RSS-Feed abonnieren
DOI: 10.1055/s-0039-1692143
A Neurologist's View of Lyme Disease and Other Tick-Borne Infections
Publikationsverlauf
Publikationsdatum:
18. September 2019 (online)
![](https://www.thieme-connect.de/media/sin/201904/lookinside/thumbnails/10-1055-s-0039-1692143_190024-1.jpg)
Abstract
Tick-borne infections—including tick-borne encephalitis viruses, represented in the United States by rare infections with Powassan and deer tick viruses, and more often Lyme disease—are of increasing importance to neurologists. Lyme neuroborreliosis (LNB) causes all or part of a triad including meningitis, radiculoneuritis, and cranial neuritis. Rarely, parenchymal brain and spinal cord involvement occur, with focal findings on examination and magnetic resonance imaging (MRI). LNB diagnosis requires plausible exposure, objective evidence of nervous system involvement, and, generally, positive two-tier serology. Central nervous system (CNS) LNB is almost always accompanied by abnormal cerebrospinal fluid (CSF) (cells, protein), often with intrathecal antibody production, which is determined by concentration-adjusted comparison of serum and CSF antibody. Measuring CSF antibody in isolation and nucleic acid-based testing of CSF are not useful in LNB and should be avoided. LNB treatment is highly effective with a 2- to 3-week course of antibiotics. Increasing evidence suggests that LNB not involving the CNS parenchyma can be treated successfully with oral doxycycline.
-
References
- 1 Steere AC, Strle F, Wormser GP. , et al. Lyme borreliosis. Nat Rev Dis Primers 2016; 2: 16090
- 2 Barbour A. Biology of the Lyme disease agents: a selective survey of clinical and epidemiologic relervance. In: Halperin J. , ed. Lyme Disease: An evidence-Based Approach. 2nd ed. Oxfordshire: CAB International; 2018: 29-44
- 3 Asbrink E, Hederstedt B, Hovmark A. The spirochetal etiology of erythema chronicum migrans Afzelius. Acta Derm Venereol 1984; 64 (04) 291-295
- 4 Benach JL, Bosler EM, Hanrahan JP. , et al. Spirochetes isolated from the blood of two patients with Lyme disease. N Engl J Med 1983; 308 (13) 740-742
- 5 Steere AC, Grodzicki RL, Kornblatt AN. , et al. The spirochetal etiology of Lyme disease. N Engl J Med 1983; 308 (13) 733-740
- 6 Pritt BS, Mead PS, Johnson DKH. , et al. Identification of a novel pathogenic Borrelia species causing Lyme borreliosis with unusually high spirochaetaemia: a descriptive study. Lancet Infect Dis 2016; 16 (05) 556-564
- 7 Schwartz AM, Hinckley AF, Mead PS, Hook SA, Kugeler KJ. Surveillance for Lyme disease - United States, 2008-2015. MMWR Surveill Summ 2017; 66 (22) 1-12
- 8 Sood S, Salzman M, Johnson B. , et al. Duration of tick attachment as a predictor of the risk of Lyme disease in an area in which Lyme disease is endemic. J Infect Dis 1997; 175 (04) 996-999
- 9 Nadelman RB, Nowakowski J, Fish D. , et al; Tick Bite Study Group. Prophylaxis with single-dose doxycycline for the prevention of Lyme disease after an Ixodes scapularis tick bite. N Engl J Med 2001; 345 (02) 79-84
