Neuroborreliosis Explained

Neuroborreliosis
Synonyms:Lyme neuroborreliosis (LNB)
Symptoms:stiff neck (meningitis), facial nerve palsy, and radiculoneuritis

Neuroborreliosis is a disorder of the central nervous system. A neurological manifestation of Lyme disease, neuroborreliosis is caused by a systemic infection of spirochetes of the genus Borrelia.[1] Symptoms of the disease include erythema migrans and flu-like symptoms.[2]

Signs and symptoms

Neuroborreliosis is often preceded by the typical symptoms of Lyme disease, which include erythema migrans and flu-like symptoms such as fever and muscle aches. Neurologic symptoms of neuroborreliosis include the meningoradiculitis (which is more common in European patients), cranial nerve abnormalities, and altered mental status. Sensory findings may also be present. Rarely, a progressive form of encephalomyelitis may occur. In children, symptoms of neuroborreliosis include headache, sleep disturbance, and symptoms associated with increased intracranial pressure, such as papilledema. Less common childhood symptoms can include meningitis, myelitis, ataxia, and chorea. Ocular Lyme disease has also been reported, as has neuroborreliosis affecting the spinal cord, but neither of these findings are common.[3]

Diagnosis

Differential diagnosis

A number of diseases can produce symptoms similar to those of Lyme neuroborreliosis. They include:

Diagnosis is determined by clinical examination of visible symptoms.[4] Neuroborreliosis can also be diagnosed serologically to confirm clinical examination via western blot, ELISA, and PCR.[5]

Treatment

In the US, neuroborreliosis is typically treated with intravenous antibiotics which cross the blood–brain barrier, such as penicillins, ceftriaxone, or cefotaxime.[6] One relatively small randomized controlled trial suggested ceftriaxone was more effective than penicillin in the treatment of neuroborreliosis.[7] Small observational studies suggest ceftriaxone is also effective in children.[8] The recommended duration of treatment is 14 to 28 days.[9] [10]

Several studies from Europe have suggested oral doxycycline is as effective as intravenous ceftriaxone in treating neuroborreliosis. Doxycycline has not been widely studied as a treatment in the US, but antibiotic sensitivities of prevailing European and US isolates of Borrelia burgdorferi tend to be identical. However, doxycycline is generally not prescribed to children due to the risk of bone and tooth damage.[6]

Discredited treatments for neuroborreliosis include:

See also

Notes and References

  1. Tobias A . Rupprecht . Uwe . Koedel . Volker . Fingerle . Hans-Walter . Pfister . The Pathogenesis of Lyme Neuroborreliosis: From Infection to Inflammation . Molecular Medicine . 14 . 3–4 . 205–12 . 2008 . 18097481 . 2148032 . 10.2119/2007-00091.Rupprecht .
  2. Koedel. Uwe. Fingerle. Volker. Pfister. Hans-Walter. 2015-08-01. Lyme neuroborreliosis-epidemiology, diagnosis and management. Nature Reviews. Neurology. 11. 8. 446–456. 10.1038/nrneurol.2015.121. 1759-4766. 26215621. 13694627 .
  3. Hildenbrand . P. . Craven . D.E. . Jones . R. . Nemeskal . P. . Lyme Neuroborreliosis: Manifestations of a Rapidly Emerging Zoonosis . American Journal of Neuroradiology . 30 . 6 . 1079–87 . 2009 . 19346313 . 7051319 . 10.3174/ajnr.A1579 . free .
  4. Meyerhoff JO, Zaidman GW and Steele RW for Medscape Drugs & Diseases, Eds. Diamond HS et al. Lyme Disease Differential Diagnoses: Diagnostic Considerations Updated: Mar 14, 2016
  5. CDC Two-step Laboratory Testing Process Page last reviewed: March 4, 2015. Page last updated: March 26, 2015
  6. Halperin . John J. . Nervous System Lyme Disease . Infectious Disease Clinics of North America . 22 . 2 . 261–74, vi . June 2008 . 18452800 . 10.1016/j.idc.2007.12.009 . 10590435 .
  7. Dattwyler RJ, Halperin JJ, Volkman DJ, Luft BJ . Treatment of late Lyme borreliosis—randomised comparison of ceftriaxone and penicillin . Lancet . 1 . 8596 . 1191–4 . May 1988 . 2897008 . 10.1016/s0140-6736(88)92011-9. 33352690 .
  8. Bloom . Bradley J. . Wyckoff . Patricia M. . Meissner . H. Cody . Steere . Allen C. . Neurocognitive abnormalities in children after classic manifestations of Lyme disease . The Pediatric Infectious Disease Journal . 17 . 3 . 189–96 . March 1998 . 9535244 . 10.1097/00006454-199803000-00004 .
  9. Wormser . G. P. . Dattwyler . R. J. . Shapiro . E. D. . Halperin . J. J. . Steere . A. C. . Klempner . M. S. . Krause . P. J. . Bakken . J. S. . Strle . F. . Stanek . G. . Bockenstedt . L. . Fish . D. . Dumler . J. S. . Nadelman . R. B. . The Clinical Assessment, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis: Clinical Practice Guidelines by the Infectious Diseases Society of America . Clinical Infectious Diseases . 43 . 9 . 1089–134 . November 2006 . 17029130 . 10.1086/508667 . free .
  10. Halperin . J. J. . Shapiro . E. D. . Logigian . E. . Belman . A. L. . Dotevall . L. . Wormser . G. P. . Krupp . L. . Gronseth . G. . Bever . C. T. . Practice Parameter: Treatment of nervous system Lyme disease (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology . Neurology . 69 . 1 . 91–102 . July 2007 . 17522387 . 10.1212/01.wnl.0000265517.66976.28 . free .
  11. Epidemiologic Notes and Reports Imported Malaria Associated with Malariotherapy of Lyme Disease -- New Jersey . Morbidity and Mortality Weekly Report . 7 December 1990 . 39 . 48 . 873–875 .
  12. Web site: . 2006-06-21 . FDA Warns Consumers and Health Care Providers Not to Use Bismacine, also known as Chromacine . https://web.archive.org/web/20120224140143/https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2006/ucm108696.htm. 24 February 2012. dead.
  13. Lantos . PM . Shapiro . ED . Auwaerter . PG . Baker . PJ . Halperin . JJ . McSweegan . E . Wormser . GP . Unorthodox alternative therapies marketed to treat Lyme disease. . Clinical Infectious Diseases . 15 June 2015 . 60 . 12 . 1776–82 . 10.1093/cid/civ186 . 25852124. 4490322 .

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