Confirmed cases of Neuroborreliosis with involvement of peripheral nervous system

Abstract

The manifestations of borreliosis in the peripheral nervous system (PNS) remain poorly described. As the symptoms of neuroborreliosis can be reversed with timely introduction of antibiotics, early identification could avoid unnecessary axonal loss. Our aim was to describe the characteristics of confirmed neuroborreliosis cases involving the PNS diagnosed between 2007 and 2017 in our neuromuscular disease center in a nonendemic area (La Pitié-Salpêtrière Hospital, Paris, France). Neuroborreliosis was defined as follows: compatible neurological symptoms without other cause of neuropathy; cerebrospinal fluid and serum analysis (positive serological tests with ELISA, confirmed by Western Blot); and improvement of symptoms with adapted antibiotherapy. All the patients consulting in our center between 2007 and 2017 underwent electrophysiological study. Sixteen confirmed cases of neuroborreliosis involving the PNS were included: 10 cases of meningoradiculoneuritis, 4 of axonal neuropathy, and 2 of demyelinating neuropathy (one acute and one chronic). Only 4 (25%) patients reported tick bites. Meningoradiculoneuritis was characterized by lymphocytic meningitis, intense pain, cranial nerve palsy, and contrast enhancement of nerve roots on imagery. The patients with axonal neuropathy presented sensory symptoms with intense pain but no motor deficit and meningitis was rare. Nerve biopsy of 1 patient revealed lymphocytic vasculitis. Electrophysiological testing showed sensory or sensorimotor axonal neuropathy (3 subacute and 1 chronic) of the lower limbs, with asymmetrical neuropathy in 1 patients, symmetrical neuropathy in one and monomelic sensory mononeuritis multiplex in another. We also found 1 case of acute demyelinating neuropathy, treated with antibiotherapy and immunoglobulins, and 1 chronic demyelinating neuropathy. Overall, diaphragmatic paralysis was frequent (18.6%). Antibiotherapy (mostly ceftriaxone 3–4 weeks) resulted in symptom resolution. This series gives an updated overview of the peripheral complications of neuroborreliosis to help identify this disease so that timely treatment could avoid axonal loss.

Combining Double-Dose and High-Dose Pulsed Dapsone Combination Therapy for Chronic Lyme Disease/Post-Treatment Lyme Disease Syndrome and Co-Infections, Including Bartonella: A Report of 3 Cases and a Literature Review

“…Many of these overlapping factors on the MSIDS map were increasing underlying symptomatology, apart from her tick-borne infections since hypoglycemia, Candida, POTS, low adrenal function, chronic insomnia, depression, low glutathione levels, vitamin and mineral deficiencies, heavy metal toxicity, and possible mitochondrial dysfunction can all increase underlying fatigue and affect mood [170][171][172][173][174][175][176][177][178][179]. Similarly, infections with Borrelia, Bartonella, and Anaplasma, heavy metal toxicity, i.e., mercury (Hg), lead (Pb), and arsenic (As), mold toxicity, vitamin B deficiency, and mitochondrial dysfunction can all cause neurological symptoms and increase neuropathy [180][181][182][183][184][185][186], which is why a full MSIDS evaluation in CLD/PTLDS is highly important for diagnosing and treating all potential overlapping etiologies. A laboratory clue that Bartonella was also playing a significant role in her chronic illness was that she had an indeterminate Bartonella Western blot and evidence of prior exposure to Bartonella vinsonii sub spp.…”

Socio-demographic Characteristics of Tick Bite and Erythema migrans not associated with the Diagnosis of Neuroboreliosis

“…Late neuroborreliosis is a rare manifestation of LNB, accounting for approximately 5% of all LNB cases, with neurological symptoms occurring more than 6 months after the primoinfection [19]. It manifests most often as myelitis and encephalomyelitis, less often as meningoencephalitis or radiculomyelitis.…”

“…Factors independently associated with definite LNB in multivariable analyses were (i) age < 18 years (aOR 7.89, 95% CI 2.00-31.03, p < 0,003), (ii) female gender (OR 6.34; 95% CI 1.66-24.17, p < 0.007), and (iii) facial nerve palsy (OR 10.54; 95% CI 2.41-55. 19, p < 0.002).…”

Peripheral neuropathy due to neuroborreliosis: Insensitivity for CXCL13 as early diagnostic marker

“…The features of acute peripheral LNB neuropathy include axonal or demyelinating disease with a distal asymmetric distribution of motor and/or sensory symptoms and pain (Kaminsky et al, 2020). Acute peripheral LNB may manifest as mononeuritis or with a multiplex distribution (Lazaro and Butt, 2019;Osman et al, 2020).…”