 56 patients. Of these microbiologically confirmed cases, viral meningitis/encephalitis was diagnosed in 25 (45%), bacterial meningitis in 21 (38%) and neuroborreliosis in 9 (16%) cases while 1 child had fungal infection. In meningitis patients, the causative agent was identified in 85% (35/41) cases and in encephalitis in 75% (12/16). The most common bacteria were Streptococcus agalactiae, Streptococcous pneumonie and Neisseria meningitidis, while the most frequently detected viruses were enteroviruses and varicella zoster virus. CONCLUSION: In 75% to 85% of paediatric CNS infections, specific microbiological diagnosis was obtained with modern laboratory techniques. The results pose a basis for prudent approach to these potentially serious diseases.
PMID: 19432824 [PubMed - indexed for MEDLINE]
20. Clin Microbiol Infect. 2009 Mar 26. [Epub ahead of print]
Concomitant human granulocytic anaplasmosis and Lyme neuroborreliosis.
Lotric-Furlan S, Ruzic-Sabljic E, Strle F.
Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia.
PMID: 19416290 [PubMed - as supplied by publisher]
21. Arch Gen Psychiatry. 2009 May;66(5):554-63.
Regional cerebral blood flow and metabolic rate in persistent Lyme encephalopathy.
Fallon BA, Lipkin RB, Corbera KM, Yu S, Nobler MS, Keilp JG, Petkova E, Lisanby SH, Moeller JR, Slavov I, Van Heertum R, Mensh BD, Sackeim HA.
Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, New York 10032, USA.
baf1@columbia.eduCONTEXT: There is controversy regarding whether objective neurobiological abnormalities exist after intensive antibiotic treatment for Lyme disease. OBJECTIVES: To determine whether patients with a history of well-characterized Lyme disease and persistent cognitive deficit show abnormalities in global or topographic distributions of regional cerebral blood flow (rCBF) or cerebral metabolic rate (rCMR). DESIGN: Case-controlled study. SETTING: A university medical center. PARTICIPANTS: A total of 35 patients and 17 healthy volunteers (controls). Patients had well-documented prior Lyme disease, a currently reactive IgG Western blot, prior treatment with at least 3 weeks of intravenous cephalosporin, and objective memory impairment. MAIN OUTCOME MEASURES: Patients with persistent Lyme encephalopathy were compared with age-, sex-, and education-matched controls. Fully quantified assessments of rCBF and rCMR for glucose were obtained while subjects were medication-free using positron emission tomography. The CBF was assessed in 2 resting room air conditions (without snorkel and with snorkel) and 1 challenge condition (room air enhanced with carbon dioxide, ie, hypercapnia). RESULTS: Statistical parametric mapping analyses revealed regional abnormalities in all rCBF and rCMR measurements that were consistent in location across imaging methods and primarily reflected hypoactivity. Deficits were noted in bilateral gray and white matter regions, primarily in the temporal, parietal, and limbic areas. Although diminished global hypercapnic CBF reactivity (P < .02) was suggestive of a component of vascular compromise, the close coupling between CBF and CMR suggests that the regional abnormalities are primarily metabolically driven. Patients did not differ from controls on global resting CBF and CMR measurements. CONCLUSIONS: Patients with persistent Lyme encephalopathy have objectively quantifiable topographic abnormalities in functional brain activity. These CBF and CMR reductions were observed in all measurement conditions. Future research should address whether this pattern is also seen in acute neurologic Lyme disease.
PMID: 19414715 [PubMed - indexed for MEDLINE]
22. Pediatrics. 2009 May;123(5):1408.
Lyme disease: new thoughts and directions.
Nachman S.
Department of Pediatrics, State University of New York at Stony Brook, Stony Brook, New York 11794-8111, USA.
sharon.nachman@stonybrook.eduComment on: Pediatrics. 2009 May;123(5):e829-34. Pediatrics. 2009 May;123(5):e835-41.
