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Lars Hagberg - One of the best experts on this subject based on the ideXlab platform.
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cerebrospinal fluid cxcl13 in Lyme Neuroborreliosis and asymptomatic hiv infection
BMC Neurology, 2013Co-Authors: Daniel Bremell, Niklas Mattsson, Mikael Edsbagge, Kaj Blennow, Ulf Andreasson, Carsten Wikkelso, Henrik Zetterberg, Lars HagbergAbstract:Background It has been suggested that cerebrospinal fluid (CSF) CXCL13 is a diagnostic marker of Lyme Neuroborreliosis (LNB), as its levels have been shown to be significantly higher in LNB than in several other CNS infections. Levels have also been shown to decline after treatment with intravenous ceftriaxone, but levels after treatment with oral doxycycline have previously not been studied. Like Borrelia burgdorferi, HIV also has neurotropic properties. Elevated serum CXCL13 concentrations have been reported in HIV patients, but data on CSF levels are limited.
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Lyme Neuroborreliosis in HIV-1 positive men successfully treated with oral doxycycline: a case series and literature review
Journal of medical case reports, 2011Co-Authors: Daniel Bremell, Christer Säll, Magnus Gisslén, Lars HagbergAbstract:Introduction: Lyme Neuroborreliosis is the most common bacterial central nervous system infection in the temperate parts of the northern hemisphere. Even though human immunodeficiency virus (HIV) -1 infection is common in Lyme borreliosis endemic areas, only five cases of co-infection have previously been published. Four of these cases presented with typical Lyme Neuroborreliosis symptoms such as meningoradiculitis and facial palsy, while a fifth case had more severe symptoms of encephalomyelitis. All five were treated with intravenous cephalosporins and clinical outcome was good for all but the fifth case Case presentations: We present four patients with concomitant presence of HIV-1 infection and Lyme Neuroborreliosis diagnosed in Western Sweden. Patient 1 was a 60-year-old Caucasian man with radicular pain and cognitive impairment. Patient 2 was a 39-year-old Caucasian man with headaches, leg weakness, and pontine infarction. Patient 3 was a 62-year-old Caucasian man with headaches, tremor, vertigo, and normal-pressure hydrocephalus. Patient 4 was a 50-year-old Caucasian man with radicular pain and peripheral facial palsy. Patients one, two, and three all had subnormal levels of CD4 cells, indicating impaired immunity. All patients were treated with oral doxycycline with good clinical outcome and normalization of CSF pleocytosis. Conclusion: Given the low HIV-1 prevalence and medium incidence of Lyme Neuroborreliosis in Western Sweden where these four cases were diagnosed, co-infection with HIV-1 and Borrelia is probably more common than previously thought. The three patients that were the most immunocompromised suffered from more severe and rather atypical neurological symptoms than are usually described among patients with Lyme Neuroborreliosis. It is therefore important for doctors treating HIV patients to consider Lyme Neuroborreliosis in a patient presenting with atypical neurological symptoms. All four patients were treated with oral doxycycline with a good outcome, further proving the efficacy of this regime.
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clinical characteristics and cerebrospinal fluid parameters in patients with peripheral facial palsy caused by Lyme Neuroborreliosis compared with facial palsy of unknown origin bell s palsy
BMC Infectious Diseases, 2011Co-Authors: Daniel Bremell, Lars HagbergAbstract:Background: Bell’s palsy and Lyme Neuroborreliosis are the two most common diagnoses in patients with peripheral facial palsy in areas endemic for Borrelia burgdorferi. Bell’s palsy is treated with corticosteroids, while Lyme Neuroborreliosis is treated with antibiotics. The diagnosis of Lyme Neuroborreliosis relies on the detection of Borrelia antibodies in blood and/or cerebrospinal fluid, which is time consuming. In this study, we retrospectively analysed clinical and cerebrospinal fluid parameters in well-characterised patient material with peripheral facial palsy caused by Lyme Neuroborreliosis or Bell’s palsy, in order to obtain a working diagnosis and basis for treatment decisions in the acute stage. Methods: Hospital records from the Department of Infectious Diseases, Sahlgrenska University Hospital, for patients with peripheral facial palsy that had undergone lumbar puncture, were reviewed. Patients were classified as Bell’s palsy, definite Lyme Neuroborreliosis, or possible Lyme Neuroborreliosis, on the basis of the presence of Borrelia antibodies in serum and cerebrospinal fluid and preceding erythema migrans. Results: One hundred and two patients were analysed; 51 were classified as Bell’s palsy, 34 as definite