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Frahier H, Klopfenstein T, Brunel AS, Chirouze C, Bouiller K. Characteristics of patients consulted for suspected Lyme neuroborreliosis in an endemic area. Ticks Tick Borne Dis 2024; 15:102353. [PMID: 38761786 DOI: 10.1016/j.ttbdis.2024.102353] [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] [Received: 02/22/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 05/20/2024]
Abstract
INTRODUCTION Some patients with unexplained neurological symptoms sought care for presumed Lyme neuroborreliosis (LNB). We aimed to compare patients' characteristics with and without LNB. MATERIAL AND METHODS All patients consulting for LNB suspicion and having a lumbar puncture between 2014 and 2020 in a high endemic area of Lyme borreliosis were included in the study. RESULTS One hundred fifty-five patients were included. Forty-five patients (29 %) had LNB (mean age: 57.6 years, 28.9 % of women) including 17 with isolated intrathecal synthesis. One hundred and ten patients had no LNB (mainly neurological (29 %) and rheumatological diseases (19 %)). Non-neurological symptoms were similar in patients with LNB and patients with no LNB (asthenia, 31 % vs. 46 %, p = 0.14, arthralgia 20 % vs. 31 %, p = 0.14) with the exception of myalgia, which was less frequent in patients with LNB (4.4 % vs. 19.1 % p = 0.02). In multivariable analysis, factors associated with LNB were presence of facial nerve palsy (OR = 5.7), radiculopathy (OR = 11.3), positive Lyme serology (OR = 5.4) and duration of symptoms less than 3 months (OR = 4.48). Patients with isolated intrathecal synthesis had a longer duration of symptoms (3 vs 1 months) than patients with pleocytosis. Asthenia (5.9 % vs. 32.1 %), headaches (0 % vs. 39.3 %) neuropathic pain (17.6 % vs. 50 %) and facial palsy (11.8 % vs. 39.3 %) were less frequent in patients with isolated intrathecal synthesis than patients with pleocytosis. The presence of isolated subjective neurological symptoms (paresthesia, memory disorders, insomnia, irritability, asthenia, headaches) was reported in 7/17 (41 %) of patients with isolated intrathecal synthesis, 2/28 (7.1 %) in patients with pleocytosis and 75/110 (68 %) in patients without LNB (p < 0.001). CONCLUSION More than one quarter of patients consulted for suspected LNB had non-neurologic symptoms, whether or not they have a LNB. Concerning patients with isolated intrathecal synthesis, the question of presence of sequelae with a spontaneously cured disease or an active Lyme borreliosis requiring antibiotic remain.
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Affiliation(s)
- Hélène Frahier
- Besançon University Hospital, Department of Infectious and Tropical Diseases, F-25000 Besançon, France
| | - Timothée Klopfenstein
- Nord Franche-Comté Hospital, Department of Infectious Diseases, 90400, Trevenans, France
| | - Anne-Sophie Brunel
- Besançon University Hospital, Department of Infectious and Tropical Diseases, F-25000 Besançon, France
| | - Catherine Chirouze
- Franche-Comté university, CHU Besançon, UMR-CNRS 6249 Chrono-environnement, Department of Infectious and Tropical Diseases, F-25000 Besançon, France
| | - Kevin Bouiller
- Franche-Comté university, CHU Besançon, UMR-CNRS 6249 Chrono-environnement, Department of Infectious and Tropical Diseases, F-25000 Besançon, France.
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Mah JM, Lo C, O'Connor MD. Isolated Intracranial Hypertension as a Presentation of Pediatric Lyme Borreliosis: A Case Report and Literature Review. Pediatr Neurol 2024; 152:196-199. [PMID: 38301323 DOI: 10.1016/j.pediatrneurol.2023.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 12/10/2023] [Accepted: 12/28/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND It is extremely rare for Lyme borreliosis to present solely with features of increased intracranial pressure. The treatment of pediatric Lyme neuroborreliosis with oral versus intravenous antibiotics remains controversial. METHODS Case report and literature review. RESULTS A 13-year-old male presented with five days of binocular diplopia, several weeks of headache, and a history of multiple tick bites six weeks prior. His examination showed a left eye abduction deficit and bilateral optic disc edema. Magnetic resonance imaging (MRI) of the brain with contrast showed tortuosity of the optic nerves, prominence of the optic nerve sheaths, and enhancement of the left fifth and bilateral sixth cranial nerves. Lumbar puncture showed an elevated opening pressure and a lymphocytic pleocytosis. Lyme IgM and IgG antibodies were positive in the serum and cerebrospinal fluid. The patient was treated with intravenous ceftriaxone for two days empirically followed by doxycycline by mouth for 19 days. Symptoms began improving after 48 hours. The strabismus resolved after two weeks, and the papilledema improved slowly with complete resolution at six months. CONCLUSIONS Lyme neuroborreliosis can present as isolated intracranial hypertension in the pediatric population; it can be differentiated from idiopathic intracranial hypertension on MRI, and lumbar puncture and can be confirmed with serum antibody testing. Oral doxycycline can be considered for Lyme neuroborreliosis in children.