PMID: 19403507 [PubMed - indexed for MEDLINE]
23. Pediatrics. 2009 May;123(5):e829-34.
Prospective validation of a clinical prediction model for Lyme meningitis in children.
Garro AC, Rutman M, Simonsen K, Jaeger JL, Chapin K, Lockhart G.
Rhode Island Hospital, Pediatric Emergency Medicine, Claverick Building, 2nd Floor, Providence, RI 02906, USA.
agarro@lifespan.orgComment in: Pediatrics. 2009 May;123(5):1408.
OBJECTIVE: Lyme meningitis is difficult to differentiate from other causes of aseptic meningitis in Lyme disease-endemic regions. Parenteral antibiotics are indicated for Lyme meningitis but not viral causes of aseptic meningitis. A clinical prediction model was developed to distinguish Lyme meningitis from other causes of aseptic meningitis. Our objective was to prospectively validate this model. METHODS: Children between 2 and 18 years of age presenting to Hasbro Children's Hospital from April through October of 2006 and 2007 were enrolled if a lumbar puncture for meningitis showed a cerebrospinal fluid white blood cell count of >8 cells per microL. Cerebrospinal fluid was sent for Lyme antibody testing. The probability of Lyme meningitis was calculated by using the percentage of cerebrospinal fluid mononuclear cells, duration of headache, and presence of cranial neuropathy by using the prediction model. Definite Lyme meningitis cases were defined as cerebrospinal fluid pleocytosis with (1) positive Lyme serology confirmed by immunoblot or (2) erythema migrans rash. Possible Lyme meningitis cases were defined as cerebrospinal fluid pleocytosis with positive cerebrospinal fluid Lyme antibody. Sensitivity, specificity, and likelihood ratios for definite and possible Lyme meningitis were determined by using 10% increments of calculated probability of Lyme meningitis. RESULTS: Fifty children were enrolled, including 14 children with definite Lyme meningitis, 6 with possible Lyme meningitis, and 30 with aseptic meningitis. A calculated probability of <10% for Lyme meningitis had a negative likelihood ratio of 0.006 for definite and possible Lyme meningitis cases. A calculated probability of >50% for Lyme meningitis had a positive likelihood ratio of 100 using these definitions. CONCLUSIONS: A clinical prediction model using the percentage of cerebrospinal fluid mononuclear cells, headache duration, and presence of cranial neuropathy can differentiate children with Lyme meningitis from children with aseptic meningitis. Our findings suggest categories of low (<10%), indeterminate (10%-50%), and high (>50%) probability of Lyme meningitis.
PMID: 19403476 [PubMed - indexed for MEDLINE]
24. Z Rheumatol. 2009 May;68(3):239-52; quiz 253-4.
[Lyme borreliosis]
[Article in German]
Krause A, Fingerle V.
Rheumakliniken Berlin-Buch und Berlin-Wannsee, Immanuel-Krankenhaus, K�nigstr. 63, 14109, Berlin, Deutschland.
a.krause@immanuel.deLyme borreliosis is a multi-system infectious disease that primarily affects the skin, nervous system, heart, and joints. It is caused by the tick-borne spirochete Borrelia burgdorferi sensu lato. Diagnosis is made on the basis of clinical symptoms and supported by a positive serology. Antibiotic therapy should be started immediately after the diagnosis has been established and is administered according to stage and symptoms of the disease. Doxycycline, amoxicillin, and ceftriaxone are the antibiotics of choice. Early Lyme disease is almost always cured by one antibiotic course that also prevents subsequent disease manifestations. After antibiotic therapy of late disease manifestations, symptoms resolve only slowly and remission is usually achieved after weeks or even months. Chronic or therapy-resistant disease courses and residual symptoms after therapy are rare.
PMID: 19387665 [PubMed - indexed for MEDLINE]
25. Diagn Microbiol Infect Dis. 2009 Jul;64(3):347-9. Epub 2009 Apr 18.
The C6 Lyme antibody test has low sensitivity for antibody detection in cerebrospinal fluid.
