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Lyme meningitis: a one-year follow up controlled study
J Cimperman1, V Maraspin, S Lotric-Furlan
1Department of Infectious Diseases, University Medical Centre, Ljubljana, Slovenia.
Abstract:
Thirty-six patients with Lyme meningitis diagnosed at the Department of Infectious Diseases, University Medical Centre, Ljubljana in 1993 and 1994 were enrolled in a prospective study. All patients had lymphocytic meningitis, negative serum IgM antibody titres to tick-borne encephalitis virus and met at least one of the following four criteria: i) isolation of Borrelia burgdorferi sensu lato from cerebrospinal fluid (2 patients), ii) intrathecal borrelial antibody production (22 patients) iii) seroconversion to borrelial antigens (3 patients) and/or iv) erythema migrans in the period of four months prior to the onset of neurological involvement (21 patients). All patients underwent antibiotic treatment and were followed up for one year. The results of our study revealed that Lyme meningitis frequently occurs without meningeal signs and is often accompanied by additional neurological and/or other manifestations of Lyme borreliosis. During the first year after antibiotic treatment, minor and major manifestations of Lyme borreliosis persisted or occurred for the first time in several patients. They were not infrequent even at the examination performed one year after therapy.
Insights
Lyme meningitis often presents without typical symptoms and can include other Lyme borreliosis signs. Some patients experience persistent or new symptoms even one year after antibiotic treatment for Lyme meningitis.
Area of Science:
- Infectious Diseases
- Neurology
- Immunology
Background:
- Lyme meningitis is a significant neurological manifestation of Lyme borreliosis.
- Accurate diagnosis can be challenging due to varied clinical presentations.
Purpose of the Study:
- To prospectively evaluate clinical characteristics and outcomes of Lyme meningitis.
- To assess the persistence and recurrence of Lyme borreliosis manifestations post-treatment.
Main Methods:
- Prospective study of 36 patients diagnosed with Lyme meningitis.
- Inclusion criteria included lymphocytic meningitis and specific Borrelia burgdorferi sensu lato evidence.
- Patients received antibiotic treatment and were followed for one year.
Main Results:
- Lyme meningitis frequently lacks meningeal signs and co-occurs with other Lyme borreliosis symptoms.
- Antibiotic treatment was administered to all patients.
- Persistent or new Lyme borreliosis manifestations were observed in several patients during the one-year follow-up.
Conclusions:
- Lyme meningitis presents atypically, often without meningeal signs.
- Long-term follow-up is crucial as Lyme borreliosis manifestations can persist or emerge post-treatment.
- Further research into optimal treatment durations and management strategies is warranted.