Practice parameters for the diagnosis of patients with nervous system Lyme borreliosis (Lyme disease)

Halperin, John J.; Logigian, Eric L.; Finkel, Michael F.; Pearl, Richard A.

doi:10.1212/wnl.46.3.619

Cited by 146 publications

(91 citation statements)

References 29 publications

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“…The latter ®ndings are supportive, but not proof, of neuroborreliosis. The suspected diagnosis is con®rmed either by the demonstration of intrathecal synthesis of Borrelia burgdorferi sensu latospeci®c IgG or IgM antibodies or by the demonstration of borrelial DNA in the CSF by PCR [3]. In Europe, three species of B. burgdorferi sensu lato are pathogenic for man.…”

Section: Introductionmentioning

confidence: 99%

False-negative serology in patients with neuroborreliosis and the value of employing of different borrelial strains in serological assays

Kaiser

2000

Journal of Medical Microbiology

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The risk of obtaining false-negative results in serological assays in serum and CSF specimens with only one strain of Borrelia burgdorferi sensu lato as antigen was investigated in 79 patients with neuroborreliosis with specimens obtained at initial presentation. Serum antibodies were assessed by immunoblotting; the criteria of Hauser et al. were used to evaluate the test. The intrathecal synthesis of borrelial-speci®c IgM and IgG antibodies was examined by enzyme immunoassay (EIA). Strains of B. burgdorferi sensu stricto (BbZ160), B. garinii (Bbii50) and B. afzelii (PKO) served as sources of antigen in both assays. All patients produced either a positive IgM or IgG test in serum with at least one strain of B. burgdorferi sensu lato. Reactivity of IgM or IgG antibodies, or both, with antigens of all three strains was demonstrated in 67 (85%) of 79 sera. The correlation of results of immunoblotting with different strains was signi®cantly better for IgG (85%) than for IgM antibodies (54%). The variability of positive IgM reactions in 18 specimens was mainly due to the fact that the antibodies were directed to the relevant variable outer-surface protein C (p23). Intrathecal synthesis of IgG antibodies was demonstrated in 58 patients (81%) of 72 and of IgM antibodies in 25 of 58 patients. No patient had isolated intrathecal synthesis of IgM antibodies. The majority of CSF samples (56 of 58) were assessed as IgG antibodypositive, independent of the borrelial strain used as antigen in EIA, whereas only 10 of 25 IgM antibody-positive CSF specimens reacted with all three strains. All patients in the study had intrathecal antibody synthesis demonstrable at 6-week follow-up. From this study it is concluded that there is a small, but real, risk of false-negative serological ®ndings at the time of initial clinical presentation in patients with typical symptoms of neuroborreliosis. In these patients a negative serological result with one strain should prompt the repetition of the test with other strains of B. burgdorferi sensu lato.

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Section: Introductionmentioning

confidence: 99%

False-negative serology in patients with neuroborreliosis and the value of employing of different borrelial strains in serological assays

Kaiser

2000

Journal of Medical Microbiology

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“…Optic neuropathy in Lyme neuro-borreliosis is a typi- cally rare complication. However, in adult cases, special attention seems reasonable in patients with unilateral painless visual disturbance, bilateral optic nerve head swelling with or without an elevated cerebrospinal fl uid opening pressure [1,3,5,6]. The differential diagnosis in a patient with subtle optic disc oedema and subretinal fl uid includes both infectious and non-infectious entities.…”

Section: Discussionmentioning

confidence: 99%

“…Cranial neuropathies are common, but neuroretinitis has been reported in a few isolated cases. The relationship between neuroretinitis and Lyme disease has not been established and the result of recent studies remains controversial [1][2][3][4][5][6]. We describe the case history of a patient with Lyme disease complicated by neuroretinitis in the right eye and incomplete empty sella.…”

Section: Introductionmentioning

confidence: 99%

Lyme disease associated neuroretinitis — Case report

Vanya

Fejes

Jakó

et al. 2015

Acta Microbiologica et Immunologica Hungarica

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We describe a rare case of Lyme disease complicated by unilateral neuroretinitis in the right eye. We report a case of a 27-year-old woman with blurred vision on her right eye. Because of the suspicion of optic neuritis (multiplex sclerosis) neurological examination was ordered. Surprisingly, computer tomography of the brain revealed incomplete empty sella, which generally results not monocular, but bilateral optic nerve swelling. Opthalmological examination (ophthalmoscopy and optical coherence tomography) indicated not only monocular optic nerve, but retinal oedema next to the temporal part of the right optic disk. Visual evoked potentials (VEP) demonstrated no P100 latency delay and mild differences between the amplitudes of the responses of the left and right eye. Optical coherence tomography (OCT) demonstrated the swelling of the optic nerve head and oedematous retina at the temporal part of the disk. Suspicion of an infl ammatory cause of visual disturbance blood tests was ordered. Doxycycline treatment was ordered till the result of the blood test arrived. The Western blot and ELISA test were positive for Borrelia burgdorferi sensu lato. Following one week corticosteroide and ceftriaxone treatments, the patient displayed a clinical improvement. Unilateral neuroretinitis with optic disk swelling due to neuroborreliosis is a rare complication and in many cases it is diffi cult to distinguish between infl ammatory and ischemic lesions. Further difficulty in the diagnosis can occur when intracranial alterations such as empty sella is demonstrated by CT examination.

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“…39 Individual case reports describe lower cranial nerve deficits (IX to XII). 42 The most commonly misdiagnosed disorder is what has been termed 'radiculoneuropathy', which probably occurs in up to 4-5% of untreated infected individuals. Patients typically have symptoms indistinguishable from a mechanical radiculopathy, such as that caused by an acute disc herniation.…”

Section: What Is Nervous System Disease?mentioning

confidence: 99%

Nervous system Lyme disease

Halperin

2010

JRCPE

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Practice parameters for the diagnosis of patients with nervous system Lyme borreliosis (Lyme disease)

Cited by 146 publications

References 29 publications

False-negative serology in patients with neuroborreliosis and the value of employing of different borrelial strains in serological assays

False-negative serology in patients with neuroborreliosis and the value of employing of different borrelial strains in serological assays

Lyme disease associated neuroretinitis — Case report

Nervous system Lyme disease

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