Tag Archives: Lyme neuroborreliosis

Diagnosis and Treatment Algorythm in Lyme Neuroborreliosis

Țilea Brîndușa1*, Bălașa Rodica1, Fodor Andrea1, Țilea Ioan1

1 University of Medicine and Pharmacy, Tîrgu Mureș, Romania

DOI: 10.1515/amma-2015-0125

Lyme neuroborreliosis is an infection of the nervous system caused by spirochetes of the Borrelia burgdorferi sensulato group. Neurological clinical manifestations usually present a steady evolution and are different in patients from Europe compared to those from America, possibly due to vector agents and different bacterial species. Various diagnostic markers were studied in consideration of a clear or possible diagnosis of the disease, because evolution and complications depend on early diagnosis and initiation of therapy. The isolation of the bacterium is difficult, microscopic examination and the bacterial dezoxiribonucleic acid amplification shows low sensitivity. However, the diagnosis of Lyme neuroborreliosis is mainly based on serological methods that have a satisfactory sensitivity and specificity. A correct diagnosis can be performed by strictly respecting clinical guidelines and protocols and carefully interpreting the serological tests. The presence of anti-borrelia burgdorferi antibodies in the cerebrospinal fluid with evidence of intrathecal antibody production is the gold standard diagnosis of Lyme neuroborreliosis. Early administration of antibiotic treatment (third generation cephalosporins, cyclins, aminopenicillins) can produce the remission of neurological symptoms, the eradication of spirochetes in acute phase of the disease, thus avoiding the development of the chronic disease.

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Lyme Neuroborreliosis – A Retrospective Study

Țilea Brîndușa1, Țilea I2, Brînzaniuc Klara3, Georgescu Anca1, Gîrbovan Cristina1

1 1st Clinic of Infectious Diseases, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Internal Medicine III, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Anatomy and Human Embriology Department, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Background: Lyme Neuroborreliosis represents the acute or chronic infection of the central nervous system (CNS) and peripheric nervous system (PNS), as a consequence of a systemic infection.
Objectives: to evaluate the epidemiological, clinical, serological and post-therapeutic implications of CNS and PNS damage during Borrelia burgdorferi (Bb) infection.
Material and method: We performed a retrospective study on 23 patients admitted between January 1st, 2009 – December 31, 2010. The patient’s inclusion was made respecting the criteria of the European Center for Diseases Control (ECDC) and the European Union Concerted Action on Lyme Borreliosis (EUCALB). The levels of antiBb antibodies (IgM, IgG) were measured in the cerebro-spinal fluid (CSF) and in the serum using ELISA and Western blot methods. Imaging techniques were used in the case of patients with meningeal and cerebral lesions. The patients were treated with 3rd generation cephalosporins and cyclins. Statistical analysis was performed using the Chi square and Student tests.
Results: Twenty patients (86.96%) were included in the acute phase and 3 patients (13.04%) in the chronic phase of the disease. Meningeal damage was observed in 16 patients (69.56%), cerebral damage in 4 patients (17.39%), cranial nerve lesions in 2 patients (8.69%), radiculoneuritis in 1 patient (4.34%). Serological investigations using the ELISA method revealed the presence of antiBb antibodies in 100% of cases, in the CSF antiBb IgM antibodies were found in 18 patients (78.26%), IgG in 3 patients (13.04%); using the Western-blot method IgM antibodies were found in 20 patients (86.96%) and IgG in 3 patients (13.04%).
Conclusions: Early diagnosis and therapy led to a favorable evolution compared with patients who were treated late, the latter presenting neurological sequelae and relapses.

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