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Affiliation(s)
- Jeffrey M Mah
- Department of Ophthalmology, University of Ottawa, Roger Guindon Hall, Ottawa, Ontario.
| | - Cody Lo
- Department of Ophthalmology, University of Ottawa, Roger Guindon Hall, Ottawa, Ontario
| | - Michael D O'Connor
- Department of Ophthalmology, University of Ottawa, Roger Guindon Hall, Ottawa, Ontario
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Dersch R, Rauer S. Efficacy and safety of pharmacological treatments for Lyme neuroborreliosis: An updated systematic review. Eur J Neurol 2023; 30:3780-3788. [PMID: 37565386 DOI: 10.1111/ene.16034] [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] [Received: 06/30/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Evidence-based recommendations for treatment of Lyme neuroborreliosis (LNB) should rely on the available literature. As new data emerges, close review and evaluation of the recent literature is needed to build evidence-based recommendations to inform clinical practice and management of LNB. We performed an update of a previous systematic review on treatment of LNB. METHODS A systematic literature search of Medline and CENTRAL was performed for published studies from 2015 to 2023 to update a previous systematic review. Randomized controlled trials (RCTs) and non-randomized studies (NRS) were evaluated. Risk of bias was assessed using the Cochrane risk of bias tools for RCTs; NRS were assessed using the ROBINS-I-tool. Quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Data were integrated into an existing meta-analysis of the available literature. RESULTS After screening 1530 records, two RCTs and five NRS with new and relevant data were additionally identified. Meta-analysis showed no statistically significant difference between doxycycline and beta-lactam antibiotics regarding residual neurological symptoms after 12 months. Meta-analysis showed no benefit of extended antibiotic treatment of LNB. Three NRS show no benefit for additional steroid use in LNB with facial palsy. DISCUSSION Additional incorporated recent research corroborates existing guideline recommendations for treatment of LNB. New RCTs add to the certainty of previous analysis showing similar efficacy for doxycycline and beta-lactam antibiotics in LNB. Available evidence shows no benefit for extended antibiotic treatment in LNB. NRS do not suggest a role for steroids in facial palsy due to LNB.
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Affiliation(s)
- Rick Dersch
- Clinic of Neurology and Neurophysiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sebastian Rauer
- Clinic of Neurology and Neurophysiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Mack I, Kohns Vasconcelos M, Ritz N, Zimmermann P. A diagnostic algorithm for children presenting with peripheral facial nerve palsy and inconclusive diagnosis of neuroborreliosis. Acta Paediatr 2023; 112:1644-1647. [PMID: 37424283 DOI: 10.1111/apa.16841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 07/11/2023]
Affiliation(s)
- Ines Mack
- Department of Paediatrics, University Children's Hospital, Regensburg, Germany
- Department for Infectious Diseases and Vaccinology, University of Basel Children's Hospital (UKBB), Basel, Switzerland
| | - Malte Kohns Vasconcelos
- Department for Infectious Diseases and Vaccinology, University of Basel Children's Hospital (UKBB), Basel, Switzerland
| | - Nicole Ritz
- Department for Infectious Diseases and Vaccinology, University of Basel Children's Hospital (UKBB), Basel, Switzerland
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics and Paediatric Infectious Diseases, Children's Hospital, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Petra Zimmermann
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
- Department of Paediatrics, Fribourg Hospital, Fribourg, Switzerland
- Infectious Diseases Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
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Semy M, Lee-Kwen P, Semy S. Lyme Disease Presenting With Interesting Neurological Features of Weakness and Hyporeflexia: A Case Report. Cureus 2023; 15:e43296. [PMID: 37692616 PMCID: PMC10492644 DOI: 10.7759/cureus.43296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 09/12/2023] Open
Abstract
Lyme disease is a tick-borne bacterial infection caused primarily by three pathogenic species of spirochete Borrelia (B. burgdorferi, B. afzelii, and B. garinii). It has a wide range of clinical manifestations ranging in severity. Although, it is generally divided into three phases: early localized, early disseminated, and late disease. Certain cases do not follow the same order described in standard books like Harrison's. Thus, it is vital to establish a chronological timeline when establishing the diagnosis. Here, we describe a 25-year-old female with numbness and tingling that began in her torso and then spread to her entire body. Physical examination revealed diminished motor reflexes and power, but the diagnosis of neuroborreliosis with monoradiculitis was only established with positive laboratory antibody evaluation and lumbar puncture. The patient's symptoms resolved quickly with a four-day inpatient course of IV ceftriaxone followed by 10 days of oral doxycycline.
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Affiliation(s)
- Mehak Semy
- Internal Medicine, Dr. Dnyandeo Yashwantrao (DY) Patil School of Medicine, Mumbai, IND
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Oteo JA, Corominas H, Escudero R, Fariñas-Guerrero F, García-Moncó JC, Goenaga MA, Guillén S, Mascaró JM, Portillo A. Executive summary of the consensus statement of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Spanish Society of Neurology (SEN), Spanish Society of Immunology (SEI), Spanish Society of Pediatric Infectology (SEIP), Spanish Society of Rheumatology (SER), and Spanish Academy of Dermatology and Venereology (AEDV), on the diagnosis, treatment and prevention of Lyme borreliosis. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2023; 41:40-45. [PMID: 36621247 DOI: 10.1016/j.eimce.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/01/2022] [Indexed: 01/09/2023]
Abstract
The diagnosis of Lyme borreliosis (LB) is based on the epidemiological history, clinical manifestations and microbiological findings in the early disseminated and late phases of the disease. Related to this fact, microbiological diagnostic techniques have recently appeared. Far from facilitating the diagnosis and the clinical-therapeutic management of LB patients, they are generating confusion. Herein, experts and representatives of Spanish Scientific Societies [Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Spanish Society of Neurology (SEN), Spanish Society of Immunology (SEI), Spanish Society of Pediatric Infectology (SEIP), Spanish Society of Rheumatology (SER), and Spanish Academy of Dermatology and Venereology (AEDV)] exposed the executive summary after reviewing the epidemiology, clinical spectrum, available diagnostic techniques for the diagnosis of Borrelia burgdorferi infection, therapeutic and prevention options of LB. By consensus, recommendations for microbiological diagnosis are offered together with those supporting the therapeutic management and prophylaxis of infection.
