Related Experiment Videos
Central nervous system infection caused by Borrelia burgdorferi. Clinico-pathological correlation of three
E Bertrand1, G M Szpak, E Piłkowska
1Department of Neuropathology, Institute of Psychiatry and Neurology, Warszawa.
Abstract:
The spirochete Borrelia burgdorferi (B. burgdorferi) may cause severe meningoencephalomyelitis as the sole manifestation of Lyme borreliosis. We would like to present three such cases, where definite neuroborreliosis was clinically diagnosed in two cases and possible neuroborreliosis was recognized in one case. Alive spirochetes were isolated and cultured from blood and cerebrospinal fluid (CSF) in both definite cases. B. burgdorferi as the causative agent of the infection was confirmed in CSF by polymerase chain reaction (PCR) in one definite case. In the possible case spirochetes were cultured from blood and CSF. Alive spirochetes were not isolated, however anti-B. burgdorferi antibody value in serum was significantly elevated. On necropsy gross examination brain edema without focal changes was detected in two cases. Cerebral atrophy was seen in Case 3. Microscopically, lymphocytic infiltrates, microglial diffuse and nodular activation, spongiform changes, diffuse demyelination of the cerebral and cerebellar white matter, and diffuse astrocytosis, were characteristic pathological features in all presented cases. Multifocal, perivascular degenerative changes in the cerebral and cerebellar white matter were observed in the first case. Inflammatory changes in the nuclei and roots of cranial nerves were present in the third case.
Insights
Borrelia burgdorferi can cause severe meningoencephalomyelitis, a form of Lyme borreliosis. This study details three cases, confirming the spirochete
Area of Science:
- Neurology
- Infectious Diseases
- Microbiology
Background:
- Lyme borreliosis, caused by Borrelia burgdorferi, can present with severe neurological complications.
- Meningoencephalomyelitis is a rare but serious manifestation of Lyme borreliosis.
Observation:
- Three cases of Borrelia burgdorferi-induced meningoencephalomyelitis are presented.
- Clinical diagnosis of definite neuroborreliosis in two cases and possible neuroborreliosis in one.
- Isolation and culture of live spirochetes from blood and cerebrospinal fluid (CSF) in definite cases.
- Polymerase chain reaction (PCR) confirmed B. burgdorferi in CSF in one definite case.
- Elevated anti-B. burgdorferi antibodies in serum were noted in the possible case.
Findings:
- Pathological examination revealed lymphocytic infiltrates, microglial activation, spongiform changes, demyelination, and astrocytosis in all cases.
- Brain edema was observed in two cases, with cerebral atrophy in one.
- Multifocal degenerative changes and cranial nerve inflammation were noted in specific cases.
Implications:
- Highlights the potential for Borrelia burgdorferi to cause severe central nervous system disease.
- Underscores the importance of considering Lyme borreliosis in cases of unexplained meningoencephalomyelitis.
- Emphasizes the utility of microbiological and serological diagnostics in confirming neuroborreliosis.