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Palmer KN, Sokola M, Uysal SP, Cooperrider J, Leung AK, Torres-Trejo A, Li Y, Abbatemarco JR. Diagnostic Challenges of Lyme Neuroborreliosis in Inpatient Neurology: A Case Series. Neurohospitalist 2024; 14:301-307. [PMID: 38895010 PMCID: PMC11181985 DOI: 10.1177/19418744241246308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024] Open
Abstract
Lyme disease is a multisystem disorder transmitted through the Ixodes tick and is most commonly diagnosed in northeastern and mid-Atlantic states, Wisconsin, and Minnesota, though its disease borders are expanding in the setting of climate change. Approximately 10%-15% of untreated Lyme disease cases will develop neurologic manifestations of Lyme neuroborreliosis (LNB). Due to varying presentations, LNB presents diagnostic challenges and is associated with a delay to treatment. We discuss three cases of LNB admitted to our referral center in a traditionally low-incidence state to highlight clinical pearls in LNB diagnosis. Three patients from low-incidence areas with prior diagnostic evaluations presented in August with neurologic manifestations of radiculoneuritis, cranial neuropathies, and/or lymphocytic meningitis. MRI findings included cranial nerve, nerve root, and leptomeningeal enhancement leading to broad differential diagnoses. Lumbar puncture demonstrated lymphocytic pleocytosis (range 85-753 cells/uL) and elevated protein (87-318 mg/dL). Each patient tested positive for Lyme on two-tiered serum testing and was diagnosed with LNB. All three cases were associated with a delay to health care presentation (mean 20 days) and a delay to diagnosis and treatment (mean 54 days) due to under-recognition and ongoing evaluation. With the geographic expansion of Lyme disease, increasing awareness of LNB manifestations and acquiring detailed travel histories in low-incidence areas is crucial to prompt delivery of care. Clinicians should be aware of two-tiered serum diagnostic requirements and use adjunctive studies such as lumbar puncture and MRI to eliminate other diagnoses. Treatment with an appropriate course of antibiotics leads to robust improvement in neurological symptoms.
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Affiliation(s)
| | - Maria Sokola
- Department of Neurology, Cleveland Clinic, Cleveland, OH, USA
| | - Sanem P. Uysal
- Department of Neurology, Cleveland Clinic, Cleveland, OH, USA
| | | | - Anthony K. Leung
- Department of Infectious Disease, Cleveland Clinic Akron General, Akron, OH, USA
| | - Alejandro Torres-Trejo
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA
| | - Yuebing Li
- Neuromuscular Center, Cleveland Clinic, Cleveland, OH, USA
| | - Justin R. Abbatemarco
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, OH, USA
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2
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Xu X, Wen S, Zhang Y, Cao W, Yue P, Kong J, Liu M, Fan Y, Chen J, Ji Z, Dong Y, Zhou G, Li B, Liu A, Bao F. A key protein from Borrelia burgdorferi could stimulate cytokines in human microglial cells and inhibitory effects of Cucurbitacin IIa. IBRO Neurosci Rep 2023; 15:376-385. [PMID: 38046885 PMCID: PMC10689270 DOI: 10.1016/j.ibneur.2023.11.004] [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: 04/01/2023] [Accepted: 11/09/2023] [Indexed: 12/05/2023] Open
Abstract
Lyme neuroborreliosis (LNB) is an infectious disease of the nervous system caused by Borrelia burgdorferi (Bb) infection. However, its pathogenesis is not fully understood. We used recombinant BmpA (rBmpA) to stimulate human microglia cell HMC3, then collected the culture supernatant and extracted total RNA from cells, and used the supernatant for cytokine chip, then ELISA and qPCR technology were used to validate the results from cytokine chip. After rBmpA stimulation of microglia, 24 inflammation-related cytokines showed elevated expression. Among them, six cytokines (IL-6, IL-8, CCL2, CCL5, CXCL1, and CXCL10) increased significantly in mRNA transcription, three cytokines (IL-6, IL-8, and CXCL10) concentrations in the cell supernatant increased significantly after the rBmpA stimulation, and CuIIa could inhibit expression of these cytokines. The BmpA can stimulate human microglia to produce large amounts of cytokines, leading to the occurrence of inflammation, which may be closely related to the development of LNB. CuIIa can inhibit BmpA-induced cytokine production in microglia, which may have potential therapeutic effects on LNB.
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Affiliation(s)
- Xin Xu
- The Institute for Tropical Medicine, Faculty of Basic Medical Sciences, Kunming Medical University, Kunming, China
- Department of Microbiology and Immunology, Kunming Medical University, Kunming, China
- Yunnan Province Key Laboratory of Children's Major Diseases Research, The Affiliated Children Hospital, Kunming Medical University, Kunming, China
| | - Shiyuan Wen
- The Institute for Tropical Medicine, Faculty of Basic Medical Sciences, Kunming Medical University, Kunming, China
- Department of Microbiology and Immunology, Kunming Medical University, Kunming, China
- Department of Intensive Care Unit, First People's Hospital of Yunnan Province, Kunming, China
| | - Yu Zhang
- The Institute for Tropical Medicine, Faculty of Basic Medical Sciences, Kunming Medical University, Kunming, China
- Department of Microbiology and Immunology, Kunming Medical University, Kunming, China
- Yunnan Province Key Laboratory of Children's Major Diseases Research, The Affiliated Children Hospital, Kunming Medical University, Kunming, China
| | - Wenjing Cao
- The Institute for Tropical Medicine, Faculty of Basic Medical Sciences, Kunming Medical University, Kunming, China
- Department of Biochemistry and Molecular Biology, Kunming Medical University, Kunming, China
| | - Peng Yue
- The Institute for Tropical Medicine, Faculty of Basic Medical Sciences, Kunming Medical University, Kunming, China
- Department of Biochemistry and Molecular Biology, Kunming Medical University, Kunming, China
| | - Jing Kong
- The Institute for Tropical Medicine, Faculty of Basic Medical Sciences, Kunming Medical University, Kunming, China
- Department of Microbiology and Immunology, Kunming Medical University, Kunming, China
| | - Meixiao Liu
- The Institute for Tropical Medicine, Faculty of Basic Medical Sciences, Kunming Medical University, Kunming, China
- Department of Microbiology and Immunology, Kunming Medical University, Kunming, China
| | - Yuxin Fan
- The Institute for Tropical Medicine, Faculty of Basic Medical Sciences, Kunming Medical University, Kunming, China
- Department of Microbiology and Immunology, Kunming Medical University, Kunming, China
| | - Jingjing Chen
- The Institute for Tropical Medicine, Faculty of Basic Medical Sciences, Kunming Medical University, Kunming, China
- Department of Microbiology and Immunology, Kunming Medical University, Kunming, China
| | - Zhenhua Ji
- The Institute for Tropical Medicine, Faculty of Basic Medical Sciences, Kunming Medical University, Kunming, China
- Department of Microbiology and Immunology, Kunming Medical University, Kunming, China
| | - Yan Dong
- The Institute for Tropical Medicine, Faculty of Basic Medical Sciences, Kunming Medical University, Kunming, China
- Department of Microbiology and Immunology, Kunming Medical University, Kunming, China
| | - Guozhong Zhou
- The Institute for Tropical Medicine, Faculty of Basic Medical Sciences, Kunming Medical University, Kunming, China
- Department of Microbiology and Immunology, Kunming Medical University, Kunming, China
| | - Bingxue Li
- The Institute for Tropical Medicine, Faculty of Basic Medical Sciences, Kunming Medical University, Kunming, China
- Department of Microbiology and Immunology, Kunming Medical University, Kunming, China
| | - Aihua Liu
- The Institute for Tropical Medicine, Faculty of Basic Medical Sciences, Kunming Medical University, Kunming, China
- Department of Microbiology and Immunology, Kunming Medical University, Kunming, China
- Yunnan Province Key Laboratory of Children's Major Diseases Research, The Affiliated Children Hospital, Kunming Medical University, Kunming, China
| | - Fukai Bao
- The Institute for Tropical Medicine, Faculty of Basic Medical Sciences, Kunming Medical University, Kunming, China
- Department of Microbiology and Immunology, Kunming Medical University, Kunming, China
- Yunnan Province Key Laboratory of Children's Major Diseases Research, The Affiliated Children Hospital, Kunming Medical University, Kunming, China
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3
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Iversen L, Boesen MS, Zibrandtsen IC. Lyme neuroborreliosis presenting with urinary retention and spastic paraparesis. Pract Neurol 2023; 23:504-506. [PMID: 37532431 DOI: 10.1136/pn-2023-003779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2023] [Indexed: 08/04/2023]
Abstract
Progressive myelopathy, urinary retention and gait problems are rare presenting features of Lyme neuroborreliosis. A 30-year-old man had 11 months of urinary retention and 3 months of spastic paraparesis. MR scans of the brain and the spinal cord showed leptomeningeal thickening with contrast enhancement. Cerebrospinal fluid showed mononuclear pleocytosis, decreased glucose, increased protein and chemokine ligand 13, with intrathecal Borrelia-specific IgM and IgG antibodies. He received 14 days of intravenous ceftriaxone followed by 14 days of oral doxycycline. Despite improvement at 6 months, he still had severe gait problems. Urinary retention in otherwise healthy people needs investigation, and Lyme neuroborreliosis is a rare cause.
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Affiliation(s)
- Lars Iversen
- Department of Neurology, Zealand University Hospital, Roskilde, Denmark
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4
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Zhao N, Chung TD, Guo Z, Jamieson JJ, Liang L, Linville RM, Pessell AF, Wang L, Searson PC. The influence of physiological and pathological perturbations on blood-brain barrier function. Front Neurosci 2023; 17:1289894. [PMID: 37937070 PMCID: PMC10626523 DOI: 10.3389/fnins.2023.1289894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/06/2023] [Indexed: 11/09/2023] Open
Abstract
The blood-brain barrier (BBB) is located at the interface between the vascular system and the brain parenchyma, and is responsible for communication with systemic circulation and peripheral tissues. During life, the BBB can be subjected to a wide range of perturbations or stresses that may be endogenous or exogenous, pathological or therapeutic, or intended or unintended. The risk factors for many diseases of the brain are multifactorial and involve perturbations that may occur simultaneously (e.g., two-hit model for Alzheimer's disease) and result in different outcomes. Therefore, it is important to understand the influence of individual perturbations on BBB function in isolation. Here we review the effects of eight perturbations: mechanical forces, temperature, electromagnetic radiation, hypoxia, endogenous factors, exogenous factors, chemical factors, and pathogens. While some perturbations may result in acute or chronic BBB disruption, many are also exploited for diagnostic or therapeutic purposes. The resultant outcome on BBB function depends on the dose (or magnitude) and duration of the perturbation. Homeostasis may be restored by self-repair, for example, via processes such as proliferation of affected cells or angiogenesis to create new vasculature. Transient or sustained BBB dysfunction may result in acute or pathological symptoms, for example, microhemorrhages or hypoperfusion. In more extreme cases, perturbations may lead to cytotoxicity and cell death, for example, through exposure to cytotoxic plaques.
