Neuroborreliosis

from Wikipedia, the free encyclopedia
Classification according to ICD-10
A69.2 + Lyme disease
G01 * Meningitis in bacterial diseases classified elsewhere
G63.0 * Polyneuropathy in infectious and parasitic diseases classified elsewhere
ICD-10 online (WHO version 2019)

Neuroborreliosis ( neuro-disease ) is a manifestation of Lyme disease , an infectious disease, caused by the bacterium Borrelia burgdorferi is produced. In Europe, this pathogen is mainly transmitted by the common wood tick ( Ixodes ricinus ), very rarely also by flying insects (horseflies, mosquitoes). Borreliosis is a systemic disease that can affect various organ systems, including the central and peripheral nervous system . Neuroborreliosis is about 50% after erythema migrans, the most common disease manifestation of a Borrelia infection in Europe and also in Germany.

course

In the initial stage ( early localized stage ) of Lyme disease, between the 3rd and 30th day after a tick bite , about half of the patients develop ring-shaped reddening ( erythema chronicum migrans ), often at the site of the tick bite. Atypical forms such as lymphocytoma are possible; other symptoms of an infection can include flu-like symptoms such as headaches, a feeling of exhaustion and a high temperature. If the erythema migrans is not treated promptly or not long enough and in high enough doses with antibiotics, there is a risk that the pathogens will spread ( disseminated or generalized stage ). The occurrence of flu-like symptoms, in particular fever, fatigue, muscle pain ( myalgia ), but without a cough and runny nose, indicates a transition to the disseminated stage.

Since the tick bite is usually painless, around 50 percent of those affected do not develop erythema migrans and this is often overlooked when it occurs in areas of the body that are difficult to see, the disease can progress further and affect all organs, but especially the central and peripheral nervous system Affects muscles and joints and the heart. Neuroborreliosis often develops in the early disseminated stage. It can also occur at the same time as erythema migrans. Due to possible longer incubation and latency periods, the disease manifestation can develop months or, in individual cases, years after an infection.

Signs of illness

In the early disseminated stage, meningitis and meningoradiculitis (Garin-Boujadoux-) Bannwarth often occur. Particularly at night, severe pain in the supply area of ​​individual nerves or nerve roots is typical, often with accompanying paralysis. It can lead to cranial nerve failure; the peripheral facial palsy , which is often bilateral, is exemplary . An isolated infestation of the peripheral nervous system in the sense of an inflammation of nerves ( neuritis ) is possible.

In the European and German recommendations for Lyme borreliosis, the following late forms of neuroborreliosis are mentioned:

  • Neurological, neuropsychiatric diseases
  • Radiculitis of spinal and cranial nerves,
  • Peripheral nerve neuritis,
  • Meningitis,
  • Myelitis,
  • cerebral vasculitis,
  • Myositis, dermatomyositis-like courses,
  • Encephalitis, encephalopathy.

Neuroborreliosis should also be considered for the following symptoms:

  • Severe nerve pain that does not respond to pain medication or standard anti-inflammatory pain relievers (NSAIDs)
  • Paralysis, especially of the legs and face
  • Numbness of the face and / or extremities
  • Heat and cold or chills
  • Severe and persistent cap-shaped headache
  • Dizziness and balance disorders
  • Visual disturbances (e.g. inflammation of the optic nerve)
  • Gait disorders (lanky gait)
  • cognitive impairments, e.g. B. concentration, memory, difficulty finding words
  • Persistent and severe exhaustion and tiredness
  • Changes of character

The early acute neuroborreliosis is usually associated with very severe symptoms. The later course can be gradual.

Diagnosis

The diagnosis of neuroborreliosis is often difficult. It can be confirmed in 10% of all cases on the basis of a nerve water examination . The following diagnostic criteria are given in the specialist literature for diagnosing neuroborreliosis:

  • A corresponding clinical picture;
  • the presence of intrathecally produced antibodies (CSF / serum index, IgG and IgM> 2.0 (or 1.5) to ensure that the antibodies have not been passively transferred from the serum, but that an antibody production has taken place in the CSF Has;
  • an increase in certain white blood cells in the CSF (lymphocytic pleocytosis);
  • as possible additional criteria the determination of the albumin quotient for the detection of a blood-liquor barrier disorder and of specific oligoclonal bands.

Depending on which criteria are met, neuroborreliosis is designated as confirmed, probable or possible. The evaluation of the diagnostic criteria is, however, controversial. In particular, if the peripheral nervous system is affected, the signs of inflammation in the liquor may be absent. In the early phase of neuroborreliosis with involvement of the central nervous system, no antibodies and therefore no intrathecal antibodies are often found in the CSF.

therapy

There are penicillins , cephalosporins ( ceftriaxone , cefotaxime ) or doxycycline used. Minocycline is beneficial in that it acts intracellularly and can cross the blood-brain barrier well. As a rule, antibiotics are given for three to four weeks .

However, the optimal therapy for neuroborreliosis is debatable. A recent American study examined whether Lyme encephalopathy responds to repeated and prolonged treatment with ceftriaxone. Only short-term improvements were found. Medical dissent concerns the type of antibiotic, the duration of the treatment, the dosage of the respective antibiotic, side effects and possible repetitions in the event of therapy failure.

literature

Web links

Individual evidence

  1. ^ Guideline on neuroborreliosis of the German Society for Neurology . In: AWMF online (as of 2005)
  2. ^ Guideline on neuroborreliosis of the German Society for Neurology . In: AWMF online (as of 2005)
  3. ^ A b G. Günther, M. Haglund: Tick-borne encephalopathies: epidemiology, diagnosis, treatment and prevention. CNS drugs . 2005; 19 (12), pp. 1009-1032. PMID 16332143 .
  4. ↑ Logigian et al. Successful treatment of Lyme encephalopathy with intravenous ceftriaxone. In: J Infect Dis . 1999 Aug; 180 (2), pp. 377-383. PMID 10395852
  5. ↑ Petra Hopf-Seidel: Sick after a tick bite. Recognize Lyme disease and treat it effectively. Knaur, Munich 2008, p. 244.
  6. ↑ Dr. Petra Hopf-Seidel: The chronic-persistent borreliosis. (PDF) Retrieved October 15, 2018 .
  7. ^ Brian A. Fallon et al.: A randomized, placebo-controlled trial of repeated IV antibiotic therapy for Lyme encephalopathy. In: Neurology. 2007, doi: 10.1212 / 01.WNL.0000284604.61160.2d .