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Chronic meningitis and Lyme disease in Sweden
Abstract:
We studied 35 patients with chronic meningitis. The neurological abnormalities included aseptic meningitis, cranial neuropathy (mostly facial palsy), motor and sensory peripheral radiculoneuropathy, and myelitis. Neurological symptoms were sometimes preceded by erythema chronicum migrans or an insect bite and were often accompanied by fever, malaise, profound fatigue, and weight loss. The cerebrospinal fluid (CSF) abnormalities consisted of a predominantly mononuclear pleocytosis, an elevated CSF protein (mean 2.3 g/l), intrathecal synthesis of oligoclonal immunoglobulin G, and, in half of the patients, a fall in the CSF/blood glucose ratio. High antibody titers to the Lyme spirochete and the Swedish Ixodes ricinus spirochete were demonstrated by immunofluorescence in 26 of the 35 patients. By imprint immunofixation of electrofocused samples of serum and CSF, intrathecal production of oligoclonal Lyme-spirochete-specific IgG was demonstrated in one patient with chronic meningitis. Four sequential paired samples of serum and CSF from this patient showed local synthesis of spirochete-specific antibodies in CSF. The 35 patients improved or recovered, sometimes dramatically, during a two-week course of intravenous penicillin G.
Insights
Chronic meningitis in 35 patients was linked to Lyme spirochetes. Treatment with intravenous penicillin G led to significant improvement or recovery, highlighting the effectiveness of antibiotic therapy for neurological Lyme disease.
Area of Science:
- Neurology
- Infectious Diseases
- Immunology
Background:
- Chronic meningitis can present with diverse neurological abnormalities.
- Lyme disease, caused by Borrelia burgdorferi, is a known cause of neurological manifestations.
- Distinguishing infectious meningitis from other causes is crucial for effective treatment.
Purpose of the Study:
- To investigate the neurological manifestations of chronic meningitis.
- To identify potential causative agents, specifically Lyme spirochetes.
- To evaluate the efficacy of antibiotic treatment in affected patients.
Main Methods:
- Studied 35 patients with chronic meningitis and neurological symptoms.
- Analyzed cerebrospinal fluid (CSF) for abnormalities including pleocytosis, protein levels, and glucose ratios.
- Used immunofluorescence and imprint immunofixation to detect antibodies against Lyme spirochetes in serum and CSF.
- Administered intravenous penicillin G for two weeks.
Main Results:
- Neurological abnormalities included aseptic meningitis, cranial neuropathy, radiculoneuropathy, and myelitis.
- CSF analysis revealed mononuclear pleocytosis, elevated protein, and intrathecal oligoclonal IgG synthesis.
- High antibody titers to Lyme spirochetes were found in 26 of 35 patients.
- Intrathecal production of spirochete-specific IgG was confirmed in one patient.
- All 35 patients showed improvement or recovery after penicillin G treatment.
Conclusions:
- Lyme spirochetes are a significant cause of chronic meningitis with neurological deficits.
- Cerebrospinal fluid analysis and serological testing are vital for diagnosis.
- Intravenous penicillin G is an effective treatment for Lyme-induced chronic meningitis.