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Affiliation(s)
- Nan Zhao
- Institute for Nanobiotechnology, Johns Hopkins University, Baltimore, MD, United States
| | - Tracy D. Chung
- Institute for Nanobiotechnology, Johns Hopkins University, Baltimore, MD, United States
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Zhaobin Guo
- Institute for Nanobiotechnology, Johns Hopkins University, Baltimore, MD, United States
| | - John J. Jamieson
- Institute for Nanobiotechnology, Johns Hopkins University, Baltimore, MD, United States
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Lily Liang
- Institute for Nanobiotechnology, Johns Hopkins University, Baltimore, MD, United States
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Raleigh M. Linville
- Institute for Nanobiotechnology, Johns Hopkins University, Baltimore, MD, United States
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Alex F. Pessell
- Institute for Nanobiotechnology, Johns Hopkins University, Baltimore, MD, United States
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Linus Wang
- Institute for Nanobiotechnology, Johns Hopkins University, Baltimore, MD, United States
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Peter C. Searson
- Institute for Nanobiotechnology, Johns Hopkins University, Baltimore, MD, United States
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States
- Department of Materials Science and Engineering, Johns Hopkins University, Baltimore, MD, United States
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5
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Khan Z, Gupta GD, Mehan S. Cellular and Molecular Evidence of Multiple Sclerosis Diagnosis and Treatment Challenges. J Clin Med 2023; 12:4274. [PMID: 37445309 DOI: 10.3390/jcm12134274] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic autoimmune disease that impacts the central nervous system and can result in disability. Although the prevalence of MS has increased in India, diagnosis and treatment continue to be difficult due to several factors. The present study examines the difficulties in detecting and treating multiple sclerosis in India. A lack of MS knowledge among healthcare professionals and the general public, which delays diagnosis and treatment, is one of the significant issues. Inadequate numbers of neurologists and professionals with knowledge of MS management also exacerbate the situation. In addition, MS medications are expensive and not covered by insurance, making them inaccessible to most patients. Due to the absence of established treatment protocols and standards for MS care, India's treatment techniques vary. In addition, India's population diversity poses unique challenges regarding genetic variations, cellular and molecular abnormalities, and the potential for differing treatment responses. MS is more difficult to accurately diagnose and monitor due to a lack of specialized medical supplies and diagnostic instruments. Improved awareness and education among healthcare professionals and the general public, as well as the development of standardized treatment regimens and increased investment in MS research and infrastructure, are required to address these issues. By addressing these issues, it is anticipated that MS diagnosis and treatment in India will improve, leading to better outcomes for those affected by this chronic condition.
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Affiliation(s)
- Zuber Khan
- Division of Neuroscience, Department of Pharmacology, ISF College of Pharmacy, IK Gujral Punjab Technical University, Jalandhar 144603, India
| | - Ghanshyam Das Gupta
- Department of Pharmaceutics, ISF College of Pharmacy, IK Gujral Punjab Technical University, Jalandhar 144603, India
| | - Sidharth Mehan
- Division of Neuroscience, Department of Pharmacology, ISF College of Pharmacy, IK Gujral Punjab Technical University, Jalandhar 144603, India
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6
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Lorquet JR, Pell R, Adams J, Tak M, Ganti L. A Non-Classical Presentation of Erythema Migrans in a 51-Year-Old Woman With Early Manifestation of Lyme Neuroborreliosis (Bannwarth Syndrome). Cureus 2023; 15:e39931. [PMID: 37416051 PMCID: PMC10319937 DOI: 10.7759/cureus.39931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 07/08/2023] Open
Abstract
The authors present a case of a 51-year-old female who presented to the emergency department with general malaise, headache, neck stiffness, and an expanding rash consistent with Lyme neuroborreliosis. In this case report, the clinical presentation, diagnosis, and management of Lyme neuroborreliosis and different presentations of erythema migrans are discussed.
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Affiliation(s)
- Jovans R Lorquet
- Emergency Medicine, HCA Florida Osceola Hospital, Kissimmee, USA
| | - Robert Pell
- Emergency Medicine, HCA Florida Osceola Hospital, Kissimmee, USA
| | - Jeffrey Adams
- Emergency Medicine, HCA Florida Osceola Hospital, Kissimmee, USA
| | - Mihir Tak
- Emergency Medicine, HCA Florida Osceola Hospital, Kissimmee, USA
| | - Latha Ganti
- Emergency Medicine, HCA Florida Osceola Hospital, Kissimmee, USA
- Emergency Medicine, Envision Physician Services, Plantation, USA
- Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA
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7
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Delaney SL, Murray LA, Fallon BA. Neuropsychiatric Symptoms and Tick-Borne Diseases. Curr Top Behav Neurosci 2023; 61:279-302. [PMID: 36512289 DOI: 10.1007/7854_2022_406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
In North America, Lyme disease (LD) is primarily caused by the spirochetal bacterium Borrelia burgdorferi, transmitted to humans by Ixodes species tick bites, at an estimated rate of 476,000 patients diagnosed per year. Acute LD often manifests with flu-like symptoms and an expanding rash known as erythema migrans (EM) and less often with neurologic, neuropsychiatric, arthritic, or cardiac features. Most acute cases of Lyme disease are effectively treated with antibiotics, but 10-20% of individuals may experience recurrent or persistent symptoms. This chapter focuses on the neuropsychiatric aspects of Lyme disease, as these are less widely recognized by physicians and often overlooked. Broader education about the potential complexity, severity, and diverse manifestations of tick-borne diseases is needed.
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Affiliation(s)
- Shannon L Delaney
- Lyme and Tick-Borne Diseases Research Center at Columbia University Irving Medical Center, New York, NY, USA.
| | - Lilly A Murray
- Lyme and Tick-Borne Diseases Research Center at Columbia University Irving Medical Center, New York, NY, USA
| | - Brian A Fallon
- Lyme and Tick-Borne Diseases Research Center at Columbia University Irving Medical Center, New York, NY, USA
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8
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Baker AL, Mannix R, Baker AH. Radiculoneuritis due to Lyme disease in a North American child. Am J Emerg Med 2022; 57:234.e1-234.e2. [PMID: 35430099 DOI: 10.1016/j.ajem.2022.03.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 11/30/2022] Open
Abstract
Lyme disease is the most frequently reported vector-borne illness in the United States. It is caused by infection with Borrelia burgdorferi via the bite of an infected blacklegged tick (Ixodes spp.) Lyme disease has three stages: early localized, early disseminated, and late. Early disseminated Lyme disease may include neurologic manifestations such as cranial nerve palsy, meningitis, and radicular pain (also called radiculoneuritis). Isolated radiculoneuritis is a rare presentation of early disseminated Lyme disease and is likely underrecognized. We report a case of isolated Lyme radiculoneuritis in a child in Massachusetts characterized by fever and allodynia of the upper back that was treated in the emergency department. Laboratory investigation demonstrated elevated inflammatory markers and positive Lyme testing. Magnetic resonance imaging with gadolinium contrast revealed nerve root enhancement in C5-C6 and C6-C7. The symptoms resolved with oral doxycycline. Neuropathic pain should raise suspicion for neurologic manifestations of Lyme disease in North America even in the absence of meningitis and cranial nerve palsy. We report how timely recognition of this rare syndrome in North America is important and may prevent progression to late disease.
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Affiliation(s)
- Arianne L Baker
- Division of Emergency Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, United States of America; Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA, United States of America.
| | - Rebekah Mannix
- Division of Emergency Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, United States of America; Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA, United States of America
| | - Alexandra H Baker
- Division of Emergency Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, United States of America; Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA, United States of America
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9
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Borrelia burgdorferi inhibits NADPH-mediated reactive oxygen species production through the mTOR pathway. Ticks Tick Borne Dis 2022; 13:101943. [DOI: 10.1016/j.ttbdis.2022.101943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 03/14/2022] [Accepted: 03/18/2022] [Indexed: 11/21/2022]
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10
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Luciano CA, Caraballo-Cartagena S. Treatment and Management of Infectious, Granulomatous, and Toxic Neuromuscular Disorders. Neuromuscul Disord 2022. [DOI: 10.1016/b978-0-323-71317-7.00016-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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11
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Skripchenko E, Ivanova G, Skripchenko N, Egorova E. Modern concepts on the pathogenesis of neuroborreliosis. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:27-35. [DOI: 10.17116/jnevro202212207127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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12
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Benninger F, Steiner I. Non-infectious mechanisms of neurological damage due to infection. J Neurol Sci 2021; 431:120057. [PMID: 34800841 DOI: 10.1016/j.jns.2021.120057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
Infections of the nervous system is a growing aspect of clinical neurology. Accumulating knowledge in early diagnosis, course, therapy and prognosis is enlarging the clinical tools required for effective therapy. Of special importance is the ability to differentiate between proper infections, where anti-microbial agents, when available, should be introduced and used and post infectious conditions where therapy is mainly directed against the host immune system. The two conditions sometimes overlap, a situation that requires the ability to combine clinical skills with the use of laboratory tools such as polymerase chain reaction (PCR), serology, and antigenic detection. In the era of the SARS-CoV-2 pandemic, the need to make this distinction is emphasized as correct diagnosis of post infectious conditions and expedited therapy is important and sometimes lifesaving. We here attempt to present several infectious agents and their possible indirect damage to the nervous system causing in some cases significant neurological deficits. We try to limit our focus on those mechanisms which do not involve the direct tissue damage by the infectious agents but rather are connected to para- and post-infectious mechanisms. We attempt to delineate the features that will enable to tailor the correct diagnosis and following the effective therapy.