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Affiliation(s)
- José A Oteo
- Centre of Rickettsiosis and Arthropod-Borne Diseases (CRETAV), Department of Infectious Diseases, San Pedro University Hospital - Centre for Biomedical Research from La Rioja (CIBIR), Logroño, Spain.
| | - Héctor Corominas
- Spanish Society of Rheumatology, Rheumatology and Systemic Autoimmune Diseases Department, Hospital de la Santa Creu i Sant Pau/Hospital Dos de Maig, Barcelona, Spain
| | - Raquel Escudero
- Special Pathogens Reference and Research Laboratory, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain
| | - Fernando Fariñas-Guerrero
- Spanish Society of Immunology. Institute of Clinical Immunology and Infectious Diseases, YNMUN Biomedicine Group, Málaga, Spain
| | - Juan Carlos García-Moncó
- Spanish Society of Neurology. Department of Neurology, Hospital Universitario Basurto, Bilbao, Spain
| | - Miguel A Goenaga
- Infectious Diseases Service, Hospital Donostia, OSI Donostialdea. Instituto BioDonostia, San Sebastián, Spain
| | - Sara Guillén
- Spanish Society of Pediatric Infectology (SEIP), Department of Pediatrics, Hospital Universitario de Getafe, Madrid, Spain
| | - José M Mascaró
- Spanish Academy of Dermatology and Venereology, Department of Dermatology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Aránzazu Portillo
- Centre of Rickettsiosis and Arthropod-Borne Diseases (CRETAV), Department of Infectious Diseases, San Pedro University Hospital - Centre for Biomedical Research from La Rioja (CIBIR), Logroño, Spain
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Bernardshaw E, Gynthersen RMM, Bremell D, Mens H, Stenør C, Lorentzen ÅR, Bodilsen J, Eikeland R, Lebech AM. Antibiotic therapy of neuroborreliosis: A survey among infectious disease specialists and neurologists in Norway, Sweden, and Denmark. Ticks Tick Borne Dis 2022; 13:102051. [PMID: 36228536 DOI: 10.1016/j.ttbdis.2022.102051] [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: 06/09/2022] [Revised: 09/05/2022] [Accepted: 09/28/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Neuroborreliosis (NB) is a prevalent tick-borne neuroinfection in Europe. To delineate current practice in antimicrobial management of adults with NB and to prioritize future trials needed to optimize treatment recommendations, a questionnaire-based survey was performed. METHODS A self-administered Internet-based survey of NB treatment practices among specialists in infectious diseases and neurology based in Norway, Sweden, and Denmark was carried out between October 2021 and February 2022. The participants were also asked to prioritize four pre-defined research questions for randomized controlled trials (RCTs) on therapy for NB. RESULTS In total, 290 physicians (45% female) from Norway (30%), Sweden (40%), and Denmark (30%) participated in the survey. Of the responders, 230 (79%) were infectious disease specialists and 56 (19%) were neurologists. The preferred antibiotic treatment for patients with early NB was oral doxycycline (n = 225, 78%). Intravenous (IV) penicillin, ceftriaxone, or cefotaxime for the full treatment course was favored by 12%. A preferred treatment duration of 10-14 days for patients with NB was reported by 245 respondents (85%), most common among participants from Sweden (97%). A total of 170 (59%) responders reported having local hospital guidelines on the treatment of NB, most often with recommendation of oral doxycycline (92%) for 10-14 days (90%) as first line treatment. The prioritization score for future RCTs was highest for adjunctive prednisone therapy in NB patients with facial palsy (median 5; IQR 4-6) and for placebo versus repeated antibiotics in patients with persistent symptoms after completed antibiotic therapy for NB (median 5, IQR 3-6). CONCLUSION In Sweden, all respondents preferred treating NB with oral doxycycline for 10-14 days, whereas 5% in Norway and 19% in Denmark still treat NB with IV antibiotics for the entire treatment course. RCTs to define the role of adjunctive prednisolone in NB patients with facial palsy and repeated antibiotics in patients with persistent symptoms are prioritized for future research.
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Affiliation(s)
- Emilie Bernardshaw
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Rigshospitalet, Copenhagen 2100, Denmark
| | - Rosa M M Gynthersen
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Rigshospitalet, Copenhagen 2100, Denmark.
| | - Daniel Bremell
- Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Helene Mens
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Rigshospitalet, Copenhagen 2100, Denmark
| | - Christian Stenør
- Department of Neurology, University hospital-Herlev Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Åslaug R Lorentzen
- Department of Neurology, Sørlandet Hospital Trust, Kristiansand, Norway; The Norwegian National Advisory Unit on Tick-borne Diseases, Sorlandet Hospital Trust, Kristiansand, Norway
| | - Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Randi Eikeland
- Department of Neurology, Sørlandet Hospital Trust, Kristiansand, Norway; The Faculty of health and sport sciences, University of Agder, Grimstad, Norway
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Rigshospitalet, Copenhagen 2100, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
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Abstract
Most patients with Lyme disease will fully recover with recommended antibiotic therapy. However, some patients report persisting nonspecific symptoms after treatment, referred to as posttreatment Lyme disease symptoms (PTLDs) or syndrome (PTLDS), depending on the degree to which the individual's symptoms impact their quality of life. PTLDs occur in a portion of patients diagnosed with chronic Lyme disease (CLD), a controversial term describing different patient populations, diagnosed based on unvalidated tests and criteria. Practitioners should review the evidence for the Lyme disease diagnosis and not overlook unrelated conditions. Current evidence shows that prolonged antibiotic therapy provides little benefit and carries significant risk. Further research to elucidate the mechanisms underlying persistent symptoms after Lyme disease and to understand CLD is needed.
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Affiliation(s)
- Adriana Marques
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, BG 10 RM 12C118 MSC 1888 10 Center, Bethesda, MD 20892-1888, USA.