Vermeersch P, Resseler S, Nackers E, Lagrou K.
University Hospitals Leuven, Belgium.
Our aim was to evaluate the performance of the commercial Immunetics C6 Lyme ELISA assay as a screening assay for anti-Borrelia burgdorferi antibodies in cerebrospinal fluid (CSF). Sensitivity of C6 ELISA was determined in 28 consecutive patients who were diagnosed with neuroborreliosis and had evidence for intrathecal antibody synthesis on immunoblot analysis. The presence of additional bands in CSF or of bands with a stronger intensity in CSF compared with serum was considered evidence of intrathecal synthesis. All 28 patients tested borderline or positive with C6 ELISA on serum. Of the 28 CSF samples, 17 (61%) and 19 (68%) tested positive with C6 ELISA using a threshold of 0.9 and 0.5 (optical density/cutoff). The C6 Lyme ELISA tested has a low sensitivity for antibody detection in cerebrospinal fluid compared with immunoblot analysis.
PMID: 19376674 [PubMed - indexed for MEDLINE]
26. Rev Neurol Dis. 2009 Winter;6(1):4-12.
Nervous system lyme disease: diagnosis and treatment.
Halperin JJ.
Department of Neurosciences, Atlantic Neuroscience Institute, Summit, NJ, USA.
Lyme disease, the multisystem infectious disease caused by the tickborne spirochete Borrelia burgdorferi, frequently affects the peripheral and central nervous systems. The earliest indication of Lyme disease infection is usually erythema migrans. This large, typically macular erythema, often with a target-like pattern of concentric pale and red circles, gradually enlarges day by day, potentially reaching many centimeters in diameter. In a significant proportion of infected individuals, an acute disseminated phase leads to seeding elsewhere in the body. Up to 5% of patients develop cardiac involvement. In about 10% to 15% of patients, the nervous system becomes symptomatically involved. Current serologic diagnostic tools are quite useful, and standard treatment regimens are highly effective. Oral antimicrobials have been shown to be effective in European neuroborreliosis and presumably are equally potent in North American patients. Long-term antibiotic treatment does not provide any additional lasting improvement, but it is frequently associated with significant morbidity.
PMID: 19367218 [PubMed - indexed for MEDLINE]
27. Curr Probl Dermatol. 2009;37:200-6. Epub 2009 Apr 8.
What are the indications for lumbar puncture in patients with Lyme disease?
Rupprecht TA, Pfister HW.
Department of Neurology, Ludwig-Maximilians University, Munich, Germany.
Lyme neuroborreliosis (LNB) is a tick-borne disease of the nervous system, caused by the spirochete Borrelia burgdorferi. Having entered the host at the site of the tick bite, the spirochetes can initially cause a local inflammatory reaction, called erythema migrans. If left untreated, the Borrelia can disseminate in the second stage of the disease and invade the central nervous system, causing LNB. The diagnosis of LNB is based on a compatible clinical picture (meningitis, cranial neuritis or radiculoneuritis), lymphocytic pleocytosis in the cerebrospinal fluid (CSF) and intrathecal Borrelia burgdorferi-specific antibody production. As the clinical picture of LNB may be unspecific, a lumbar puncture to analyze the CSF is usually mandatory for confirmation of the suspected diagnosis. The indications for a lumbar puncture and the limitations of the different diagnostic procedures are the main topics of this review. In addition, a short overview of the epidemiology and the therapeutic principles of LNB is given. Copyright 2009 S. Karger AG, Basel.
PMID: 19367105 [PubMed - indexed for MEDLINE]
28. Curr Probl Dermatol. 2009;37:111-29. Epub 2009 Apr 8.
Treatment and prevention of Lyme disease.
Hansmann Y.