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Affiliation(s)
- Felix Benninger
- Felsenstein Medical Research Center, Petach Tikva, Israel; Department of Neurology, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Israel Steiner
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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13
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Ørbæk M, Gynthersen RMM, Mens H, Stenør C, Wiese L, Brandt C, Ostrowski SR, Nielsen SD, Lebech AM. Stimulated Immune Response by TruCulture ® Whole Blood Assay in Patients With European Lyme Neuroborreliosis: A Prospective Cohort Study. Front Cell Infect Microbiol 2021; 11:666037. [PMID: 34041044 PMCID: PMC8141554 DOI: 10.3389/fcimb.2021.666037] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/13/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Borrelia burgdorferi sensu lato complex (B. burgdorferi) can cause a variety of clinical manifestations including Lyme neuroborreliosis. Following the tick-borne transmission, B. burgdorferi initially evade immune responses, later symptomatic infection is associated with occurrence of specific antibody responses. We hypothesized that B. burgdorferi induce immune hyporesponsiveness or immune suppression and aimed to investigate patients with Lyme neuroborreliosis ability to respond to immune stimulation. Methods An observational cohort study investigating the stimulated immune response by standardized whole blood assay (TruCulture®) in adult patients with Lyme neuroborreliosis included at time of diagnosis from 01.09.2018-31.07.2020. Reference intervals were based on a 5-95% range of cytokine concentrations from healthy individuals (n = 32). Patients with Lyme neuroborreliosis and references were compared using Mann-Whitney U test. Heatmaps of cytokine responses were generated using the webtool Clustvis. Results In total, 22 patients with Lyme neuroborreliosis (19 definite, 3 probable) were included. In the unstimulated samples, the concentrations of cytokines in patients with Lyme neuroborreliosis were comparable with references, except interferon (IFN)-α, interleukin (IL)-17A, IL-1β and IL-8, which were all significantly below the references. Patients with Lyme neuroborreliosis had similar concentrations of most cytokines in all stimulations compared with references. IFN-α, IFN-γ, IL-12 and IL-17A were lower than references in multiple stimulations. Conclusion In this exploratory cohort study, we found lower or similar concentrations of circulating cytokines in blood from patients with Lyme neuroborreliosis at time of diagnosis compared with references. The stimulated cytokine release in blood from patients with Lyme neuroborreliosis was in general slightly lower than in the references. Specific patterns of low IL-12 and IFN-γ indicated low Th1-response and low concentrations of IL-17A did not support a strong Th17 response. Our results suggest that patients with Lyme neuroborreliosis elicit a slightly suppressed or impaired immune response for the investigated stimulations, however, whether the response normalizes remains unanswered.
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Affiliation(s)
- Mathilde Ørbæk
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Cluster for Molecular Imaging, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Helene Mens
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian Stenør
- Department of Neurology, Herlev Hospital, Herlev, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lothar Wiese
- Department of Infectious Diseases, Sjællands University Hospital, Roskilde, Denmark
| | - Christian Brandt
- Department of Infectious Diseases, Sjællands University Hospital, Roskilde, Denmark
| | - Sisse Rye Ostrowski
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Susanne Dam Nielsen
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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14
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Petrulionienė A, Radzišauskienė D, Paulauskas A, Venalis A. Lyme Disease among Patients at an Ambulatory Unit in a Highly Endemic Country: Lithuania. ACTA ACUST UNITED AC 2021; 57:medicina57020184. [PMID: 33669940 PMCID: PMC7924869 DOI: 10.3390/medicina57020184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 11/21/2022]
Abstract
Background and objectives: Lyme disease is the most common tick-borne infectious disease in Europe, caused by the spirocheta bacteria of Borrelia burgdorferi. Several genospecies of B. burgdorferi are pathogenic to humans. B. burgdorferi sensu stricto, which is prevalent in North America, causes reactive arthritis, whereas B. garinii and B. afzelii, common in Europe, can affect the skin, heart, or nervous system; it has been shown that the clinical symptoms of the disease may be very different. The objective of this study was to identify the baseline characteristics of Lyme disease and to elucidate the frequency of different Lyme disease syndromes in Lithuania. Materials and Methods: Patients who were diagnosed with Lyme disease during an ambulatory visit to the Center of Infectious Diseases, Vilnius University Santaros clinics, from 2014 to 2016, were enrolled in this study. A retrospective material analysis was conducted. Results: In total, 1005 patients were enrolled with the following prevalence of clinical syndromes: erythema migrans (EM), 945 (94.02%); Lyme arthritis, 32 (3.18%); neuroborreliosis, 23 (2.28%); Lyme carditis, 4 (0.39%); and acrodermatitis, 1 (0.09%). Erythema migrans was dominant among middle-aged women, with a rash appearing mainly on the lower extremities. Lyme arthritis mainly manifested among middle-aged women as an oligoarthritis, mostly affecting the knee joint. Neuroborreliosis was seen more often in middle-aged women than men and the main symptom was nervus facialis neuropathy. Lyme carditis, manifested as an atrioventricular block, with a male/female ratio of 3:1, and the median age was 51. Acrodermatitis was diagnosed in a 61-year-old woman, as a painful, red rash on the hand. Conclusions: According to the prevalence of B. garinii and B. afzelii in Europe, previously it was thought that Lyme disease presented as erythema migrans, and less frequently as neuroborreliosis; however, this study revealed that other syndromes may also be seen. In addition, we revealed that the longer it takes for erythema migrans to appear, the greater the likelihood of Lyme arthritis developing.
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Affiliation(s)
- Agnė Petrulionienė
- Clinic of Rheumatology, Orthopaedics Traumatology and Reconstructive Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania
- Correspondence: ; Tel.: +370-6401-9811
| | - Daiva Radzišauskienė
- Clinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania;
| | | | - Algirdas Venalis
- Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania;
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Casselli T, Divan A, Vomhof-DeKrey EE, Tourand Y, Pecoraro HL, Brissette CA. A murine model of Lyme disease demonstrates that Borrelia burgdorferi colonizes the dura mater and induces inflammation in the central nervous system. PLoS Pathog 2021; 17:e1009256. [PMID: 33524035 PMCID: PMC7877756 DOI: 10.1371/journal.ppat.1009256] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 02/11/2021] [Accepted: 12/22/2020] [Indexed: 02/06/2023] Open
Abstract
Lyme disease, which is caused by infection with Borrelia burgdorferi and related species, can lead to inflammatory pathologies affecting the joints, heart, and nervous systems including the central nervous system (CNS). Inbred laboratory mice have been used to define the kinetics of B. burgdorferi infection and host immune responses in joints and heart, however similar studies are lacking in the CNS of these animals. A tractable animal model for investigating host-Borrelia interactions in the CNS is key to understanding the mechanisms of CNS pathogenesis. Therefore, we characterized the kinetics of B. burgdorferi colonization and associated immune responses in the CNS of mice during early and subacute infection. Using fluorescence-immunohistochemistry, intravital microscopy, bacterial culture, and quantitative PCR, we found B. burgdorferi routinely colonized the dura mater of C3H mice, with peak spirochete burden at day 7 post-infection. Dura mater colonization was observed for several Lyme disease agents including B. burgdorferi, B. garinii, and B. mayonii. RNA-sequencing and quantitative RT-PCR showed that B. burgdorferi infection was associated with increased expression of inflammatory cytokines and a robust interferon (IFN) response in the dura mater. Histopathologic changes including leukocytic infiltrates and vascular changes were also observed in the meninges of infected animals. In contrast to the meninges, we did not detect B. burgdorferi, infiltrating leukocytes, or large-scale changes in cytokine profiles in the cerebral cortex or hippocampus during infection; however, both brain regions demonstrated similar changes in expression of IFN-stimulated genes as observed in peripheral tissues and meninges. Taken together, B. burgdorferi is capable of colonizing the meninges in laboratory mice, and induces localized inflammation similar to peripheral tissues. A sterile IFN response in the absence of B. burgdorferi or inflammatory cytokines is unique to the brain parenchyma, and provides insight into the potential mechanisms of CNS pathology associated with this important pathogen.
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Affiliation(s)
- Timothy Casselli
- Department of Biomedical Sciences, University of North Dakota, School of Medicine and Health Sciences, Grand Forks, North Dakota, United States of America
- * E-mail: (TC); (CAB)
| | - Ali Divan
- Department of Biomedical Sciences, University of North Dakota, School of Medicine and Health Sciences, Grand Forks, North Dakota, United States of America
| | - Emilie E. Vomhof-DeKrey
- Department of Biomedical Sciences, University of North Dakota, School of Medicine and Health Sciences, Grand Forks, North Dakota, United States of America
- Department of Surgery, University of North Dakota, School of Medicine and Health Sciences, Grand Forks, North Dakota, United States of America
| | - Yvonne Tourand
- Department of Biomedical Sciences, University of North Dakota, School of Medicine and Health Sciences, Grand Forks, North Dakota, United States of America
| | - Heidi L. Pecoraro
- Veterinary Diagnostic Laboratory, North Dakota State University, Fargo, North Dakota, United States of America
| | - Catherine A. Brissette
- Department of Biomedical Sciences, University of North Dakota, School of Medicine and Health Sciences, Grand Forks, North Dakota, United States of America
- * E-mail: (TC); (CAB)
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Kanaujia V, Verma S, Yadav R, Patra B. A case of neuroborreliosis: A challenge to physiatrist. JOURNAL OF ORTHOPEDICS, TRAUMATOLOGY AND REHABILITATION 2021. [DOI: 10.4103/jotr.jotr_29_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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17
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Lintner H, Hochgatterer-Rechberger P, Pischinger B, Seier J, Vollmann P, Haushofer A, Rittner H, Sommer C, Topakian R. Sensitivity and specificity of cerebrospinal fluid CXCL13 for diagnosing Lyme neuroborreliosis - a study on 1410 patients and review of the literature. J Neurol Sci 2020; 414:116843. [PMID: 32344220 DOI: 10.1016/j.jns.2020.116843] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 03/23/2020] [Accepted: 04/15/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The B-cell chemoattractant CXCL13 has been suggested as a cerebrospinal fluid (CSF) biomarker for Lyme neuroborreliosis (LNB). Our aim was to substantiate the value of CXCL13 in a large unselected cohort and determine a practical cut-off value to diagnose LNB. METHODS We retrospectively studied clinical and CSF data of consecutive patients who underwent CSF CXCL13 testing over a period of three years (February 2015 to January 2018) at our academic teaching hospital. Patients were classified into 12 groups according to their final diagnosis. To diagnose LNB (definite or probable/possible), definitions of the respective guideline of the German Neurological Society were applied. RESULTS Of 1410 patients, 29 were diagnosed with definite LNB and 9 with probable/possible LNB. Median CXCL13 levels were highly elevated in both LNB groups (554 pg/mL and 649 pg/mL, respectively) and the group with bacterial/fungal CNS infections (410 pg/mL; n = 6), while all other groups had markedly lower median CXCL13 levels (p < .001). For definite LNB, the best CXCL13 test cut-off was 55.5 pg/mL with a sensitivity of 96.6% (95% confidence interval, CI, 80.4%-99.8%) and a specificity of 94.9% (95% CI 93.5%-95.9%). All patients with LNB showed clinical improvement after antibiotic treatment. CONCLUSION In this large monocentric cohort, CSF CXCL13 was found to be a highly sensitive and useful marker for LNB. In conditions with low index of suspicion for LNB, CXCL13 testing may be unwarranted. A review of the literature on the sensitivity and specificity of CSF CXCL13 in the differential of LNB is provided.
