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Jeantin L, Rodriguez-Regent C, De Martino S, Gayraud M, Cosserat J. Intrathecal antibody kinetics in neuroborreliosis: A report on three cases and a literature review. Infect Dis Now 2021; 51:627-629. [PMID: 33870892 DOI: 10.1016/j.idnow.2021.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 02/16/2021] [Indexed: 11/17/2022]
Abstract
Borreliosis is a common affliction in northern countries and its neurological manifestations often mislead trained clinicians. We present three cases of Lyme neuroborreliosis, with intrathecal synthesis of specific antibodies, lymphocytic meningitis and magnetic-resonance imaging (MRI) findings. Our description aims at illustrating the natural history of the infection, highlighting persistent intrathecal synthesis of anti-Borrelia antibodies months after treatment completion, and its clinical significance. We then review the literature on MRI findings in neuroborreliosis and the kinetics of intrathecal synthesis of specific anti-Borrelia antibodies.
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Affiliation(s)
- L Jeantin
- Service de médecine interne, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - C Rodriguez-Regent
- Service de radiologie, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - S De Martino
- Centre national de référence de la maladie de Lyme, 1, rue Koeberlé, 67000 Strasbourg, France; Laboratoire de biologie, centre hospitalier de Mende, 53, avenue du 8-mai-1945, 48000 Mende, France
| | - M Gayraud
- Service de médecine interne, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - J Cosserat
- Service de médecine interne, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France.
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Ding Z, Sun L, Bi Y, Zhang Y, Yue P, Xu X, Cao W, Luo L, Chen T, Li L, Ji Z, Jian M, Lu L, Abi ME, Liu A, Bao F. Integrative Transcriptome and Proteome Analyses Provide New Insights Into the Interaction Between Live Borrelia burgdorferi and Frontal Cortex Explants of the Rhesus Brain. J Neuropathol Exp Neurol 2020; 79:518-529. [PMID: 32196082 DOI: 10.1093/jnen/nlaa015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 01/03/2020] [Accepted: 02/13/2020] [Indexed: 01/01/2023] Open
Abstract
Borrelia burgdorferi (Bb), which is neurotropic, can attack the central nervous system (CNS), leading to the development of various neurologic symptoms. The pathogenesis of Lyme neuroborreliosis (LNB) remains poorly understood. Presently, there is a lack of knowledge of the changes in mRNA and proteins in the CNS following early disseminated Lyme disease. Explants from the frontal cortex of 3 rhesus brains were incubated with medium alone or with medium containing live Bb for 6, 12, or 24 hours. Then, we analyzed identified mRNA and proteins in the frontal cortex tissues, allowing for an in-depth view of the transcriptome and proteome for a macroscopic and unbiased understanding of early disseminated Lyme disease in the brain. Through bioinformatics analysis, a complex network of enriched pathways that were mobilized during the progression of Lyme spirochete infection was described. Furthermore, based on the analysis of omics data, translational regulation, glycosaminoglycan/proteoglycan-binding activity in colonization and dissemination to tissues, disease-associated genes, and synaptic function were enriched, which potentially play a role in pathogenesis during the interaction between frontal cortex tissues and spirochetes. These integrated omics results provide unbiased and comprehensive information for the further understanding of the molecular mechanisms of LNB.
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Affiliation(s)
- Zhe Ding
- From the Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities.,Department of Microbiology and Immunology
| | - Luyun Sun
- From the Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities
| | - Yunfeng Bi
- From the Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities
| | - Yu Zhang
- From the Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities.,Department of Microbiology and Immunology
| | - Peng Yue
- From the Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities.,Department of Microbiology and Immunology
| | - Xin Xu
- From the Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities.,Department of Biochemistry and Molecular Biology, Kunming Medical University
| | - Wenjing Cao
- From the Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities.,Department of Biochemistry and Molecular Biology, Kunming Medical University
| | - Lisha Luo
- From the Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities.,Department of Biochemistry and Molecular Biology, Kunming Medical University
| | - Taigui Chen
- From the Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities.,Department of Microbiology and Immunology
| | - Lianbao Li
- From the Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities.,Department of Microbiology and Immunology
| | - Zhenhua Ji
- From the Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities.,Department of Microbiology and Immunology
| | - Miaomiao Jian
- From the Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities.,Department of Biochemistry and Molecular Biology, Kunming Medical University
| | - Lihong Lu
- From the Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities
| | - Manzama-Esso Abi
- From the Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities.,Department of Microbiology and Immunology
| | - Aihua Liu
- From the Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities.,Yunnan Province Key Laboratory for Children's Major Diseases Research, The Children's Hospital of Kunming.,Department of Biochemistry and Molecular Biology, Kunming Medical University.,Yunnan Demonstration Base of International Science and Technology Cooperation for Tropical Diseases, Kunming, China
| | - Fukai Bao
- From the Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities.,Yunnan Province Key Laboratory for Children's Major Diseases Research, The Children's Hospital of Kunming.,Department of Microbiology and Immunology.,Yunnan Demonstration Base of International Science and Technology Cooperation for Tropical Diseases, Kunming, China
