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Chronic progressive neurological involvement in Borrelia burgdorferi infection
Abstract:
Five patients with chronic meningitis were hospitalized several times for progressive neurological symptoms. The clinical manifestations included cranial neuritis, radiculoneuritis, myelitis and encephalitis. In two cases cerebral infarction occurred. The course was commonly characterized by a tendency to deteriorate. From the clinical point of view, it was repeatedly difficult to exclude multiple sclerosis or tuberculous meningitis. Finally, specific antibodies against Borrelia burgdorferi were detected by indirect immunofluorescence assay. The diagnosis of a borreliosis was not considered initially because there was no history of tick-bite or erythema chronicum migrans, and the neurological involvement of the central nervous system seemed unusual. The latency between the first symptoms and diagnosis varied from 3 months to 5 years. After a parenteral, high-dose therapy with penicillin, there was a significant improvement in all patients. In two cases, there was evidence of intrathecally produced antibodies to myelin basic protein.
Insights
Chronic meningitis can be caused by Borrelia burgdorferi, a bacterium responsible for Lyme disease. Early diagnosis and high-dose penicillin treatment significantly improved neurological symptoms in patients with this rare manifestation of borreliosis.
Area of Science:
- Neurology
- Infectious Diseases
- Immunology
Background:
- Chronic meningitis presents with progressive neurological deterioration, often mimicking other conditions like multiple sclerosis or tuberculous meningitis.
- Neurological borreliosis, particularly affecting the central nervous system, can be challenging to diagnose.
- Typical Lyme disease indicators such as tick-bite history or erythema migrans may be absent.
Purpose of the Study:
- To investigate the role of Borrelia burgdorferi in patients presenting with chronic meningitis and progressive neurological symptoms.
- To highlight the diagnostic challenges and treatment outcomes for neuroborreliosis presenting as chronic meningitis.
Main Methods:
- Clinical case series of five patients hospitalized for progressive neurological symptoms.
- Diagnostic evaluation included neurological examinations and serological testing for Borrelia burgdorferi antibodies via indirect immunofluorescence assay.
- Assessment of treatment response to high-dose parenteral penicillin therapy.
Main Results:
- All five patients were diagnosed with borreliosis after detection of specific antibodies against Borrelia burgdorferi.
- Neurological manifestations included cranial neuritis, radiculoneuritis, myelitis, encephalitis, and cerebral infarction.
- Significant clinical improvement was observed in all patients following high-dose penicillin treatment.
- Intrathecally produced antibodies to myelin basic protein were found in two cases, suggesting an autoimmune component.
Conclusions:
- Borrelia burgdorferi should be considered in the differential diagnosis of chronic meningitis with progressive neurological symptoms, even without classic Lyme disease indicators.
- Prompt diagnosis and aggressive antibiotic treatment are crucial for favorable outcomes in neuroborreliosis.
- Further research is warranted to understand the immunopathogenesis of central nervous system involvement in Lyme disease.