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Affiliation(s)
- Hannes Lintner
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
| | | | - Barbara Pischinger
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
| | - Josef Seier
- Central Laboratory, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
| | - Peter Vollmann
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
| | - Alexander Haushofer
- Central Laboratory, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
| | - Heike Rittner
- Department of Anaesthesiology, University Hospital of Würzburg, Würzburg, Germany
| | - Claudia Sommer
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany
| | - Raffi Topakian
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria.
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18
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Bonduelle T, Tang HMA, Marchal C, Thomas B. Severe Lyme neuroborreliosis with bilateral hemorrhagic temporal encephalitis. J Neurol 2020; 267:852-854. [PMID: 31955245 DOI: 10.1007/s00415-020-09706-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 01/08/2020] [Accepted: 01/10/2020] [Indexed: 12/11/2022]
Affiliation(s)
- T Bonduelle
- Department of Neurology, CHU de Bordeaux, University of Bordeaux, Place Amélie Raba Léon, 33000, Bordeaux, France.
| | - Hoang M-A Tang
- Department of Neurology, CHU de Bordeaux, University of Bordeaux, Place Amélie Raba Léon, 33000, Bordeaux, France
| | - C Marchal
- Department of Neurology, CHU de Bordeaux, University of Bordeaux, Place Amélie Raba Léon, 33000, Bordeaux, France
| | - B Thomas
- Department of Neurology, CHU de Bordeaux, University of Bordeaux, Place Amélie Raba Léon, 33000, Bordeaux, France
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19
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Garcia-Monco JC, Benach JL. Lyme Neuroborreliosis: Clinical Outcomes, Controversy, Pathogenesis, and Polymicrobial Infections. Ann Neurol 2019; 85:21-31. [PMID: 30536421 DOI: 10.1002/ana.25389] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/04/2018] [Accepted: 12/05/2018] [Indexed: 12/16/2022]
Abstract
Lyme borreliosis is the object of numerous misconceptions. In this review, we revisit the fundamental manifestations of neuroborreliosis (meningitis, cranial neuritis, and radiculoneuritis), as these have withstood the test of time. We also discuss other manifestations that are less frequent. Stroke, as a manifestation of Lyme neuroborreliosis, is considered in the context of other infections. The summary of the literature regarding clinical outcomes of neuroborreliosis leads to its controversies. We also include new information on pathogenesis and on the polymicrobial nature of tick-borne diseases. In this way, we update the review that we wrote in this journal in 1995. ANN NEUROL 2019;85:21-31.
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Affiliation(s)
- Juan Carlos Garcia-Monco
- Department of Neurology, University Hospital of Basurto, Bilbao, Vizcaya, Spain.,Departments of Molecular Genetics and Microbiology, Stony Brook University School of Medicine, Stony Brook, NY
| | - Jorge L Benach
- Departments of Molecular Genetics and Microbiology, Stony Brook University School of Medicine, Stony Brook, NY.,Pathology, Stony Brook University School of Medicine, Stony Brook, NY
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20
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Ramada MA, Kannangara S, Eskarous H. An Unusual Case of Suspected Lyme Neuroborreliosis in a Patient Presenting with Ear Pain. J Glob Infect Dis 2019; 11:160-162. [PMID: 31849437 PMCID: PMC6906891 DOI: 10.4103/jgid.jgid_75_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 09/11/2019] [Accepted: 10/16/2019] [Indexed: 11/24/2022] Open
Abstract
We report a case of suspected Lyme neuroborreliosis (LNB) where the patient's sole symptom was chronic, intermittent episodes of unilateral ear pain. This case was unusual because this patient did not show any other neurological or extraneurological symptoms of Lyme disease. LNB is a manifestation of infection by Borrelia burgdorferi spirochetes that can manifest in a number of different clinical presentations depending on the nervous system dissemination of the bacteria. Most commonly, these neurological findings present as peripheral nerve radiculopathies, but rarer involvement of the central nervous system (CNS) can occur if a patient goes untreated. Most often, CNS involvement presents as meningitis with increased lymphocytes but can, in rarer cases, involve the spinal cord or brain parenchyma. The diagnosis of LNB was made after the patient was found to have suspicious lesions in the spinal cord and brain parenchyma on magnetic resonance imaging as well as cerebrospinal fluid Borrelia antibody index was consistent with CNS Lyme disease. We discuss this case as a unique clinical presentation of suspected LNB and the diagnostic findings associated with this infection.
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Affiliation(s)
- Michael Anthony Ramada
- Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Saman Kannangara
- Department of Infectious Disease, Easton Hospital, Wilson, Pennsylvania, USA
| | - Hany Eskarous
- Department of Infectious Disease, Easton Hospital, Wilson, Pennsylvania, USA
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21
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Ding Z, Ma M, Tao L, Peng Y, Han Y, Sun L, Dai X, Ji Z, Bai R, Jian M, Chen T, Luo L, Wang F, Bi Y, Liu A, Bao F. Rhesus Brain Transcriptomic Landscape in an ex vivo Model of the Interaction of Live Borrelia Burgdorferi With Frontal Cortex Tissue Explants. Front Neurosci 2019; 13:651. [PMID: 31316336 PMCID: PMC6610209 DOI: 10.3389/fnins.2019.00651] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 06/06/2019] [Indexed: 12/12/2022] Open
Abstract
Lyme neuroborreliosis (LNB) is the most dangerous manifestation of Lyme disease caused by the spirochete Borrelia burgdorferi which can reach the central nervous system most commonly presenting with lymphocytic meningitis; however, the molecular basis for neuroborreliosis is still poorly understood. We incubated explants from the frontal cortex of three rhesus brains with medium alone or medium with added live Borrelia burgdorferi for 6, 12, and 24 h and isolated RNA from each group was used for RNA sequencing with further bioinformatic analysis. Transcriptomic differences between the ex vivo model of live Borrelia burgdorferi with rhesus frontal cortex tissue explants and the controls during the progression of the infection were identified. A total of 2249, 1064, and 420 genes were significantly altered, of which 80.7, 52.9, and 19.8% were upregulated and 19.3, 47.1, 80.2% were downregulated at 6, 12, and 24 h, respectively. Gene ontology and KEGG pathway analyses revealed various pathways related to immune and inflammatory responses during the spirochete infection were enriched which is suggested to have a causal role in the pathogenesis of neurological Lyme disease. Moreover, we propose that the overexpressed FOLR2 which was demonstrated by the real-time PCR and western blotting could play a key role in neuroinflammation of the neuroborreliosis based on PPI analysis for the first time. To our knowledge, this is the first study to provide comprehensive information regarding the transcriptomic signatures that occur in the frontal cortex of the brain upon exposure to Borrelia burgdorferi, and suggest that FOLR2 is a promising target that is associated with neuroinflammation and may represent a new diagnostic or therapeutic marker in LNB.
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Affiliation(s)
- Zhe Ding
- Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities, Kunming Medical University, Kunming, China.,Department of Microbiology and Immunology, Kunming Medical University, Kunming, China
| | - Mingbiao Ma
- Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities, Kunming Medical University, Kunming, China.,Department of Microbiology and Immunology, Kunming Medical University, Kunming, China
| | - Lvyan Tao
- Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities, Kunming Medical University, Kunming, China.,Department of Biochemistry and Molecular Biology, Kunming Medical University, Kunming, China
| | - Yun Peng
- Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities, Kunming Medical University, Kunming, China.,Department of Microbiology and Immunology, Kunming Medical University, Kunming, China
| | - Yuanyuan Han
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Luyun Sun
- Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities, Kunming Medical University, Kunming, China
| | - Xiting Dai
- Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities, Kunming Medical University, Kunming, China.,Department of Microbiology and Immunology, Kunming Medical University, Kunming, China
| | - Zhenhua Ji
- Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities, Kunming Medical University, Kunming, China.,Department of Microbiology and Immunology, Kunming Medical University, Kunming, China
| | - Ruolan Bai
- Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities, Kunming Medical University, Kunming, China.,Department of Biochemistry and Molecular Biology, Kunming Medical University, Kunming, China
| | - Miaomiao Jian
- Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities, Kunming Medical University, Kunming, China.,Department of Biochemistry and Molecular Biology, Kunming Medical University, Kunming, China
| | - Taigui Chen
- Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities, Kunming Medical University, Kunming, China.,Department of Microbiology and Immunology, Kunming Medical University, Kunming, China
| | - Lisha Luo
- Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities, Kunming Medical University, Kunming, China.,Department of Biochemistry and Molecular Biology, Kunming Medical University, Kunming, China
| | - Feng Wang
- Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities, Kunming Medical University, Kunming, China
| | - Yunfeng Bi
- Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities, Kunming Medical University, Kunming, China
| | - Aihua Liu
- Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities, Kunming Medical University, Kunming, China.,Department of Biochemistry and Molecular Biology, Kunming Medical University, Kunming, China.,Yunnan Province Integrative Innovation Center for Public Health, Diseases Prevention and Control, Kunming Medical University, Kunming, China.,Yunnan Demonstration Base of International Science and Technology Cooperation for Tropical Diseases, Kunming, China
| | - Fukai Bao
- Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities, Kunming Medical University, Kunming, China.,Department of Microbiology and Immunology, Kunming Medical University, Kunming, China.,Yunnan Province Integrative Innovation Center for Public Health, Diseases Prevention and Control, Kunming Medical University, Kunming, China.,Yunnan Demonstration Base of International Science and Technology Cooperation for Tropical Diseases, Kunming, China
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Colonization and pathology of Borrelia afzelii in its natural hosts. Ticks Tick Borne Dis 2019; 10:822-827. [PMID: 31005618 DOI: 10.1016/j.ttbdis.2019.03.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 03/12/2019] [Accepted: 03/24/2019] [Indexed: 01/01/2023]
Abstract
Studies of Borrelia burgdorferi sensu lato in laboratory mice and humans have shown that spirochaetes disseminate from the site of infection (skin) to internal tissues, and cause various pathological effects. However, less is known about colonization and pathology of Lyme borreliosis spirochaetes in their natural hosts. In the present study, we assessed the colonization and manifestations during B. afzelii infection in reservoir hosts (yellow-necked mouse, Apodemus flavicollis; bank vole, Myodes glareolus; common shrew, Sorex araneus) infected in the wild. The infection prevalence and bacterial load was measured in skin (ear), joints and heart by quantitative PCR, and pathology in infected joints was evaluated by histology. The prevalence of B. afzelii was higher in skin than in joints and heart, but most animals that were positive in skin were also positive in internal tissues, and there was no difference between species in tissue-specific prevalence. Thus, spirochaetes disseminated from skin to other tissues in a similar way in all species. The bacterial load varied among host species and among different tissues within the same host species. In the case of skin and joints, bank voles and common shrews had higher bacterial loads than yellow-necked mice. In hearts, voles had higher bacterial loads than shrews and mice. Histological analyses showed no inflammation in joints of infected animals when compared to controls. We conclude that B. afzelii disseminates to internal tissues in natural hosts, but that levels of colonization vary between both species and tissues. There is as yet little evidence for pathological effects in natural hosts.
