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Lyme borreliosis-associated encephalopathy
J J Halperin1, L B Krupp, M G Golightly
1Department of Neurology, State University of New York, Stony Brook 11794.
Insights
Central nervous system (CNS) Lyme disease, a common cause of confusion, rarely involves Borrelia burgdorferi (Lyme disease) infection in seronegative patients. Intrathecal antibody production confirms CNS infection in a small subset of seropositive individuals.
Area of Science:
- Neuroscience
- Infectious Diseases
- Immunology
Background:
- Central nervous system (CNS) dysfunction, including mild confusional states, is a frequent complication of Borrelia burgdorferi infection (Lyme disease).
- The underlying mechanisms of CNS Lyme disease, particularly the confusional state, remain largely unknown.
- Intrathecal antibody synthesis is a recognized indicator of CNS infection by Borrelia burgdorferi.
Purpose of the Study:
- To investigate the presence and diagnostic criteria for Borrelia burgdorferi infection in the CNS of patients presenting with a confusional state.
- To determine the frequency of intrathecal antibody production in patients with suspected CNS Lyme disease.
Main Methods:
- Cerebrospinal fluid (CSF) analysis was performed on 73 patients with suspected CNS Lyme disease presenting with a confusional state.
- Serological tests for Borrelia burgdorferi antibodies were conducted.
- Intrathecal antibody production was assessed in CSF samples.
- Cell-mediated immune responses to Borrelia burgdorferi in peripheral blood were evaluated in seronegative patients.
Main Results:
- Of 30 seropositive patients, only 5 demonstrated intrathecal antibody production, indicating CNS infection.
- Seven seronegative patients showed positive cell-mediated immune responses, but none had CSF antibody production.
- The remaining 36 patients with negative serology lacked compelling evidence of CNS infection.
Conclusions:
- Central nervous system infection by Borrelia burgdorferi occurs in a small proportion of seropositive patients with a confusional state.
- CNS Lyme disease is extremely uncommon in seronegative individuals presenting with similar clinical symptoms.
- The findings underscore the importance of intrathecal antibody production in diagnosing CNS Lyme disease.
Abstract:
Borrelia burgdorferi infection (Lyme disease) is frequently accompanied by CNS dysfunction. Particularly common is a mild confusional state, the mechanism of which is unknown. Since CNS infection with B burgdorferi is usually accompanied by intrathecal synthesis of specific antibody, we studied CSF in 73 patients referred for presumed CNS Lyme, manifested primarily as this confusional state. Of 30 seropositive patients evaluated, only 5 had intrathecal antibody production. Seven seronegative patients had positive cell-mediated immune responses to B burgdorferi in the peripheral blood; none had antibody production in the CSF. Of the remaining 36 patients referred with this diagnosis despite negative serologic studies, none had compelling evidence of CNS infection by this criterion. We conclude that CNS infection with B burgdorferi does occur in a small proportion of seropositive patients with this confusional state but is extremely uncommon among seronegative individuals with this clinical presentation.