Service des Maladies Infectieuses et Tropicales, H�pitaux Universitaires de Strasbourg, Strasbourg, France.
yves.hansmann@chru-strasbourg.frRandomized controlled trials have ascertained the efficiency of antibiotics in treating erythema migrans, the hallmark of early stage Lyme borreliosis. Oral amoxicillin and doxycycline are first-line treatment options, though phenoxymethylpenicillin, cefuroxime axetil and azithromycin are alternative second-line options. Treatments for secondary and tertiary Lyme borreliosis are more poorly documented, and antibiotics are not always effective. This is due to the unique pathophysiology of late Lyme borreliosis, which involves not only bacterial infection, but also immunological response. Since there is no completely reliable method of diagnosis, it is difficult to choose the proper treatment and to evaluate treatment efficacy. However, numerous studies have shown that ceftriaxone and doxycycline are the 2 most efficient antibiotics, particularly in Lyme arthritis and in neuroborreliosis. In late Lyme borreliosis, these antibiotics are less efficient, and different treatment schemes with variations in dosage or duration did not produce convincing results. Copyright 2009 S. Karger AG, Basel.
PMID: 19367098 [PubMed - indexed for MEDLINE]
29. Arch Neurol. 2009 Apr;66(4):534-5.
Bilateral facial palsy in neuroborreliosis.
Hagemann G, Aroyo IM.
Department of Neurology, Friedrich-Schiller-University, Erlanger Alle 101, 07740 Jena, Germany.
hagemann@med.uni-jena.dePMID: 19364942 [PubMed - indexed for MEDLINE]
30. Orv Hetil. 2009 Apr 19;150(16):725-32.
[Lyme borreliosis--experience of the last 25 years in Hungary]
[Article in Hungarian]
Lakos A.
Kullancsbetegs�gek Ambulanci�ja, Budapest, Visegr�di u. 14. 1132.
alakos@t-online.huWe recognized the first Hungarian Lyme patients just 25 years ago, in 1984. It was exactly 20 years ago, when we opened the Lyme Disease Outpatient Service at the Central (L�szl�) Hospital for Infectious Diseases. 15 years ago we established the financially independent Center for Tick-borne Diseases. The milestones of this work at the Center for Tick-borne Diseases are the description of a new tick-borne rickettsial illness (tick-borne lymphadenopathy), development of a Lyme immunoblot kit and an automated immunoblot reader. We described a simple and reliable method for detection of intrathecal borrelia antibody synthesis which is necessary for the diagnosis of neuroborreliosis. We also developed and routinely apply the comparative immunoblot assay for the evaluation of serological progression and/or regression, which can help the clinicians to decide whether a serological reaction is resulted from a previous healed or an active borrelia infection. We studied the pregnancy outcome of borrelia infected mothers and provided that untreated borrelia infection is associated with higher chance of adverse pregnancy outcome.
PMID: 19362925 [PubMed - indexed for MEDLINE]
31. AJNR Am J Neuroradiol. 2009 Jun;30(6):1079-87. Epub 2009 Apr 3.
Lyme neuroborreliosis: manifestations of a rapidly emerging zoonosis.
Hildenbrand P, Craven DE, Jones R, Nemeskal P.
Department of Radiology, Lahey Clinic Medical Center, Burlington, MA 01805, USA.
Hildenbrand@lahey.orgLyme disease has a worldwide distribution and is the most common vector-borne disease in the United States. Incidence, clinical manifestations, and presentations vary by geography, season, and recreational habits. Lyme neuroborreliosis (LNB) is neurologic involvement secondary to systemic infection by the spirochete Borrelia burgdorferi in the United States and by Borrelia garinii or Borrelia afzelii species in Europe. Enhanced awareness of the clinical presentation of Lyme disease allows inclusion of LNB in the imaging differential diagnosis of facial neuritis, multiple enhancing cranial nerves, enhancing noncompressive radiculitis, and pediatric leptomeningitis with white matter hyperintensities on MR imaging. The MR imaging white matter appearance of successfully treated LNB and multiple sclerosis display sufficient similarity to suggest a common autoimmune pathogenesis for both. This review highlights differences in the epidemiology, clinical manifestations, diagnosis, and management of Lyme disease in the United States, Europe, and Asia, with an emphasis on neurologic manifestations and neuroimaging.