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Kaiser EA, George DK, Rubenstein MN, Berger JR. Lyme myelopathy: Case report and literature review of a rare but treatable disorder. Mult Scler Relat Disord 2019; 29:1-6. [DOI: 10.1016/j.msard.2018.12.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/23/2018] [Accepted: 12/27/2018] [Indexed: 12/26/2022]
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Affiliation(s)
- Christine S. Kim
- Division of Otolaryngology, Albany Medical Center, Albany, New York
| | - Alexander G. Bien
- Division of Otolaryngology, Albany Medical Center, Albany, New York
- Albany ENT & Allergy Services, PC, Albany, New York
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25
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Novak P, Felsenstein D, Mao C, Octavien NR, Zubcevik N. Association of small fiber neuropathy and post treatment Lyme disease syndrome. PLoS One 2019; 14:e0212222. [PMID: 30753241 PMCID: PMC6372188 DOI: 10.1371/journal.pone.0212222] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 01/29/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES To examine whether post-treatment Lyme disease syndrome (PTLDS) defined by fatigue, cognitive complaints and widespread pain following the treatment of Lyme disease is associated with small fiber neuropathy (SFN) manifesting as autonomic and sensory dysfunction. METHODS This single center, retrospective study evaluated subjects with PTLDS. Skin biopsies for assessment of epidermal nerve fiber density (ENFD), sweat gland nerve fiber density (SGNFD) and functional autonomic testing (deep breathing, Valsalva maneuver and tilt test) were performed to assess SFN, severity of dysautonomia and cerebral blood flow abnormalities. Heart rate, end tidal CO2, blood pressure, and cerebral blood flow velocity (CBFv) from middle cerebral artery using transcranial Doppler were monitored. RESULTS 10 participants, 5/5 women/men, age 51.3 ± 14.7 years, BMI 27.6 ± 7.3 were analyzed. All participants were positive for Lyme infection by CDC criteria. At least one skin biopsy was abnormal in all ten participants. Abnormal ENFD was found in 9 participants, abnormal SGNFD in 5 participants, and both abnormal ENFD and SGNFD were detected in 4 participants. Parasympathetic failure was found in 7 participants and mild or moderate sympathetic adrenergic failure in all participants. Abnormal total CBFv score was found in all ten participants. Low orthostatic CBFv was found in 7 participants, three additional participants had abnormally reduced supine CBFv. CONCLUSIONS SFN appears to be associated with PTLDS and may be responsible for certain sensory symptoms. In addition, dysautonomia related to SFN and abnormal CBFv also seem to be linked to PTLDS. Reduced orthostatic CBFv can be associated with cerebral hypoperfusion and may lead to cognitive dysfunction. Autonomic failure detected in PTLDS is mild to moderate. SFN evaluation may be useful in PTLDS.
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Affiliation(s)
- Peter Novak
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Donna Felsenstein
- Department of Infectious Disease, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Charlotte Mao
- Dean Center for Tick Borne Illness, Spaulding Rehabilitation Hospital, Boston, Massachusetts, United States of America
| | - Nadlyne R. Octavien
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts, United States of America
| | - Nevena Zubcevik
- Dean Center for Tick Borne Illness, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
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Precision Medicine: The Role of the MSIDS Model in Defining, Diagnosing, and Treating Chronic Lyme Disease/Post Treatment Lyme Disease Syndrome and Other Chronic Illness: Part 2. Healthcare (Basel) 2018; 6:healthcare6040129. [PMID: 30400667 PMCID: PMC6316761 DOI: 10.3390/healthcare6040129] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/31/2018] [Accepted: 10/31/2018] [Indexed: 12/12/2022] Open
Abstract
We present a precision medical perspective to assist in the definition, diagnosis, and management of Post Treatment Lyme Disease Syndrome (PTLDS)/chronic Lyme disease. PTLDS represents a small subset of patients treated for an erythema migrans (EM) rash with persistent or recurrent symptoms and functional decline. The larger population with chronic Lyme disease is less understood and well defined. Multiple Systemic Infectious Disease Syndrome (MSIDS) is a multifactorial model for treating chronic disease(s), which identifies up to 16 overlapping sources of inflammation and their downstream effects. A patient symptom survey and a retrospective chart review of 200 patients was therefore performed on those patients with chronic Lyme disease/PTLDS to identify those variables on the MSIDS model with the greatest potential effect on regaining health. Results indicate that dapsone combination therapy decreased the severity of eight major Lyme symptoms, and multiple sources of inflammation (other infections, immune dysfunction, autoimmunity, food allergies/sensitivities, leaky gut, mineral deficiencies, environmental toxins with detoxification problems, and sleep disorders) along with downstream effects of inflammation may all affect chronic symptomatology. In part two of our observational study and review paper, we postulate that the use of this model can represent an important and needed paradigm shift in the diagnosis and treatment of chronic disease.
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27
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Imaging in Lyme neuroborreliosis. Insights Imaging 2018; 9:833-844. [PMID: 30187265 PMCID: PMC6206375 DOI: 10.1007/s13244-018-0646-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/25/2018] [Accepted: 07/04/2018] [Indexed: 12/13/2022] Open
Abstract
Abstract Lyme neuroborreliosis (LNB) is a tick-borne spirochetal infection with a broad spectrum of imaging pathology. For individuals who live in or have travelled to areas where ticks reside, LNB should be considered among differential diagnoses when clinical manifestations from the nervous system occur. Radiculitis, meningitis and facial palsy are commonly encountered, while peripheral neuropathy, myelitis, meningoencephalitis and cerebral vasculitis are rarer manifestations of LNB. Cerebrospinal fluid (CSF) analysis and serology are key investigations in patient workup. The primary role of imaging is to rule out other reasons for the neurological symptoms. It is therefore important to know the diversity of possible imaging findings from the infection itself. There may be no imaging abnormality, or findings suggestive of neuritis, meningitis, myelitis, encephalitis or vasculitis. White matter lesions are not a prominent feature of LNB. Insight into LNB clinical presentation, laboratory test methods and spectrum of imaging pathology will aid in the multidisciplinary interaction that often is imperative to achieve an efficient patient workup and arrive at a correct diagnosis. This article can educate those engaged in imaging of the nervous system and serve as a comprehensive tool in clinical cases. Key Points • Diagnostic criteria for LNB emphasise exclusion of an alternative cause to the clinical symptoms. • MRI makes a crucial contribution in the diagnosis and follow-up of LNB. • MRI may have normal findings, or show neuritis, meningitis, myelitis, encephalitis or vasculitis. • White matter lesions are not a prominent feature of LNB.
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Ezequiel M, Teixeira AT, Brito MJ, Luís C. Pseudotumor cerebri as the presentation of Lyme disease in a non-endemic area. BMJ Case Rep 2018; 2018:bcr-2017-222976. [PMID: 29602888 DOI: 10.1136/bcr-2017-222976] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Intracranial hypertension is a rare entity in prepubertal children, and its differential diagnosis includes a number of systemic diseases, drugs, vitamin deficiencies and excesses, and hereditary conditions. Infectious aetiology is rare. The case of a 9-year-old boy with intracranial hypertension secondary to acute neuroborreliosis is described. He presented with daily pulsatile frontotemporal headache, pallor, photophobia and phonophobia. His neurological examination revealed papilledema with no nuchal rigidity. The lumbar puncture showed increased pressure (50 cm H2O) and lymphocytic pleocytosis. Serum and cerebrospinal fluid (CSF) Borrelia burgdorferi antibodies were positive. This kind of infection is rare in Portugal but a trip to an endemic area was identified. A careful history, considering the exposure to rural areas together with the intracranial hypertension and inflammatory CSF, are important clues to the diagnosis, allowing the institution to select appropriate treatment.