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Solheim AM, Lorentzen ÅR, Dahlberg AO, Flemmen HØ, Brune S, Forselv KJN, Pripp AH, Bø MH, Eikeland R, Reiso H, Mygland Å, Ljøstad U. Six versus 2 weeks treatment with doxycycline in European Lyme neuroborreliosis: a multicentre, non-inferiority, double-blinded, randomised and placebo-controlled trial. J Neurol Neurosurg Psychiatry 2022; 93:jnnp-2022-329724. [PMID: 35896378 PMCID: PMC9606522 DOI: 10.1136/jnnp-2022-329724] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/12/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND There is limited evidence regarding optimal duration of antibiotic treatment in neuroborreliosis. We aimed to compare efficacy and safety of oral doxycycline for 2 and 6 weeks in European Lyme neuroborreliosis (LNB). METHODS The trial had a randomised, double-blinded, placebo-controlled, non-inferiority design. Patients with LNB were recruited from eight Norwegian hospitals and randomised to doxycycline 200 mg once daily for 2 weeks, followed by 4 weeks of placebo, or doxycycline 200 mg once daily for 6 weeks. The primary endpoint was clinical improvement as measured by difference in a Composite Clinical Score (0-64 points) from baseline to 6 months. The non-inferiority margin was predetermined to 0.5 points. RESULTS One hundred and twenty-one patients were included. Fifty-two treated for 2 weeks and 53 for 6 weeks were included in the intention-to-treat analyses, and 52 and 51 in per-protocol analysis. Mean difference in clinical improvement between the groups was 0.06, 95% CI -1.2 to 1.2, p=0.99 in the intention-to-treat population, and -0.4, 95% CI -1.4 to 0.7, p=0.51 in the per-protocol population and non-inferiority could not be established. There were no treatment failures and no serious adverse events. The groups did not differ in secondary outcomes including clinical scores at 10 weeks and 12 months, cerebrospinal fluid data and patient-reported outcome measures. Patients receiving 6 weeks doxycycline reported slightly more side effects in week 5. CONCLUSION Our results strongly indicate that there are no benefits of doxycycline treatment beyond 2 weeks in European LNB. TRIAL REGISTRATION NUMBER 2015-001481-25.
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Affiliation(s)
- Anne Marit Solheim
- Department of Neurology, Sørlandet sykehus HF Kristiansand, Kristiansand, Norway
- Institute of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Åslaug Rudjord Lorentzen
- Department of Neurology, Sørlandet sykehus HF Kristiansand, Kristiansand, Norway
- The Norwegian National Advisory Unit on Tick-borne diseases, Sørlandet sykehus HF Arendal, Arendal, Norway
| | - Audun Olav Dahlberg
- Department of Neurology, Møre og Romsdal Hospital Trust, Molde, Norway
- Department of Neurology and Clinical Neurophysiology, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Synne Brune
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | | | - Are Hugo Pripp
- Biostatistics and Epidemiology Unit, Oslo University Hospital, Oslo, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | | | - Randi Eikeland
- The Norwegian National Advisory Unit on Tick-borne diseases, Sørlandet sykehus HF Arendal, Arendal, Norway
- Institute of Health and Nursing Science, University of Agder, Kristiansand, Norway
| | - Harald Reiso
- The Norwegian National Advisory Unit on Tick-borne diseases, Sørlandet sykehus HF Arendal, Arendal, Norway
| | - Åse Mygland
- Department of Neurology, Sørlandet sykehus HF Kristiansand, Kristiansand, Norway
- Institute of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Unn Ljøstad
- Department of Neurology, Sørlandet sykehus HF Kristiansand, Kristiansand, Norway
- Institute of Clinical Medicine, University of Bergen, Bergen, Norway
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Arnason S, Skogman BH. Effectiveness of antibiotic treatment in children with Lyme neuroborreliosis - a retrospective study. BMC Pediatr 2022; 22:332. [PMID: 35676665 PMCID: PMC9178872 DOI: 10.1186/s12887-022-03335-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 05/04/2022] [Indexed: 11/30/2022] Open
Abstract
Background Lyme neuroborreliosis (LNB) is a tick-borne infection caused by the spirochete Borrelia burgdorferi sensu lato complex with various neurological manifestations. The recommended treatment for LNB in Swedish children has been intravenous ceftriaxone 50–100 mg/kg × 1 (< 8 years of age) or oral doxycycline 4 mg/kg × 1 (≥ 8 years of age) for 10–14 days. Studies on adult LNB patients have shown equal efficacy for ceftriaxone and doxycycline, but no such studies have been conducted on pediatric LNB patients. The aim of this study is to retrospectively evaluate clinical outcome in children with LNB who have received intravenous ceftriaxone or oral doxycycline. Results Clinical and laboratory data from three previously conducted prospective studies on children with LNB (1998–2014) were retrospectively analyzed. A total of 321 children (1–19 years of age), who received antibiotic treatment for definite LNB or possible LNB, were included. Clinical outcome at the 2-month follow-up (recovery/non-recovery) was evaluated using Chi2 test and logistic multivariate regression analysis. Out of 321 LNB patients, 194 children (60%) had received ceftriaxone and 127 children (40%) had received doxycycline. When comparing clinical outcome between treatment groups, no difference was found (p = 0,217). Results did not change when incorporating relevant clinical and laboratory data into the logistic multivariate regression analysis. Conclusion In this large retrospective study, no difference in clinical outcome was found, independent of age, when comparing children who received ceftriaxone with those who received doxycycline, supporting an equal effectiveness for treatment of LNB pediatric patients. However, future randomized comparative treatment studies are warranted for evaluation of efficacy of antibiotic treatment in pediatric LNB patients.
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Affiliation(s)
- Sigurdur Arnason
- Department of Clinical Science, Intervention and Technology - CLINTEC, Alfred Nobels Allé 8, S-141 52, Huddinge, Sweden.,Department of Pediatric Infectious Diseases, Astrid Lindgren's Children's Hospital, Karolinska Vägen 22, S-171 64 Solna, Stockholm, Sweden
| | - Barbro H Skogman
- Center for Clinical Research Dalarna - Uppsala University, Nissers Väg 3, S-791 82, Falun, Sweden. .,Department of Clinical Science, Intervention and Technology - CLINTEC, Karolinska Institutet, Alfred Nobels Allé 8, S-141 52, Huddinge, Sweden. .,Department of Medical Sciences, Örebro University, Södra Grev Rosengatan 42 B, S-703 62, Örebro, Sweden.