- 10 Gerber MA, Shapiro ED, Burke GS, Parcells VJ, Bell GL. ; Pediatric Lyme Disease Study Group. Lyme disease in children in southeastern Connecticut. N Engl J Med 1996; 335 (17) 1270-1274
- 11 Wormser GP, Masters E, Liveris D. , et al. Microbiologic evaluation of patients from Missouri with erythema migrans. Clin Infect Dis 2005; 40 (03) 423-428
- 12 Garin C, Bujadoux A. Paralysie par les tiques. J Med Lyon 1922; 71: 765-767
- 13 Hollstrom E. Successful treatment of erythema migrans Afzelius. Acta Derm Venereol 1951; 31 (02) 235-243
- 14 Reik L, Steere AC, Bartenhagen NH, Shope RE, Malawista SE. Neurologic abnormalities of Lyme disease. Medicine (Baltimore) 1979; 58 (04) 281-294
- 15 Pachner AR, Steere AC. The triad of neurologic manifestations of Lyme disease: meningitis, cranial neuritis, and radiculoneuritis. Neurology 1985; 35 (01) 47-53
- 16 Belman AL, Iyer M, Coyle PK, Dattwyler R. Neurologic manifestations in children with North American Lyme disease. Neurology 1993; 43 (12) 2609-2614
- 17 Zemel L. Lyme disease and pseudotumor. Mayo Clin Proc 2000; 75 (03) 315
- 18 Ramgopal S, Obeid R, Zuccoli G, Cleves-Bayon C, Nowalk A. Lyme disease-related intracranial hypertension in children: clinical and imaging findings. J Neurol 2016; 263 (03) 500-507
- 19 Sibony P, Halperin J, Coyle P, Patel K. Reactive Lyme serology in patients with optic neuritis and papilledema. J Neuro-Ophthal 2005; 25 (02) 71-82
- 20 Halperin J, Luft BJ, Volkman DJ, Dattwyler RJ. Lyme neuroborreliosis. Peripheral nervous system manifestations. Brain 1990; 113 (Pt 4): 1207-1221
- 21 Vallat JM, Hugon J, Lubeau M, Leboutet MJ, Dumas M, Desproges-Gotteron R. Tick-bite meningoradiculoneuritis: clinical, electrophysiologic, and histologic findings in 10 cases. Neurology 1987; 37 (05) 749-753
- 22 Meier C, Grahmann F, Engelhardt A, Dumas M. Peripheral nerve disorders in Lyme-Borreliosis. Nerve biopsy studies from eight cases. Acta Neuropathol 1989; 79 (03) 271-278
- 23 Halperin JJ, Little BW, Coyle PK, Dattwyler RJ. Lyme disease: cause of a treatable peripheral neuropathy. Neurology 1987; 37 (11) 1700-1706
- 24 Hopf HC. Peripheral neuropathy in acrodermatitis chronica atrophicans (Herxheimer). J Neurol Neurosurg Psychiatry 1975; 38 (05) 452-458
- 25 England JD, Bohm Jr RP, Roberts ED, Philipp MT. Mononeuropathy multiplex in rhesus monkeys with chronic Lyme disease. Ann Neurol 1997; 41 (03) 375-384
- 26 Halperin JJ, Luft BJ, Anand AK. , et al. Lyme neuroborreliosis: central nervous system manifestations. Neurology 1989; 39 (06) 753-759
- 27 Dressler F, Whalen JA, Reinhardt BN, Steere AC. Western blotting in the serodiagnosis of Lyme disease. J Infect Dis 1993; 167 (02) 392-400
- 28 Branda JA, Linskey K, Kim YA, Steere AC, Ferraro MJ. Two-tiered antibody testing for Lyme disease with use of 2 enzyme immunoassays, a whole-cell sonicate enzyme immunoassay followed by a VlsE C6 peptide enzyme immunoassay. Clin Infect Dis 2011; 53 (06) 541-547
- 29 Wormser GP, Schriefer M, Aguero-Rosenfeld ME. , et al. Single-tier testing with the C6 peptide ELISA kit compared with two-tier testing for Lyme disease. Diagn Microbiol Infect Dis 2013; 75 (01) 9-15