PMID: 19346313 [PubMed - indexed for MEDLINE]
32. Clin Immunol. 2009 Jul;132(1):93-102. Epub 2009 Apr 2.
Strong IgG antibody responses to Borrelia burgdorferi glycolipids in patients with Lyme arthritis, a late manifestation of the infection.
Jones KL, Seward RJ, Ben-Menachem G, Glickstein LJ, Costello CE, Steere AC.
Division of Rheumatology, Allergy, and Immunology, Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
In this study, the membrane lipids of B. burgdorferi were separated into 16 fractions; the components in each fraction were identified, and the immunogenicity of each fraction was determined by ELISA using sera from Lyme disease patients. Only the 2 glycolipids, acylated cholesteryl galactoside (ACG, BbGL-I) and monogalactosyl diacylglycerol (MgalD, BbGL-II), were immunogenic. Early in the infection, 24 of 84 patients (29%) who were convalescent from erythema migrans and 19 of the 35 patients (54%) with neuroborreliosis had weak IgG responses to purified MgalD, and a smaller percentage of patients had early responses to synthetic ACG. However, almost all of 75 patients with Lyme arthritis, a late disease manifestation, had strong IgG reactivity with both glycolipids. Thus, almost all patients with Lyme arthritis have strong IgG antibody responses to B. burgdorferi glycolipid antigens.
PMCID: 2752957 PMID: 19342303 [PubMed - indexed for MEDLINE]
33. Eur J Neurol. 2009 May;16(5):639-42. Epub 2009 Mar 20.
Tumefactive demyelinating disease treated with decompressive craniectomy.
Nilsson P, Larsson EM, Kahlon B, Nordstr�m CH, Norrving B.
Department of Neurology, Clinical Sciences Lund, Lund University, Sweden.
petra.c.nilsson@skane.seComment in: Eur J Neurol. 2009 May;16(5):e102.
BACKGROUND: Tumefactive demyelinating disease (TDD) is a rare primary demyelinating disease with diagnostic and therapeutic challenges. METHODS AND RESULTS: We report a 50-year old woman with TDD successfully treated with decompressive craniectomy and corticosteroids. The patient presented with seizures, subacute progressive hemispheric syndrome, and a tumourlike abnormality on MRI. Demyelinating disease was initially considered unlikely. Due to a rapidly evolving herniation syndrome hemicraniectomy was performed. Outcome was favourable with only very mild neurological deficits 6 weeks later. CONCLUSION: TDD should be considered as a differential diagnosis in tumour-like presentations, and appears to have distinctive neuroimaging features. In the advent of treatement failure from high dose corticosteroids and plasmapheresis and development of severe mass effect, decompressive hemicraniectomy is an important treatment option.
PMID: 19309337 [PubMed - indexed for MEDLINE]
34. Rev Med Chir Soc Med Nat Iasi. 2008 Apr-Jun;112(2):496-501.
[Results of etiologic diagnosis in clinical syndrome consistent with acute and chronic borreliosis]
[Article in Romanian]
Perseca� T, Feder A, Molnar GB.
Institutul de Sa�na�tate Publica�, Prof. Dr. Iuliu Moldovan" Cluj Napoca.
