Lyme Neuroborreliosis: Preliminary Results from an Urban Referral Center Employing Strict CDC Criteria for Case Selection.

David S Younger,Stuart Orsher

doi:10.1155/2010/525206

Abstract

Lyme neuroborreliosis or “neurological Lyme disease” was evidenced in 2 of 23 patients submitted to strict criteria for case selection of the Centers for Disease Control and Prevention employing a two-tier test to detect antibodies to Borrelia burgdorferi at a single institution. One patient had symptomatic polyradiculoneuritis, dysautonomia, and serological evidence of early infection; and another had symptomatic small fiber sensory neuropathy, distal polyneuropathy, dysautonomia, and serological evidence of late infection. In the remaining patients symptoms initially ascribed to Lyme disease were probably unrelated to B. burgdorferi infection. Our findings suggest early susceptibility and protracted involvement of the nervous system most likely due to the immunological effects of B. burgdorferi infection, although the exact mechanisms remain uncertain.

Highlights

Lyme disease is a multisystem infectious disease caused by the bite of the hard shelled Ixodes tick-borne spirochete B. burgdorferi sensu stricto, which frequently affects the nervous system [1]
The records of 50 consecutive patients referred to the author (D.S.Y.) were selected for inclusion based upon conformity to strict criteria for clinical and laboratory case definition of Lyme disease of the Centers for Disease Control and Prevention (CDC) [4, 5]
The remaining 21 patients had negative or indeterminate laboratory evidence of Lyme disease indicating that symptoms initially ascribed to Lyme disease were probably unrelated to B. burgdorferi infection

Summary

Introduction

Lyme disease is a multisystem infectious disease caused by the bite of the hard shelled Ixodes tick-borne spirochete B. burgdorferi sensu stricto (hereafter referred to as B. burgdorferi), which frequently affects the nervous system [1]. Heightened awareness of the spectrum of Lyme neuroborreliosis (LNB) has resulted in increased serological testing to detect antibodies to B. burgdorferi in patients with early and late infection, and in many, even without the typical clinical features, who may be receiving empiric antibiotics for late disease [2]. With this in mind the first 50 patients with presumed LNB were screened and strict criteria were applied for case ascertainment of Lyme disease. A preliminary report has been published [3]

Methods

Patient Descriptions

Findings

Discussion