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Oteo JA, Corominas H, Escudero R, Fariñas-Guerrero F, García-Moncó JC, Goenaga MA, Guillén S, Mascaró JM, Portillo A. Executive summary of the consensus statement of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Spanish Society of Neurology (SEN), Spanish Society of Immunology (SEI), Spanish Society of Pediatric Infectology (SEIP), Spanish Society of Rheumatology (SER), and Spanish Academy of Dermatology and Venereology (AEDV), on the diagnosis, treatment and prevention of Lyme borreliosis. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Del Valle I, Hoang V, Wood ST. A Case of Lyme Carditis With Variable Heart Block Successfully Treated With Oral Doxycycline. Cureus 2022; 14:e24729. [PMID: 35676996 PMCID: PMC9166513 DOI: 10.7759/cureus.24729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 11/30/2022] Open
Abstract
A 39-year-old male without significant past medical history presented with three weeks of worsening fatigue, migratory arthralgia, rash, and unilateral facial weakness after spending three months in Vermont. Serology showed positive Lyme titers 1:64 for both IgM and IgG. EKG on presentation showed a P-R interval of 384 ms, and the patient was admitted for concern of Lyme carditis. Serial EKGs obtained throughout his stay demonstrated variability between first- and second-degree heart blocks. After consultation with Infectious Disease, he was transitioned to oral doxycycline to complete a 21-day course. The patient’s heart block and other symptoms had resolved on follow-up after the treatment course had been completed.
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Nguyen CT, Cifu AS, Pitrak D. Prevention and Treatment of Lyme Disease. JAMA 2022; 327:772-773. [PMID: 35191942 DOI: 10.1001/jama.2021.25302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Portales-Castillo CA, Said M. To Lumbar Puncture or Not to Lumbar Puncture: A Case of Lyme Neuroborreliosis. Cureus 2021; 13:e17970. [PMID: 34660154 PMCID: PMC8516016 DOI: 10.7759/cureus.17970] [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] [Accepted: 09/14/2021] [Indexed: 11/05/2022] Open
Abstract
Lyme disease is a zoonotic infection increasing in prevalence across the United States. While the recognition of its classic clinical signs is sufficient to establish the diagnosis in the early stages, the diagnosis of Lyme neuroborreliosis (LNB) may be challenging and the diagnostic approaches may have to be tailored. We report a rare case of early disseminated LNB presenting with features of Banwarth syndrome in the form of painful radiculoneuritis, motor weakness, and facial palsy in a middle-aged female who presented to an Upstate New York Hospital during summer. Lyme antibody testing was found to be positive at a level of 11.70 by enzyme immunoassay and Western Blot was IgM positive with three out of three reactive borrelial proteins. Lumbar puncture was not performed per the patient's preference. Otherwise, the laboratory workup along with MRI of the brain and cervical spine were grossly unremarkable. The patient was treated with a four-week course of oral doxycycline with resolution of all her symptoms. The diagnostic value of lumbar puncture in certain presentations of LNB remains controversial and is further discussed in this review.
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Affiliation(s)
| | - Mina Said
- Internal Medicine, Rochester Regional Health, Rochester, USA
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15
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Kortela E, Kanerva MJ, Kurkela S, Oksi J, Koivisto M, Järvinen A. Consumption of healthcare services and antibiotics in patients with presumed disseminated Lyme borreliosis before and after evaluation of an infectious disease specialist. Ticks Tick Borne Dis 2021; 13:101854. [PMID: 34695770 DOI: 10.1016/j.ttbdis.2021.101854] [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: 11/04/2020] [Revised: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
Abstract
Our objective was to study the consumption of healthcare services and antibiotics in patients with suspicion of disseminated Lyme borreliosis (LB) before and after consultation of an infectious disease specialist. We evaluated retrospectively all presumed disseminated LB patients (n = 256) with a referral to the Department of Infectious Diseases (DID) in Helsinki University Hospital in 2013. Medical records from all healthcare providers in the area were reviewed and the number of physician contacts because of symptoms leading to LB suspicion and antimicrobial purchases were calculated 1 year before and after consultation or treatment at the DID. Patients were divided into three groups according to certainty of LB: unlikely, possible or probable/definite LB. The number of healthcare contacts 1 year before referral was higher among 121 patients with unlikely LB (6; interquartile range [IQR] 3-10), than 65 possible (4; IQR 2.5-7; p = 0.018) or 66 probable/definite LB patients (4; IQR 2.8-7; p = 0.010). The median number of contacts to healthcare during one year after consultation or treatment was 3 (IQR 0.5-7), 1 (IQR 0-3) and 0.5 (IQR 0-2.3), respectively, with a statistically significant difference between the groups (p<0.001). Antibiotics were purchased by 151 (60%) patients one year before referral and by 127 (50%) patients year after consultation or treatment at DID without statistically significant difference between groups with different LB certainty. These antibiotic purchases do not include the treatments prescribed by infectious disease specialists. In the case of 27 patients, an antimicrobial treatment was recommended in the consultation reply. In conclusion, patients with unlikely LB used more healthcare services than patients with possible or probable/definite LB. Antimicrobial consumption was similar between groups of different LB certainty.