Borreliosis is a multisystem infection, which in the absence of adequate diagnosis and clinical management, may develop towards various clinical forms of chronic pathology. Due to the heterogeneity of clinical manifestations it is known under more names: erythema migrans, Lyme disease, neuroborreliosis etc. MATERIAL AND METHOD: Taking into account the present interest and the weight in pathology of syndromes consistent with the suspicion of a Borrelia spp. infection, since 2002 we applied in current practice the investigation of this etiology. There have been investigated 481 subjects, clinically suspected of Borrelia spp. infection that had historical risk of tick bite and cases of serous meningitis, after exclusion of usual etiology. Tests were performed on ELISA kits with standardised immunoreagents and recently, for result validation, on Western immunoblot kits (WB). RESULTS: Our results revealed the Borrelia etiology in 32% of cases (27.96-36.29% CI = 95%) at the screening, value expressed by the persistent positivity of the specific immunoglobulins (Ig) IgM (80.5%) and IgM+IgG (19.5%). Historic infection, represented exclusively by IgG positivity, was present in 8.6% (5.87-11.98% CI = 95%) from the cases that were negative for IgM (68%, 63.71-72.04%, CI = 95%). This weight is superposable with the results obtained in investigating a comparable sample of healthy individuals (193 subjects with 6.74% historical IgG, 3.79-10.96%, CI = 95%). Based on these results, it can be considered that ELISA procedure is useful and of reliable prognosis value for screening the Borrelia spp. etiology, the next step, taking into account the higher sensitivity of WB, being WB procedure which is useful for confirmation of ELISA positive cases and for treatment efficiency surveillance. The results prove that Borrelia spp. infections are a public health issue, which due to the diversity of clinical manifestations and diagnosis difficulties need repeated and complex laboratory investigations.
PMID: 19295026 [PubMed - indexed for MEDLINE]
35. Joint Bone Spine. 2009 May;76(3):293-5. Epub 2009 Mar 16.
Atypical forms of syphilis: two cases.
Avenel G, Go�b V, Abboud P, Ait-Abdesselam T, Vittecoq O.
Service de Rhumatologie, CHU-H�pitaux de Rouen, & Inserm, U905, IFRMP23, Institut de Biologie Clinique, Rouen, France.
avenel_gilles@hotmail.frSyphilis is a sexually transmitted disease caused by the spirochete Treponema pallidum. A chancre usually develops initially. Organ involvement and neurological complications may occur, sometimes several years after the initial exposure. We managed two patients with syphilis responsible for joint or neurological manifestations, diagnosed in 2008. One patient presented with oligoarthritis involving the knees and right elbow, coinciding with a maculopapular and pustular eruption. In the other patient, meningoradiculitis involving the T8, T9, and T10 metameres prompted a test for Lyme disease, which was weakly positive, leading to evaluation for false-positivity due to a cross-reaction. Neither patient was infected with the HIV.
PMID: 19289298 [PubMed - indexed for MEDLINE]
36. Scand J Infect Dis. 2009;41(5):355-62.
Laboratory data in children with Lyme neuroborreliosis, relation to clinical presentation and duration of symptoms.
Tveitnes D, �ymar K, Nat�s O.
Departments of Paediatrics, University of Bergen, Norway.
The occurrence of IgM and IgG antibodies against Borrelia burgdoferi in serum and cerebrospinal fluid (CSF) and intrathecal synthesis of antibodies (antibody index) were studied in relation to clinical presentation and the duration of symptoms before diagnosis in 146 children diagnosed with neuroborreliosis. Lymphocytic meningitis was demonstrated in 141 of these children. Levels of white blood cells (WBC) and protein in CSF correlated significantly to numbers of d with symptoms. Children were divided into 3 clinical groups: A (n = 37): only cranial neuropathy; B (n = 68): both cranial neuropathy and other neurological symptoms; C (n = 41): neurological symptoms without cranial neuropathy. Levels of WBC and protein in CSF as well as the proportion of children with antibodies in serum and CSF were generally lowest in group A, intermediate in group B and highest in group C. The proportion of children with antibodies in serum and CSF and a positive antibody index was also related to duration of symptoms; the antibody index was present in 51% of children with symptoms < or = 7 d, and in 80% of children with symptoms > 7 d (p<0.01). The clinical presentation and duration of symptoms must be considered when interpreting laboratory data in children with suspected neuroborreliosis.
PMID: 19253089 [PubMed - indexed for MEDLINE]
37. Wien Med Wochenschr. 2009;159(1-2):58-61.
Normal pressure hydrocephalus or neuroborreliosis?
Aboul-Enein F, Kristoferitsch W.