- 30 Henriksson A, Link H, Cruz M, Stiernstedt G. Immunoglobulin abnormalities in cerebrospinal fluid and blood over the course of lymphocytic meningoradiculitis (Bannwarth's syndrome). Ann Neurol 1986; 20 (03) 337-345
- 31 Logigian EL, Kaplan RF, Steere AC. Chronic neurologic manifestations of Lyme disease. N Engl J Med 1990; 323 (21) 1438-1444
- 32 Steere AC, Pachner AR, Malawista SE. Neurologic abnormalities of Lyme disease: successful treatment with high-dose intravenous penicillin. Ann Intern Med 1983; 99 (06) 767-772
- 33 Dattwyler RJ, Halperin JJ, Pass H, Luft BJ. Ceftriaxone as effective therapy in refractory Lyme disease. J Infect Dis 1987; 155 (06) 1322-1325
- 34 Skogman BH, Lager M, Henningsson AJ, Tjernberg I. The recomBead Borrelia antibody index, CXCL13 and total IgM index for laboratory diagnosis of Lyme neuroborreliosis in children. Eur J Clin Microbiol Infect Dis 2017; 36 (11) 2221-2229
- 35 Rupprecht TA, Manz KM, Fingerle V. , et al. Diagnostic value of cerebrospinal fluid CXCL13 for acute Lyme neuroborreliosis. A systematic review and meta-analysis. Clin Microbiol Infect 2018; 24 (12) 1234-1240
- 36 Eckman EA, Pacheco-Quinto J, Herdt AR, Halperin JJ. Neuroimmunomodulators in neuroborreliosis and Lyme encephalopathy. Clin Infect Dis 2018; 67 (01) 80-88
- 37 Scoles GA, Papero M, Beati L, Fish D. A relapsing fever group spirochete transmitted by Ixodes scapularis ticks. Vector Borne Zoonotic Dis 2001; 1 (01) 21-34
- 38 Gugliotta JL, Goethert HK, Berardi VP, Telford III SR. Meningoencephalitis from Borrelia miyamotoi in an immunocompromised patient. N Engl J Med 2013; 368 (03) 240-245
- 39 Boden K, Lobenstein S, Hermann B, Margos G, Fingerle V. Borrelia miyamotoi-associated neuroborreliosis in immunocompromised person. Emerg Infect Dis 2016; 22 (09) 1617-1620
- 40 Lee MS, Goslee TE, Lessell S. Ehrlichiosis optic neuritis. Am J Ophthalmol 2003; 135 (03) 412-413
- 41 Grant AC, Hunter S, Partin WC. A case of acute monocytic ehrlichiosis with prominent neurologic signs. Neurology 1997; 48 (06) 1619-1623
- 42 Ismail N, Bloch KC, McBride JW. Human ehrlichiosis and anaplasmosis. Clin Lab Med 2010; 30 (01) 261-292
- 43 El Khoury MY, Hull RC, Bryant PW. , et al. Diagnosis of acute deer tick virus encephalitis. Clin Infect Dis 2013; 56 (04) e40-e47
- 44 Wormser GP, Pritt B. Update and commentary on four emerging tick-borne infections: Ehrlichia muris-like agent, Borrelia miyamotoi, deer tick virus, Heartland virus, and whether ticks play a role in transmission of Bartonella henselae . Infect Dis Clin North Am 2015; 29 (02) 371-381
- 45 Hermance ME, Thangamani S. Powassan virus: an emerging arbovirus of public health concern in North America. Vector Borne Zoonotic Dis 2017; 17 (07) 453-462
- 46 Birge J, Sonnesyn S. Powassan virus encephalitis, Minnesota, USA. Emerg Infect Dis 2012; 18 (10) 1669-1671
- 47 Tavakoli NP, Wang H, Dupuis M. , et al. Fatal case of deer tick virus encephalitis. N Engl J Med 2009; 360 (20) 2099-2107
- 48 Todd SR, Dahlgren FS, Traeger MS. , et al. No visible dental staining in children treated with doxycycline for suspected Rocky Mountain Spotted Fever. J Pediatr 2015; 166 (05) 1246-1251