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Affiliation(s)
- Elisa Kortela
- Division of infectious diseases, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Clinical Medicine, University of Turku, Turku, Finland.
| | - Mari J Kanerva
- Division of infectious diseases, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Satu Kurkela
- Virology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jarmo Oksi
- Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland
| | - Mari Koivisto
- Department of Biostatistics, University of Turku, Turku, Finland
| | - Asko Järvinen
- Division of infectious diseases, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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16
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Burns M, Robben P, Venkataraman R. Lyme Carditis With Complete Heart Block Successfully Treated With Oral Doxycycline. Mil Med 2021; 188:usab420. [PMID: 34612503 DOI: 10.1093/milmed/usab420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/15/2021] [Accepted: 09/27/2021] [Indexed: 11/13/2022] Open
Abstract
Lyme disease is a vector-borne infection that can affect multiple different organ systems. Lyme carditis represents one of these sequelae and is defined by acute onset of high-grade atrioventricular block in the presence of laboratory-confirmed infection. Current guidelines recommend patients with Lyme carditis be admitted for close cardiac monitoring and intravenous antibiotics therapy. Our case illustrates an active duty male who was initially diagnosed with Lyme disease after initially reporting symptoms including headache, fever, eye pain, and rash, with subsequent development of exercise intolerance 6 weeks later. An electrocardiogram (ECG) obtained at that time was misinterpreted as first-degree heart block, and he was initiated on oral doxycycline therapy and referred to cardiology. On follow-up to cardiology clinic, the prior ECG was reviewed and interpreted as complete heart block. A repeat ECG showed resolution of the heart block, and exercise stress testing showed chronotropic competence. This case illustrates the resolution of complete heart block in Lyme carditis with oral doxycycline, suggesting this antibiotic as a possible alternative treatment agent.
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Affiliation(s)
- Michael Burns
- Department of Internal Medicine, Walter Reed National Military Medical Center, Bethesda, MD 20889-5611, USA
| | - Paul Robben
- Department of Infectious Diseases, Walter Reed National Military Medical Center, Bethesda, MD 20889-5611, USA
- Center for Infectious Disease Research, Walter Reed Army Institute of Research, Bethesda, MD 20817, USA
| | - Ramesh Venkataraman
- Department of Cardiology, Walter Reed National Military Medical Center, Bethesda, MD 20889-5611, USA
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17
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Karna R, Hans B, Murone J, Black J. Cranial nerve palsies, SIADH and atrial fibrillation: a diagnostic challenge. BMJ Case Rep 2021; 14:e244807. [PMID: 34521742 PMCID: PMC8442043 DOI: 10.1136/bcr-2021-244807] [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: 08/31/2021] [Indexed: 11/03/2022] Open
Abstract
We recently encountered a 79-year-old Caucasian man who presented with blurring of vision and facial muscle weakness. The patient also had hyponatraemia, atrial fibrillation with rapid ventricular response and underlying Brugada type II pattern. Urine and serum osmolality were consistent with syndrome of inappropriate antidiuretic hormone secretion (SIADH). It was only after extensive imaging and workup that we were able to tie together these three different presentations of Lyme disease-cranial nerve palsies, SIADH and atrial fibrillation and treat them accordingly. To the best of our knowledge, only eight cases of SIADH in patients with Lyme neuroborreliosis have been reported in the literature. Although our patient did not have a history of arrhythmias, case findings suggest that underlying Brugada type II morphology could have been the predisposing factor, and Lyme disease the trigger.
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Affiliation(s)
- Rahul Karna
- Department of Internal Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Bandhul Hans
- Department of Internal Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Julie Murone
- Department of Internal Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - John Black
- Department of Internal Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
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18
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19
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Methodological Quality Assessment with the AGREE II Scale and a Comparison of European and American Guidelines for the Treatment of Lyme Borreliosis: A Systematic Review. Pathogens 2021; 10:pathogens10080972. [PMID: 34451436 PMCID: PMC8399315 DOI: 10.3390/pathogens10080972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Most European and American countries recently updated their guidelines on Lyme borreliosis (LB). The aim of this study was to provide a comparative overview of existing guidelines on the treatment of LB in Europe and America and to assess the methodological quality of their elaboration. METHODS A systematic search was carried out in MEDLINE, Google Scholar, and the national databases of scientific societies from 2014 to 2020. Quality was assessed by two independent reviewers using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. RESULTS Twelve guidelines were included. The scores for the AGREE II domains (median ± IQR) were: overall assessment 100 ± 22, scope and purpose 85 ± 46, stakeholder involvement 88 ± 48, rigour of development 67 ± 35, clarity of presentation 81 ± 36, applicability 73 ± 52 and editorial independence 79% ± 54%. Cohen's weighted kappa showed a high agreement (K = 0.90, 95%CI 0.84-0.96). Guidelines were quite homogeneous regarding the recommended molecules (mostly doxycycline in the first intention and ceftriaxone in the second intention), their duration (10 to 28 days), and their dosage. The differences were due to the lack of well-conducted comparative trials. The International Lyme and Associated Diseases Society (ILADS) guidelines were the only ones to suggest longer antibiotics based on an expert consensus. CONCLUSION European and American guidelines for the treatment of LB were quite homogeneous but based on moderate- to low-evidence studies. Well-conducted comparative trials are needed to assess the best molecules, the optimal duration and the most effective doses.