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Ørbæk M, Bodilsen J, Gynthersen RMM, Shekhrajka N, Nordberg CL, Larsen L, Storgaard M, Brandt C, Wiese L, Hansen BR, Luttichau HR, Andersen AB, Mens H, Nielsen H, Lebech AM. CT and MR neuroimaging findings in patients with Lyme neuroborreliosis: A national prospective cohort study. J Neurol Sci 2020; 419:117176. [PMID: 33130434 DOI: 10.1016/j.jns.2020.117176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/30/2020] [Accepted: 10/08/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND We aimed to describe the use and findings of cranial computerized tomography (CT-head), spine and brain magnetic resonance imaging (MRI-spine/MRI-brain) in Lyme neuroborreliose (LNB). METHODS Patients with LNB were identified using a nationwide, population-based prospective cohort of all adults treated for neuroinfections at departments of infectious diseases in Denmark from 2015 to 2019. Multivariate logistic regression analyses assessed associations between clinical characteristics and MRI-findings consistent with LNB. RESULTS We included 368 patients (272 definite LNB and 96 probable LNB), 280 scans were performed in 198 patients. Neuroimaging was associated with older age (59 vs. 57, p = 0.03), suspicion of other diseases (77% vs. 37%, p < 0.0001), no history of tick bites (58% vs. 43%, p = 0.01), physical/cognitive deficits prior to admission (15% vs 5%, p = 0.006), peripheral palsy (10% vs. 2%, p = 0.0008), encephalitis (8% vs. 1%, p = 0.0007) and cognitive impairment (8% vs. 2%, p = 0.03) compared with those without neuroimaging. Normal or incidental findings were common (93/98 CT-head and 154/182 MRI). 1/98 CT-head, 19/131 MRI-brain and 6/51 MRI-spine had findings consistent with LNB. Symptoms ≥45 days was associated with MRI-findings consistent with LNB (adjusted odds ratio (aOR) 4.2, 95%confidence interval 1.2-14.4, p = 0.02). CONCLUSION In this Danish cohort including 368 LNB-patients, use of neuroimaging was common and often performed in older comorbid patients without previous tick-bite intended to investigate alternative diagnoses. The results were in general without pathology and neuroimaging cannot exclude LNB or replace lumbar puncture. MRI is of value when investigating alternative neurological diseases and may support suspicion of LNB in cases with meningeal/leptomeningeal/neural enhancement.
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Affiliation(s)
- Mathilde Ørbæk
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark.
| | - Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Denmark
| | | | - Nitesh Shekhrajka
- Department of Neuroradiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | | | - Lykke Larsen
- Department of Infectious Diseases, Odense University Hospital, Denmark
| | - Merete Storgaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Brandt
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, University of Copenhagen, Hillerød, Denmark; Department of Infectious Diseases, Sjællands University Hospital, Roskilde, Denmark
| | - Lothar Wiese
- Department of Infectious Diseases, Sjællands University Hospital, Roskilde, Denmark
| | - Birgitte Rønde Hansen
- Department of Infectious Diseases, Hvidovre University Hospital, Copenhagen, Denmark
| | - Hans R Luttichau
- Department of Infectious Diseases, Herlev Gentofte Hospital, Copenhagen, Denmark
| | - Aase Bengaard Andersen
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Helene Mens
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen
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Dibaj P, Schnegelsberg M, Kröger R. Lyme Neuroborreliosis with Long Meningeal Enhancement and Ischemic Stroke. Eur Neurol 2020; 83:323-324. [PMID: 32668437 DOI: 10.1159/000508496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/07/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Payam Dibaj
- Center for Rare Diseases Göttingen, University Medical Center Göttingen, Georg August University, Göttingen, Germany, .,Max-Planck-Institute for Experimental Medicine, Göttingen, Germany, .,Center for Neurology, Asklepios Hospitals Schildautal, Seesen, Germany,
| | | | - Renate Kröger
- Department of Radiology, Asklepios Hospitals Schildautal, Seesen, Germany
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Ørbæk M, Klausen C, Lebech AM, Mens H. Lyme Neuroborreliosis in a Patient with Breast Cancer: MRI and PET/CT Findings. Diagnostics (Basel) 2020; 10:diagnostics10010036. [PMID: 31936608 PMCID: PMC7169463 DOI: 10.3390/diagnostics10010036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/05/2020] [Accepted: 01/06/2020] [Indexed: 11/16/2022] Open
Abstract
We present a case demonstrating the performance of different radiographical and nuclear medicine imaging modalities in the diagnostic work-up of a patient with Lyme neuroborreliosis. The patient presented in late summer 2019 with radicular pains followed by a foot drop and peripheral facial palsy, both right-sided. Due to a history of breast cancer, disseminated malignant disease was initially suspected. Bone metastasis was ruled out by skeletal scintigraphy. Magnetic resonance imaging (MRI) of the neuroaxis and a whole body 18F-FDG PET-CT was performed within 48 hours. The MRI revealed a strong contrast enhancement of the conus medullaris and fibers of the cauda equina, while the 18F-FDG PET/CT was without pathological findings. Examination of cerebrospinal fluid led to the definitive diagnosis of Lyme neuroborreliosis with monocytic pleocytosis and a positive intrathecal test for Borrelia burgdorferi. The patient became pain-free after 10 days of ceftriaxone, and the paralysis slowly regressed the following month. This case highlights the difficulty of the diagnosis of Lyme neuroborreliosis and discusses the relevant imaging findings.
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Affiliation(s)
- Mathilde Ørbæk
- Department of Infectious Diseases, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark (H.M.)
- Correspondence: ; Tel.: +45-35451498
| | - Camilla Klausen
- Department of Radiology, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark;
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark (H.M.)
| | - Helene Mens
- Department of Infectious Diseases, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark (H.M.)
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