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Affiliation(s)
- Marta Ezequiel
- Department of Pediatria, Hospital Professor Doutor Fernando Fonseca, EPE, Amadora, Portugal
| | - Ana Teresa Teixeira
- Department of Pediatria, Hospital Professor Doutor Fernando Fonseca, EPE, Amadora, Portugal
| | - Maria João Brito
- Department of Pediatria, Hospital Professor Doutor Fernando Fonseca, EPE, Amadora, Portugal
| | - Catarina Luís
- Department of Pediatria, Hospital Professor Doutor Fernando Fonseca, EPE, Amadora, Portugal
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Siller S, Kasem R, Witt TN, Tonn JC, Zausinger S. Painless motor radiculopathy of the cervical spine: clinical and radiological characteristics and long-term outcomes after operative decompression. J Neurosurg Spine 2018; 28:621-629. [PMID: 29570047 DOI: 10.3171/2017.10.spine17821] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Various neurological diseases are known to cause progressive painless paresis of the upper limbs. In this study the authors describe the previously unspecified syndrome of compression-induced painless cervical radiculopathy with predominant motor deficit and muscular atrophy, and highlight the clinical and radiological characteristics and outcomes after surgery for this rare syndrome, along with its neurological differential diagnoses. METHODS Medical records of 788 patients undergoing surgical decompression due to degenerative cervical spine diseases between 2005 and 2014 were assessed. Among those patients, 31 (3.9%, male to female ratio 4.8 to 1, mean age 60 years) presented with painless compressive cervical motor radiculopathy due to neuroforaminal stenosis without signs of myelopathy; long-term evaluation was available in 23 patients with 49 symptomatic foraminal stenoses. Clinical, imaging, and operative findings as well as the long-term course of paresis and quality of life were analyzed. RESULTS Presenting symptoms (mean duration 13.3 months) included a defining progressive flaccid radicular paresis (median grade 3/5) without any history of radiating pain (100%) and a concomitant muscular atrophy (78%); 83% of the patients were smokers and 17% patients had diabetes. Imaging revealed a predominantly anterior nerve root compression at the neuroforaminal entrance in 98% of stenoses. Thirty stenoses (11 patients) were initially decompressed via an anterior surgical approach and 19 stenoses (12 patients) via a posterior surgical approach. Overall reoperation rate due to new or recurrent stenoses was 22%, with time to reoperation shorter in smokers (p = 0.033). Independently of the surgical procedure chosen, long-term follow-up (mean 3.9 years) revealed a stable or improved paresis in 87% of the patients (median grade 4/5) and an excellent general performance and quality of life. CONCLUSIONS Painless cervical motor radiculopathy predominantly occurs due to focal compression of the anterior nerve root at the neuroforaminal entrance. Surgical decompression is effective in stabilizing or improving motor function with a resulting favorable long-term outcome.
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Role of glutathione metabolism in host defense against Borrelia burgdorferi infection. Proc Natl Acad Sci U S A 2018; 115:E2320-E2328. [PMID: 29444855 DOI: 10.1073/pnas.1720833115] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Pathogen-induced changes in host cell metabolism are known to be important for the immune response. In this study, we investigated how infection with the Lyme disease-causing bacterium Borrelia burgdorferi (Bb) affects host metabolic pathways and how these metabolic pathways may impact host defense. First, metabolome analysis was performed on human primary monocytes from healthy volunteers, stimulated for 24 h with Bb at low multiplicity of infection (MOI). Pathway analysis indicated that glutathione (GSH) metabolism was the pathway most significantly affected by Bb Specifically, intracellular levels of GSH increased on average 10-fold in response to Bb exposure. Furthermore, these changes were found to be specific, as they were not seen during stimulation with other pathogens. Next, metabolome analysis was performed on serum samples from patients with early-onset Lyme disease in comparison with patients with other infections. Supporting the in vitro analysis, we identified a cluster of GSH-related metabolites, the γ-glutamyl amino acids, specifically altered in patients with Lyme disease, and not in other infections. Lastly, we performed in vitro experiments to validate the role for GSH metabolism in host response against Bb. We found that the GSH pathway is essential for Bb-induced cytokine production and identified glutathionylation as a potential mediating mechanism. Taken together, these data indicate a central role for the GSH pathway in the host response to Bb GSH metabolism and glutathionylation may therefore be important factors in the pathogenesis of Lyme disease and potentially other inflammatory diseases as well.
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Monteventi O, Steinlin M, Regényi M, Roulet-Perez E, Weber P, Fluss J. Pediatric stroke related to Lyme neuroborreliosis: Data from the Swiss NeuroPaediatric Stroke Registry and literature review. Eur J Paediatr Neurol 2018; 22:113-121. [PMID: 29208342 DOI: 10.1016/j.ejpn.2017.10.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 10/09/2017] [Accepted: 10/24/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Cerebrovascular complications of Lyme neuroborreliosis (LNB) are poorly documented in the paediatric population. METHODS We performed a retrospective analysis from prospectively registered cases of acute ischemic stroke (AIS) from the Swiss NeuroPaediatric Stroke Registry (SNPSR) from 2000 to 2015. Only cases with serologically confirmed LNB were included. In addition, a literature review on paediatric stroke cases secondary to Lyme neuroborreliosis in the same time frame was performed. RESULTS 4 children out of 229 children with arterial ischemic childhood stroke and serologically confirmed LNB were identified in the SNPSR giving a global incidence of 1.7%. Median age was 9.9 years. A prior history of tick bites or erythema migrans (EM) was reported in two cases. Clinical presenting signs were suggestive of acute cerebellar/brainstem dysfunction. On imaging, three children demonstrated a stroke in the distribution of the posterior inferior cerebellar artery. The remaining fourth child had a "stroke-like" picture with scattered white matter lesions and a multifocal vasculitis with prominent basilar artery involvement. Lymphocytic pleocytosis as well as intrathecal synthesis of Borrelia burgdorferi antibodies were typical biological features. Acute intravenous third generation cephalosporins proved to be effective with rapid improvement in all patients. No child had recurrent stroke. Data from the literature concerning eight patients gave similar results, with prominent posterior circulation stroke, multifocal vasculitis and abnormal CSF as distinctive features. CONCLUSIONS Lyme Neuroborreliosis accounts for a small proportion of paediatric stroke even in an endemic country. The strong predilection towards posterior cerebral circulation with clinical occurrence of brainstem signs associated with meningeal symptoms and CSF lymphocytosis are suggestive features that should rapidly point to the diagnosis. This can be confirmed by appropriate serological testing in the serum and CSF. Clinicians must be aware of this rare neurological complication of Lyme disease that demands specific antibiotic treatment.
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Affiliation(s)
- O Monteventi
- Pediatric Neurology Unit, Pediatrics Subspecialities Service, Geneva Children's Hospital, Switzerland
| | - M Steinlin
- Department of Neuropediatrics, Development and Rehabilitation, University Children's Hospital, Inselspital Bern, Switzerland
| | - M Regényi
- Department of Neuropediatrics, Development and Rehabilitation, University Children's Hospital, Inselspital Bern, Switzerland
| | - E Roulet-Perez
- Pediatric Neurology and Neurorehabilitation Unit, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - P Weber
- University Children's Hospital Basel, Division of Neuropediatrics and Developmental Medicine, Basel, Switzerland
| | - J Fluss
- Pediatric Neurology Unit, Pediatrics Subspecialities Service, Geneva Children's Hospital, Switzerland.
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Borrelia burgdorferi basic membrane protein A could induce chemokine production in murine microglia cell line BV2. Microb Pathog 2017; 111:174-181. [PMID: 28867633 DOI: 10.1016/j.micpath.2017.08.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 08/27/2017] [Accepted: 08/30/2017] [Indexed: 02/07/2023]
Abstract
Lyme neuroborreliosis is a nervous system infectious disease caused by Borrelia burgdorferi (B. burgdorferi). It has been demonstrated that cytokines induced by B. burgdorferi are related to Lyme neuroborreliosis. Microglia is known as a key player in the immune responses that occur within the central nervous system. In response to inflammation, it will be activated and generate cytokines and chemokines. Experiments in vitro cells have showed that B. Burgdorferi membrane protein A (BmpA), a major immunogen of B. Burgdorferi, could induce Lyme arthritis and stimulate human and murine lymphocytes to produce inflammatory cytokines. In our study, the murine microglia BV2 cell line was used as a cell model to explore the stimulating effects of recombinant BmpA (rBmpA); Chemokine chip, ELISA and QPCR technology were used to measure the production of chemokines from microglial cells stimulated by rBmpA. Compared with the negative control group, CXCL2, CCL22, and CCL5 concentrations in the cell supernatant increased significantly after the rBmpA stimulation; the concentration of these chemokines increased with rBmpA concentration increasing; the mRNA expression levels of chemokines (CXCL2, CCL22, and CCL5) in murine BV2 cells increased significantly with 10 μg/mL and 20 μg/mL rBmpA stimulation; CXCL13 was not change after the rBmpA stimulation. Our study shows that chemokines, such as CXCL2, CCL22, and CCL5 were up-regulated by the rBmpA in the BV2 cells. The production of chemokines in Lyme neuroborreliosis may be mainly from microglia cells and the rBmpA may be closely related with the development of Lyme neuroborreliosis.
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Fillatre P, Crabol Y, Morand P, Piroth L, Honnorat J, Stahl JP, Lecuit M. Infectious encephalitis: Management without etiological diagnosis 48hours after onset. Med Mal Infect 2017; 47:236-251. [PMID: 28314470 PMCID: PMC7131623 DOI: 10.1016/j.medmal.2017.02.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 02/22/2017] [Indexed: 12/18/2022]
Abstract
Introduction The etiological diagnosis of infectious encephalitis is often not established 48 hours after onset. We aimed to review existing literature data before providing management guidelines. Method We performed a literature search on PubMed using filters such as “since 01/01/2000”, “human”, “adults”, “English or French”, and “clinical trial/review/guidelines”. We also used the Mesh search terms “encephalitis/therapy” and “encephalitis/diagnosis”. Results With Mesh search terms “encephalitis/therapy” and “encephalitis/diagnosis”, we retrieved 223 and 258 articles, respectively. With search terms “encephalitis and corticosteroid”, we identified 38 articles, and with “encephalitis and doxycycline” without the above-mentioned filters we identified 85 articles. A total of 210 articles were included in the analysis. Discussion Etiological investigations must focus on recent travels, animal exposures, age, immunodeficiency, neurological damage characteristics, and potential extra-neurological signs. The interest of a diagnosis of encephalitis for which there is no specific treatment is also to discontinue any empirical treatments initially prescribed. Physicians must consider and search for autoimmune encephalitis.