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20
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Stupica D, Bajrović FF, Blagus R, Cerar Kišek T, Collinet-Adler S, Lah A, Levstek E, Ružić-Sabljić E. Clinical manifestations and long-term outcome of early Lyme neuroborreliosis according to the European Federation of Neurological Societies diagnostic criteria (definite versus possible) in central Europe. A retrospective cohort study. Eur J Neurol 2021; 28:3155-3166. [PMID: 34114701 DOI: 10.1111/ene.14962] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 06/07/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE The characteristics and long-term outcome of Lyme neuroborreliosis (LNB) according to diagnostic certainty (definite vs. possible) are incompletely understood. METHODS In this retrospective cohort study of adults with definite or possible LNB, clinical and microbiological characteristics and long-term outcome over 12 months were evaluated at a single medical center. Severity of acute disease and long-term outcome were assessed using a composite clinical score encompassing clinical findings and symptoms and by the probability of incomplete recovery. RESULTS Amongst 311 adult patients enrolled from 2008 to 2017, 139 (44.7%) had definite LNB and 172 (55.3%) had possible LNB. The most frequent LNB manifestation was cranial neuropathy with or without meningitis (53.4%). Patients with definite LNB more often had Bannwarth syndrome (53.2% vs. 18.6%), more severe disease (6 points vs. 4 points), longer pre-treatment duration (median 21 days vs. 13.5 days), higher cerebrospinal fluid pleocytosis (median 139 × 106 /L vs. 11 × 106 /L) and higher rate of Borrelia seropositivity (84.2% vs. 68.6%) than those with possible LNB. Ceftriaxone was prescribed more often than oral doxycycline in definite LNB than in possible LNB (96.4% vs. 65.7%). Unfavorable outcomes decreased during follow-up, being higher in patients with more severe disease at enrollment and in those with possible LNB, but were not associated with antibiotic therapy. CONCLUSIONS Early LNB, most often presenting as cranial neuropathy, was definitively diagnosed in less than half of cases. A better diagnostic approach is needed to confirm borrelial etiology. Ceftriaxone was not superior to doxycycline in the treatment of early LNB, regardless of diagnostic certainty. In this retrospective cohort study of 311 adults with Lyme neuroborreliosis (LNB), allocated according to diagnostic certainty, early LNB was definitively diagnosed in less than half of cases and the most frequent LNB manifestation was cranial neuropathy with or without meningitis. Patients with definite LNB more often had Bannwarth syndrome, more severe disease, longer pre-treatment duration, higher cerebrospinal fluid pleocytosis and higher rate of Borrelia seropositivity than those with possible LNB. A better diagnostic approach is needed to confirm borrelial etiology. Ceftriaxone was not superior to doxycycline in the treatment of early LNB, regardless of diagnostic certainty.
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Affiliation(s)
- Daša Stupica
- Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Fajko F Bajrović
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Department of Neurology, University Medical Center Ljubljana, Ljubljana, Slovenia.,Institute of Pathophysiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Rok Blagus
- Institute for Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Faculty of Sports, University of Ljubljana, Ljubljana, Slovenia
| | - Tjaša Cerar Kišek
- Institute for Microbiology and Immunology Ljubljana, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Stefan Collinet-Adler
- Department of Infectious Diseases, Park Nicollet, Methodist Hospital, Saint Louis Park, MN, USA
| | - Anja Lah
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Eva Levstek
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Eva Ružić-Sabljić
- Institute for Microbiology and Immunology Ljubljana, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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21
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Lyme neuroborreliosis-associated cerebrovascular events in the Finnish endemic area. J Neurol Sci 2021; 427:117544. [PMID: 34153843 DOI: 10.1016/j.jns.2021.117544] [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: 02/05/2021] [Revised: 05/31/2021] [Accepted: 06/14/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Neuroborreliosis is a rare cause of cerebral vasculitis and stroke. The incidence of Lyme borreliosis in Finland has been increasing in the last 20 years, so we expect that Lyme neuroborreliosis-associated vasculitis can be a more common cause of stroke in the future. MATERIALS & METHODS We have retrospectively identified all adult patients (>16 years old) diagnosed with borreliosis (A69.2 Lyme borreliosis), transient ischemic attack (TIA, G45), and ischemic stroke (I63) at Helsinki University Hospital during 1.1.2014-31.10.2019 at our neurological emergency department. Medical data and follow-up data were retrospectively collected from medical records. Neuroborreliosis was diagnosed according to the European Federation of Neurological Societies guidelines. RESULTS We have identified 10 cases of neuroborreliosis-associated stroke or TIA and/or vasculitis. Vasculitis as a manifestation of borreliosis was diagnosed in six patients of 1454 (0.4%) and stroke or TIA in nine (0.6%) of all borreliosis patients at Helsinki University Hospital. Clinical outcomes for all our patients were good with a modified Rankin scale (mRS) 0-2. CONCLUSIONS Lyme neuroborreliosis-associated vasculopathy and cerebrovascular events still remain rare but should be considered especially in Lyme borreliosis endemic areas. Prognosis is good with appropriate antibiotic treatment, but additional immunosupressive treatment is sometimes needed.
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22
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Dersch R, Fingerle V. [Lyme borreliosis and Lyme neuroborreliosis - an update]. Dtsch Med Wochenschr 2021; 146:728-732. [PMID: 34062587 DOI: 10.1055/a-1265-4397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Lyme borreliosis is a tick-borne infectious disease caused by the spirochete bacterium Borrelia burgdorferi sensu lato. Lyme borreliosis is the most frequent zoonosis in Germany.Most cases show dermatological manifestations, like erythema migrans, followed by infections of the nervous system. Cerebrospinal fluid analysis should be performed if Lyme neuroborreliosis is suspected. Cell-based assays (like LTT or ELISPOT) should not be used when investigating Lyme disease.A recent randomized controlled trial showed a similar effect of doxycycline compared to betalactam-antibiotics regarding neurological symptoms in Lyme neuroborreliosis. This corroborates current German guideline recommendations.The prognosis of Lyme disease after antibiotic treatment is usually favorable. Frequency of fatigue, depression, impairments in quality of life and cognitive impairment are similar in patients after treatment of Lyme neuroborreliosis when compared to the general population.