Department of Neurology, Sozialmedizinisches Zentrum Ost, Donauspital, Vienna, Austria.
fahmy.aboul-enein@chello.atBACKGROUND: An 80-year-old woman presented with progressive cognitive decline and with a 6-month history of gait ataxia. Brain MRI depicted enlarged ventricles and periventricular lesions. Clinical improvement after CSF spinal tap test suggested a normal pressure hydrocephalus syndrome. But CSF pleocytosis with activated lymphocytes and plasma cells and intrathecal Borrelia burgdorferi specific antibody production led to the diagnosis of active Lyme neuroborreliosis. Clinical symptoms of NPH resolved after a course of ceftriaxone. METHODS: Neurological examination, MMSE, brain MRI, lumbar puncture, spinal tap test. RESULTS: Dementia due Borrelia burgdorferi infection with chronic meningitis was reversible after treatment with iv.2 g ceftriaxone per day for 4 weeks. CONCLUSIONS: Rare but treatable dementias must be diagnosed promptly to slow down or even reverse cognitive decline.
PMID: 19225737 [PubMed - indexed for MEDLINE]
38. Przegl Epidemiol. 2008;62(4):793-800.
[Evaluation of cerebrospinal fluid serotonin (5-HT) concentration in patients with post-Lyme disease syndrome--preliminary study]
[Article in Polish]
Kepa L, Oczko-Grzesik B, Badura-Glombik T.
Oddzia� Chor�b Zaka�nych Slaskiego Uniwersytetu Medycznego w Bytomiu.
The aim of the study was evaluation of usefulness of cerebrospinal fluid (CSF) serotonin level examination in diagnostics of post-Lyme disease syndrome. The study was performed in 16 subjects. In all individuals CSF serotonin concentration was estimated on the 1st day of hospitalization. In patients with depressive and cognitive impairments, proved in neuropsychological tests, - group I--mean CSF serotonin concentration was 1,26 ng/ml, whereas in subjects without abnormalities in tests--group II--respectively--3,87 ng/ml. The difference of mean CSF serotonin levels was statistically significant (p<0,01). The obtained results indicate usefulness of this CSF parameter, besides neuropsychological tests, in objective evaluation of clinical state in patients with post-Lyme disease syndrome.
PMID: 19209742 [PubMed - indexed for MEDLINE]
39. Przegl Lek. 2008;65(11):810-2.
[Neuroboreliosis with motoric disturbations in the developmental age]
[Article in Polish]
Skowronek-Ba�a B, Weso�owska E, Gergont A, Kaci�ski M.
Klinika Neurologii Dzieciecej, Uniwersytet Jagiello�ski Collegium Medicum, Krak�w.
neupedkr@cm-uj.krakow.plBACKGROUND: Neurological symptoms develop in 10-20% of children suffered borreliosis (LD). AIM OF THE STUDY: It was a presentation of motoric disturbances of neuroboreliosis in children. MATERIAL AND METHODS: Children with neuroborreliosis and other neurological diseases were admitted to the University hospital during 2005-2007. Of these 13 patients, there were 9 males and 4 females, ranging in age between 3-17 years. Neurological diagnostic was performed using ELISA Biomedica kit and western blot bands. A 2-6 week sequential treatment with either iv ceftazidime or amoxicillin and oral doxycycline or amoxicillin was provided. Children were monitored regularly during the next 4-36 months. RESULTS: The 13 children with neuroborreliosis constitute 0.5% of the pediatric neurology department's patients. The clinical manifestation of LD were usual and unusual from patient to patient. They included four cases of facial nerve paralysis (with bilateral paralysis in one case), in three cases transverse myelitis and in a single case, hemiparesis, and oculomotor nerve paresis. In 9/13 children motoric disturbances of neuroboreliosis was diagnosed indeed. The antibiotic treatment was successful in 6 patients and only partially effective in 3 children with facial nerve paralysis. CONCLUSION: The most common symptoms of neuroborreliosis in children was motoric dysfunction.
PMID: 19205367 [PubMed - indexed for MEDLINE]