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Affiliation(s)
- P Fillatre
- Service de maladies infectieuses et réanimation médicale, CHU Pontchaillou, 35000 Rennes, France
| | - Y Crabol
- Médecine interne, CHBUA site de Vannes, 56017 Vannes, France
| | - P Morand
- Virologie, CHU Grenoble Alpes, 38043 Grenoble cedex 9, France
| | - L Piroth
- Infectiologie, CHU de Dijon, 21000 Dijon, France
| | - J Honnorat
- Inserm U1028, CNRS UMR5292, équipe neuro-oncologie et neuro-inflammation (Oncoflam), centre de recherche en neurosciences (CRNL), université Lyon 1, 69500 Bron, France
| | - J P Stahl
- Service d'infectiologie, CHU de Grenoble, 38043 Grenoble cedex 9, France.
| | - M Lecuit
- Institut Pasteur, Biology of Infection Unit, CNR CCOMS Listeria, Inserm U1117, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Department of Infectious Diseases and Tropical Medicine, Necker-Enfants-Malades University Hospital, Institut Imagine, Assistance Publique-Hôpitaux de Paris, Paris, France
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Maes L, Carolus T, De Preter V, Ignoul S, Cartuyvels R, Braeken L, D'Huys PJ, Saegeman V, Kabamba B, Raymaekers M. Technical and clinical validation of three commercial real-time PCR kits for the diagnosis of neuroborreliosis in cerebrospinal fluid on three different real-time PCR platforms. Eur J Clin Microbiol Infect Dis 2016; 36:273-279. [PMID: 27714590 DOI: 10.1007/s10096-016-2797-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 09/16/2016] [Indexed: 10/20/2022]
Abstract
This study reports the evaluation of the technical and clinical validation of the O-DiaBorburg kit (DIA), Borrelia burgdorferi PCR kit, ISEX (GENE), and Borrelia burgdorferi sensu lato Real-TM (SAC) for the diagnosis of neuroborreliosis in cerebrospinal fluid based on both Borrelia DNA and CSF samples from patients with clinical suspicion of neuroborreliosis. This validation study was done by analysing the kits on the Rotorgene Q (RGQ), CFX96, and LightCycler480 (LC480). For all kits, the linear range was larger on RGQ than on CFX96 and LC480. A good reproducibility was obtained for all assays on all instruments. Storage at -20 °C resulted in a decreased reproducibility for SAC. Results of the limit of detection (LOD95) experiments indicated a better sensitivity than described in the kit insert for all kits on all PCR platforms. No cross-reactivity was found for genetically related organisms nor for other pathogens which may be present in CSF. All species of the Borrelia burgdorferi sensu lato complex were detected with the GENE and SAC kits. The DIA kit failed to detect B. lusitaniae. The results seemed to indicate a better overall performance for the GENE kit on RGQ. However, its diagnostic value could not be confirmed in the clinical validation study, wherein none of the 103 CSF samples from clinical neuroborreliosis cases showed a positive real-time PCR result with the GENE kit analysed on RGQ.
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Affiliation(s)
- L Maes
- Research group Lab4U, Group of Management and Technology, UC Leuven-Limburg, Agoralaan gebouw B bus 3, 3590, Diepenbeek, Belgium.
| | - T Carolus
- Research group Lab4U, Group of Management and Technology, UC Leuven-Limburg, Agoralaan gebouw B bus 3, 3590, Diepenbeek, Belgium
| | - V De Preter
- Research group Lab4U, Group of Management and Technology, UC Leuven-Limburg, Agoralaan gebouw B bus 3, 3590, Diepenbeek, Belgium.,Translational Research Center for Gastrointestinal Disorders (TARGID), University Hospital Gasthuisberg, KULeuven, Leuven, Belgium
| | - S Ignoul
- Research group Lab4U, Group of Management and Technology, UC Leuven-Limburg, Agoralaan gebouw B bus 3, 3590, Diepenbeek, Belgium
| | - R Cartuyvels
- Clinical Biology, Laboratory for Molecular Diagnostics, Campus Salvator, Jessa Hospital, Salvatorstraat 20, 3500, Hasselt, Belgium
| | - L Braeken
- Research group Lab4U, Faculty of Industrial Engineering, KU Leuven - Campus Diepenbeek, Agoralaan gebouw B, 3590, Diepenbeek, Belgium
| | - P-J D'Huys
- Research group Lab4U, Group of Management and Technology, UC Leuven-Limburg, Agoralaan gebouw B bus 3, 3590, Diepenbeek, Belgium
| | - V Saegeman
- Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - B Kabamba
- Clinical Microbiology, Laboratory of Microbiology, University Clinic St-Luc UCL, Avenue Mounier 10 F, 1200, Brussels, Belgium
| | - M Raymaekers
- Clinical Biology, Laboratory for Molecular Diagnostics, Campus Salvator, Jessa Hospital, Salvatorstraat 20, 3500, Hasselt, Belgium
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Lyme Disease Presenting with Multiple Cranial Nerve Deficits: Report of a Case. Case Rep Emerg Med 2016; 2016:7218906. [PMID: 27635267 PMCID: PMC5011200 DOI: 10.1155/2016/7218906] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/30/2016] [Accepted: 08/01/2016] [Indexed: 11/19/2022] Open
Abstract
Lyme disease is a tick-transmitted multisystem inflammatory disease caused by the spirochete Borrelia burgdorferi. With more than 25,000 CDC reported cases annually, it has become the most common vector-borne disease in the United States. We report a case of 38-year-old man with Lyme disease presenting with simultaneous palsy of 3rd, 5th, 7th, 9th, and 10th cranial nerves.
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Moniuszko-Malinowska A, Łuczaj W, Jarocka-Karpowicz I, Pancewicz S, Zajkowska J, Andrisic L, Zarkovic N, Skrzydlewska E. Lipid peroxidation in the pathogenesis of neuroborreliosis. Free Radic Biol Med 2016; 96:255-63. [PMID: 27140232 DOI: 10.1016/j.freeradbiomed.2016.04.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 04/05/2016] [Accepted: 04/26/2016] [Indexed: 12/11/2022]
Abstract
This study analyzed the onset of lipid peroxidation (LPO) in neuroborreliosis and the effects of ceftriaxone therapy on LPO. Twenty-two patients with early neuroborreliosis and 22 healthy subjects were studied. LPO in the cerebrospinal fluid (CSF), as well as the plasma and urine was estimated by the levels of reactive aldehydes: 4-hydroxynonenal (4-HNE), 4-hydroxyhexenal, malondialdehyde, and 4-oxononenal, F2-isoprostanes and A4/J4-neuroprostanes (NPs). The plasma level of 4-HNE-protein adducts arachidonic acid (AA), docosahexaenoic acid (DHA) and vitamin E was determined. Additionally, enzymatic activities of phospholipase A2 (PLA2), platelet-activating factor acetylhydrolase (PAF-AH) and glutathione peroxidase (GSH-Px) were determined. A decrease of AA, DHA levels and GSH-Px activity in plasma was associated with a significant increase of aldehydes in the CSF, plasma and urine. Similarly, the increase of F2-isoprostanes and NPs in the CSF and plasma was associated with the decreased activity of PLA2 and PAF-AH. Ceftriaxone therapy cured patients and reduced the levels of F2-isoprostanes, NPs and reactive aldehydes. However, the activities of PLA2 and PAF-AH increased. Pathophysiological association of neuroborreliosis with systemic LPO was revealed. Effective antibiotic therapy attenuated LPO. Biomarkers of LPO could be useful to monitor the onset of neuroborreliosis and show the effectiveness of pharmacotherapy.
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Affiliation(s)
- Anna Moniuszko-Malinowska
- Department of Infectious Diseases and Neuroinfection, Medical University of Bialystok, Żurawia 14, 15-540 Bialystok, Poland
| | - Wojciech Łuczaj
- Department of Analytical Chemistry, Medical University of Bialystok, Mickiewicza 2d, 15-222 Bialystok, Poland.
| | - Iwona Jarocka-Karpowicz
- Department of Analytical Chemistry, Medical University of Bialystok, Mickiewicza 2d, 15-222 Bialystok, Poland
| | - Sławomir Pancewicz
- Department of Infectious Diseases and Neuroinfection, Medical University of Bialystok, Żurawia 14, 15-540 Bialystok, Poland
| | - Joanna Zajkowska
- Department of Infectious Diseases and Neuroinfection, Medical University of Bialystok, Żurawia 14, 15-540 Bialystok, Poland
| | | | | | - Elżbieta Skrzydlewska
- Department of Analytical Chemistry, Medical University of Bialystok, Mickiewicza 2d, 15-222 Bialystok, Poland
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Boudreault K, Durand ML, Rizzo JF. Investigation-Directed Approach to Inflammatory Optic Neuropathies. Semin Ophthalmol 2016; 31:117-30. [DOI: 10.3109/08820538.2015.1114835] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Tveitnes D, Øymar K. Gender Differences in Childhood Lyme Neuroborreliosis. Behav Neurol 2015; 2015:790762. [PMID: 26576072 PMCID: PMC4630376 DOI: 10.1155/2015/790762] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 10/01/2015] [Accepted: 10/04/2015] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Many neurological diseases show differences between genders. We studied gender differences in childhood Lyme neuroborreliosis (LNB) in an endemic area of Lyme borreliosis in Norway. METHODS In a population based study, all children (<14 years of age) with symptoms suspicious of LNB, including all children with acute facial nerve palsy, were evaluated for LNB by medical history, clinical examination, blood tests, and lumbar puncture. LNB was diagnosed according to international criteria. RESULTS 142 children were diagnosed with LNB during 2001-2009. Facial nerve palsy was more common in girls (86%) than in boys (62%) (p < 0.001), but headache and/or neck stiffness as the only symptom was more common in boys (30%) than in girls (10%) (p = 0.003). The girls were younger than boys and had a shorter duration of symptoms, but boys had a higher level of pleocytosis than girls. In a multivariate analysis, both gender and having headache and neck stiffness were associated with a higher level of pleocytosis. CONCLUSION Girls and boys have different clinical presentations of LNB, and boys have a higher level of inflammation than girls independent of the clinical presentation.