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Affiliation(s)
- Rick Dersch
- Klinik für Neurologie und Neurophysiologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert- Ludwigs-Universität Freiburg
| | - Volker Fingerle
- Nationales Referenzzentrum für Borrelien, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Oberschleißheim
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23
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Rouhiainen M, Pietikäinen A, Kortela E, Kanerva MJ, Oksi J, Hytönen J. C6 peptide enzyme immunoassay in Lyme borreliosis serology. J Microbiol Methods 2020; 180:106122. [PMID: 33326821 DOI: 10.1016/j.mimet.2020.106122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/28/2020] [Accepted: 12/02/2020] [Indexed: 12/22/2022]
Abstract
The cut-off values used in C6 peptide-based enzyme immunoassay (EIA), a widely used test in Lyme borreliosis (LB) serology, have not been thoroughly analysed. The objective of the study was to examine the performance of the C6 EIA, and to determine optimal cut-off values for the test. The analysed data contained results of 1368 serum samples. C6 EIA index values were compared statistically with the immunoblot (IB) test results. The identified cut-off values were further tested in a well-defined LB patient cohort. Cut-off value 1.6 appeared to be optimal when C6 EIA was used as a stand-alone test. When using C6 EIA as the first-tier test, the optimal cut-off values were 0.9 and 2.4 for negative and positive results. When C6 EIA was used as a second-tier test, samples yielding C6 index values ≥3.0 could be considered positive. The identified cut-off values had also a high sensitivity to identify seropositivity among definite LB patients. The identified cut-off values refine the role of C6 EIA in LB serology. Importantly, the use of C6 EIA leads to a reduction in the number of samples that need to be analysed using an IB, thus also reducing the costs. Two alternative workflows for LB serology including the C6 EIA are suggested.
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Affiliation(s)
- Meri Rouhiainen
- Institute of Biomedicine, University of Turku, Turku, Finland; Doctoral Programme in Clinical Research, Turku, Finland.
| | - Annukka Pietikäinen
- Institute of Biomedicine, University of Turku, Turku, Finland; Laboratory Division, Clinical Microbiology, Turku University Hospital, Turku, Finland
| | - Elisa Kortela
- Department of Clinical Medicine, University of Turku, Turku, Finland; Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mari J Kanerva
- Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jarmo Oksi
- Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland
| | - Jukka Hytönen
- Institute of Biomedicine, University of Turku, Turku, Finland; Laboratory Division, Clinical Microbiology, Turku University Hospital, Turku, Finland
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24
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Forde KM, O'Gorman J, Gavin PJ, Dryden MS, Keady D, Hanahoe B, McDonnell C, Power L, Cryan B, Sweeney J, Conyard KF, O'Grady MJ. The clinical presentation, treatment and outcome of serologically confirmed paediatric Lyme disease in the Republic of Ireland over a 5-year period: a retrospective cohort study. Eur J Clin Microbiol Infect Dis 2020; 40:725-734. [PMID: 33040217 DOI: 10.1007/s10096-020-04064-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 10/01/2020] [Indexed: 01/04/2023]
Abstract
Lyme disease (LD) is the most common tick-borne illness in Europe. Population-based studies in European children are few. This study aimed to assess the incidence, clinical presentation, treatment and outcome of serologically confirmed paediatric LD in the Republic of Ireland over a 5-year period. A retrospective review of records from accredited laboratories performing Borrelia burgdorferi serological testing was undertaken. Proformas were distributed to clinicians of children and adolescents with positive Lyme serology. Data were requested regarding clinical presentation, treatment and outcome. Updated NICE guidelines were used to classify clinical cases. Serology testing for B. burgdorferi was performed on 2908 samples. Sixty-three (2.2%) children were two-tier positive, generating a crude annual incidence rate of 1.15/100,000. Proformas were returned for 55 (87%) and 47 met clinical and laboratory criteria for LD. Twenty-seven (57%) presented with non-focal symptoms (erythema migrans and/or influenza-like symptoms), and 20 (43%) with focal symptoms (cranial nerve involvement, 11; CNS involvement, 8; arthritis, 1). Median age at presentation was 8.2 (2.5-17.9) years. Seventeen (36%) acquired LD overseas. Twenty-five (83%) of the remaining 30 children acquired infection in the West/Northwest of Ireland. Full resolution of symptoms was reported in 97% of those with available data. Serologically confirmed LD in children is relatively rare in the Republic of Ireland. Ninety-eight percent of children tested were seronegative. Of the seropositive cases, 40% could have been diagnosed based on clinical findings alone. Neurological presentations (40%) were common. Full resolution of symptoms occurred in almost all (97%) where data were available.
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Affiliation(s)
- Karina M Forde
- Department of Paediatrics, Regional Hospital Mullingar, Westmeath, Ireland. .,Department of Paediatric Infectious Diseases, Children's Health Ireland, Crumlin and Temple St., Dublin, Ireland.
| | - Joanne O'Gorman
- National Virus Reference Laboratory, University College Dublin, Belfield, Dublin 4, Ireland
| | - Patrick J Gavin
- Department of Paediatric Infectious Diseases, Children's Health Ireland, Crumlin and Temple St., Dublin, Ireland
| | - Matthew S Dryden
- Rare and Imported Pathogens Laboratory, Public Health England, Porton Down, Salisbury, UK
| | - Deirbhile Keady
- Department of Medical Microbiology, Galway University Hospital, Galway, Ireland
| | - Belinda Hanahoe
- Department of Medical Microbiology, Galway University Hospital, Galway, Ireland
| | - Colm McDonnell
- Department of Medical Microbiology, University Hospital Limerick, Limerick, Ireland
| | - Lorraine Power
- Department of Medical Microbiology, University Hospital Limerick, Limerick, Ireland
| | - Bartley Cryan
- Department of Medical Microbiology, Cork University Hospital, Wilton, Cork, Ireland
| | - James Sweeney
- Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland
| | - Karl F Conyard
- CSTAR, University College Dublin, Belfield, Dublin 4, Ireland
| | - Michael J O'Grady
- Department of Paediatrics, Regional Hospital Mullingar, Westmeath, Ireland.,Women's and Children's Health, University College Dublin, Belfield, Dublin 4, Ireland
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