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Affiliation(s)
- Dag Tveitnes
- Department of Pediatrics, Stavanger University Hospital, Gerd Ragna Bloch Thorsens Gate 8, 4011 Stavanger, Norway
| | - Knut Øymar
- Department of Pediatrics, Stavanger University Hospital, Gerd Ragna Bloch Thorsens Gate 8, 4011 Stavanger, Norway
- Department of Clinical Science, University of Bergen, 5020 Bergen, Norway
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Kontzialis M, Poretti A, Michell H, Bosemani T, Tekes A, Huisman TAGM. Spinal Nerve Root Enhancement on MRI Scans in Children: A Review. J Neuroimaging 2015; 26:169-79. [PMID: 26365273 DOI: 10.1111/jon.12294] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 08/04/2015] [Indexed: 12/17/2022] Open
Abstract
Spinal nerve root enhancement in pediatric patients is generally nonspecific, and clinical and laboratory correlation is essential. Nerve root enhancement indicates lack of integrity of the blood-nerve barrier. In this review, we will present a range of pediatric conditions that can present with spinal nerve root enhancement including inflammatory, infectious, hereditary, and neoplastic causes. Familiarity with the various pathologic entities associated with spinal nerve root enhancement is important for a concise differential diagnosis in the appropriate clinical setting. This will avoid unnecessary additional investigations.
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Affiliation(s)
- Marinos Kontzialis
- Division of Neuroradiology, Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Andrea Poretti
- Pediatric Radiology, Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Hans Michell
- Pediatric Radiology, Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Thangamadhan Bosemani
- Pediatric Radiology, Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Aylin Tekes
- Pediatric Radiology, Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Thierry A G M Huisman
- Pediatric Radiology, Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD
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Sokolov AA, Lienhard R, Du Pasquier R, Erard V. Acute Lyme Neuroborreliosis With Transient Hemiparesis and Aphasia. Ann Emerg Med 2015; 66:60-4. [DOI: 10.1016/j.annemergmed.2015.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 01/08/2015] [Accepted: 01/12/2015] [Indexed: 10/23/2022]
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Abstract
PURPOSE OF REVIEW Infections are important, potentially treatable causes of peripheral nervous system disease. This article reviews the clinical presentation and management of several common peripheral nervous system diseases due to viral, bacterial, spirochetal, and parasitic infections. RECENT FINDINGS The clinical presentation and evaluation of infectious peripheral nervous system diseases are well established. Advances in the treatment and, in some cases, the prevention of these diseases are still evolving. SUMMARY A diverse range of peripheral nervous system diseases, including peripheral neuropathy, radiculopathy, radiculomyelopathy, cranial neuropathy, and motor neuropathy, are caused by numerous infectious agents. In some patients, peripheral neuropathy may be a side effect of anti-infectious drugs. Infectious neuropathies are important to recognize as they are potentially treatable. This article discusses the clinical presentation, evaluation, and treatment of several common peripheral nervous system diseases caused by viral, bacterial, spirochetal, and parasitic infections, as well as some peripheral nerve disorders caused by adverse effects of the treatments of these infectious diseases.
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Mycobacterium tuberculosis
infection of the ‘non‐classical immune cell’. Immunol Cell Biol 2015; 93:789-95. [DOI: 10.1038/icb.2015.43] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 03/02/2015] [Accepted: 03/18/2015] [Indexed: 01/29/2023]
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Li S, Vytopil M, Hreib K, Craven DE. Lyme disease presenting as multiple ischaemic strokes. Pract Neurol 2015; 15:284-8. [DOI: 10.1136/practneurol-2014-001072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2015] [Indexed: 12/18/2022]
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Diaphragm Paralysis in Lyme Disease: Late Occurrence in the Course of Treatment and Long-Term Recovery. Ann Am Thorac Soc 2015; 12:618-20. [DOI: 10.1513/annalsats.201501-070le] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ewers EC, Dennison DH, Stagliano DR. A unique case of adolescent neuroborreliosis presenting with multiple cranial neuritis and cochlear inflammation on magnetic resonance imaging. Pediatr Neurol 2015; 52:107-9. [PMID: 25459362 DOI: 10.1016/j.pediatrneurol.2014.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 10/08/2014] [Accepted: 10/09/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND Lyme disease is the most common vector-borne disease in the United States and is caused by infection with the spirochete Borrelia burgdorferi. In children, neuroborreliosis usually presents as peripheral facial nerve palsy and lymphocytic meningitis and only rarely is associated with cranial polyneuritis. PATIENT DESCRIPTION We present a 15-year-old with tinnitus, hearing loss, and facial nerve palsy in the setting of acute, severe right arm pain and a several week history of malaise and headache. Lumbar puncture was notable for lymphocytic pleocytosis. Serologic testing demonstrated positive Lyme antibody and a positive immunoglobulin M Western blot. Immunofluorescent assay of cerebrospinal fluid was also positive for anti-Lyme immunoglobulin M. Audiologic testing revealed mixed, right-sided hearing loss. Neuroimaging demonstrated cranial polyneuritis and right-sided cochlear inflammation. The patient was treated with parenteral ceftriaxone with resolution of his symptoms at close follow-up. DISCUSSION Neuroborreliosis with radiculopathy, lymphocytic meningitis, and cranial polyneuritis is a rare presentation of pediatric Lyme disease. Additionally, cochlear inflammation along with cranial nerve VIII inflammation may contribute to hearing loss in patients with neuroborreliosis.
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Affiliation(s)
- Evan C Ewers
- Department of Medicine, Tripler Army Medical Center, Honolulu, Hawaii.
| | - David H Dennison
- Department of Neurology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - David R Stagliano
- Pediatric Infectious Diseases, Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, Maryland
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Kouge J, Hayashida S, Imaki H, Mitsuo K. [A Japanese case of neuroborreliosis with papillitis]. Rinsho Shinkeigaku 2015; 55:248-253. [PMID: 25904254 DOI: 10.5692/clinicalneurol.55.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A 53-year-old Japanese female developed a fever about two months after a tick bite. She also exhibited blurred vision, central scotoma in the left eye, left facial paresis and mild ataxia. A fundus examination revealed left disc swelling in the left eye. An ophthalmological examination showed decreased visual acuity with central scotoma in the left eye. We suspected neuroborreliosis because of the presence of pleocytosis and an elevated level of IL-6 in the cerebrospinal fluid (CSF), in addition to the characteristic neurological findings. She was positive for serum IgG antibodies against Borrelia by a Western blot of her serum. Therefore, we diagnosed her to have neuroborreliosis with papillitis. After the combined administration of antibiotics and steroids, her symptoms gradually improved, but not all of her eye manifestations resolved. Although ocular involvement is rare in neuroborreliosis, this case highlights the fact that neuroborreliosis shoud be considered as a differential diagnosis for patients presenting with papillitis. The diagnosis of neuroborreliosis is important since improvement of the visual acuity is possible with specific antibiotheraphy. In cases with papillitis of unknown etiology, it might be better to consider the possibility of neuroborreliosis should be considered when there are signs of Lyme borreliosis, such as facial nerve palsy, arthritis or radiculoneuritis.
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Affiliation(s)
- Junpei Kouge
- Department of Neurology, National Hospital Organization Beppu Medical Center
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Blanc F, Jaulhac B, Hansmann Y, Dietemann JL, Tranchant C. Borreliosi di Lyme e neuroborreliosi. Neurologia 2014. [DOI: 10.1016/s1634-7072(14)68869-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Sinha A, Dietzman T, Ross D, Sulieman S, Fieldston E. Lyme neuroborreliosis: a diagnostic headache. Hosp Pediatr 2014; 4:400-4. [PMID: 25362084 DOI: 10.1542/hpeds.2014-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | | | - David Ross
- Department of Family Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Salwa Sulieman
- Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
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Abstract
Background Lyme disease is an emerging zoonotic infection in Canada. As the Ixodes tick expands its range, more Canadians will be exposed to Borrelia burgdorferi, the bacterium that causes Lyme disease. Objective To review the clinical diagnosis and treatment of Lyme disease for front-line clinicians. Methods A literature search using PubMed and restricted to articles published in English between 1977 and 2014. Results Individuals in Lyme-endemic areas are at greatest risk, but not all tick bites transmit Lyme disease. The diagnosis is predominantly clinical. Patients with Lyme disease may present with early disease that is characterized by a "bull's eye rash", fever and myalgias or with early disseminated disease that can manifest with arthralgias, cardiac conduction abnormalities or neurologic symptoms. Late Lyme disease in North America typically manifests with oligoarticular arthritis but can present with a subacute encephalopathy. Antibiotic treatment is effective against Lyme disease and works best when given early in the infection. Prophylaxis with doxycyline may be indicated in certain circumstances. While a minority of patients may have persistent symptoms, evidence does not demonstrate that prolonged courses of antibiotics improve outcome. Conclusion Clinicians need to be aware of the signs and symptoms of Lyme disease. Knowing the regions where Borrelia infection is endemic in North America is important for recognizing patients at risk and informing the need for treatment.
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Nagata R, Inamori Y, Takata Y, Ikeda K, Watanabe O, Takashima H. [A case of Lyme neuroborreliosis coexistent with T-cell lymphoma]. Rinsho Shinkeigaku 2014; 54:146-50. [PMID: 24583590 DOI: 10.5692/clinicalneurol.54.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
An 80-year-old Japanese man developed sensory disturbance of his extremities. One week after the onset of sensory disturbance, he also developed bilateral facial nerve palsy, weakness of the extremities, vesicorectal disturbance, general fatigue, and syndrome of inappropriate antidiuretic hormone secretion (SIADH). His symptoms worsened gradually. Despite the absence of apparent tick bite and characteristic skin lesions, we suspected Lyme neuroborreliosis (LNB) because of pleocytosis and elevated protein levels in the cerebrospinal fluid (CSF), in addition to the aforementioned symptoms. After combined administration of antibiotics and steroids, his symptoms improved rapidly. CSF showed highly elevated levels of the chemokine CXCL-13 and his serum was positive for IgM against Borrelia afzelii. Therefore, we diagnosed him as having LNB. He developed an exacerbation of SIADH and generalized fatigue during the course of LNB. His condition deteriorated despite further administration of antibiotics and steroids. Bone marrow aspiration revealed the presence of medium- to large-sized atypical lymphoma cells and lymphoma cells positive for CD8 but negative for CD45. Therefore, we diagnosed T-cell lymphoma. In recent years, an association between Borrelial infection and lymphoma development has been suspected. Borrelia afzelii infection may have been involved in the development of T-cell lymphoma in this case.
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Affiliation(s)
- Ryusei Nagata
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Science
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