Lyme Neuroborreliosis and 17 as possible Lyme Neuroborreliosis. Patients with definite Lyme Neuroborreliosis fell ill during the second half of the year, with a peak in August, whereas patients with Bell’s palsy fell ill in a more evenly distributed manner over the year. Patients with definite Lyme Neuroborreliosis had significantly more neurological symptoms outside the paretic area of the face and significantly higher levels of mononuclear cells and albumin in their cerebrospinal fluid. A reported history of tick bite was uncommon in both groups. Conclusions: We found that the time of the year, associated neurological symptoms and mononuclear pleocytosis were strong predictive factors for Lyme Neuroborreliosis as a cause of peripheral facial palsy in an area endemic for Borrelia. For these patients, we suggest that ex juvantibus treatment with oral doxycycline should be preferred to early corticosteroid treatment. Background Peripheral facial palsy occurs in the general population, with an annual incidence of 20-53 per 100,000 [1,2]. In areas endemic for Borrelia burgdorferi (Bb), Lyme Neuroborreliosis (LNB) is estimated to cause 2-25% of peripheral facial palsy cases [3-6]. The remaining cases are caused by a wide range of diagnoses, such as Ramsay Hunt syndrome, sarcoidosis, Sjogren’s syndrome, tumours and acute idiopathic peripheral facial palsy, also known as Bell’s palsy (BP). Of these, BP constitutes by far the largest group, causing 60-75% of cases of peripheral facial palsy [2,7]. While LNB is treated with oral doxycycline or intravenous ceftriaxone, early treatment (within 72 hours) with corticosteroids improves the outcome in BP [8-12]. In order to choose the right treatment, it is important to differentiate between these two conditions. Antibodies to Bb in serum and cerebrospinal fluid (CSF) are often helpful in
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intravenous ceftriaxone compared with oral doxycycline for the treatment of Lyme Neuroborreliosis
Scandinavian Journal of Infectious Diseases, 2005Co-Authors: Rebecca Borg, Lars Hagberg, Leif Dotevall, Stanka Lotricfurlan, Vera Maraspin, Joze Cimperman, Franc StrleAbstract:This prospective, open-label, non-randomized trial at the University Departments of Infectious Diseases in Ljubljana, Slovenia, and Goteborg, Sweden, was conducted to compare the kinetics of the cerebrospinal fluid (CSF) mononuclear cell count after 10-14 d of ceftriaxone or doxycycline for treatment of Lyme Neuroborreliosis. 29 patients were treated with intravenous ceftriaxone 2 g daily in Ljubljana and 36 patients with oral doxycycline 400 mg daily in Goteborg. The study protocol included lumbar puncture before and 6-8 weeks after treatment initiation. There was a marked decrease (1.2 log10 x 10(6)/l) of the median CSF mononuclear cell count following treatment. With the assumption of a linear regression of the logarithmic mononuclear cell counts between the 2 lumbar punctures, no significant difference between the 2 antibiotic treatments could be found. All patients were clinically much improved after treatment. At 6 months follow-up 23 (79%) of the ceftriaxone- and 26 (72%) of the doxycycline-treated patients were completely recovered. Intravenous ceftriaxone or oral doxycycline was found to be effective, safe, and convenient for treatment of Lyme Neuroborreliosis.
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Pain as presenting symptom in Lyme Neuroborreliosis
European journal of pain (London England), 2003Co-Authors: Leif Dotevall, Lars Hagberg, Tore Eliasson, Clas MannheimerAbstract:Neurogenic pain with radiculitis is often the starting symptom in adult patients with tick-borne Lyme Neuroborreliosis and in some cases the only clinical manifestation. Cranial paresis and other neurologic signs usually occur after the onset of pain. The present paper describes four patients who had severe pain as the main presenting symptom of Lyme Neuroborreliosis. Opioids had good short-term effect in two of the cases. Oral doxycycline treatment was used successfully to eliminate the infection.
Daniel Bremell - One of the best experts on this subject based on the ideXlab platform.
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oral doxycycline for Lyme Neuroborreliosis with symptoms of encephalitis myelitis vasculitis or intracranial hypertension
European Journal of Neurology, 2014Co-Authors: Daniel Bremell, Leif DotevallAbstract:Background and purpose The treatment recommendation for Lyme Neuroborreliosis with central nervous system (CNS) symptoms is intravenous ceftriaxone, according to current American and European guidelines. For Lyme Neuroborreliosis with peripheral nervous system (PNS) symptoms, treatment with intravenous ceftriaxone and oral doxycycline is considered equally effective. The purpose of this study was to evaluate the efficacy of oral doxycycline in the treatment of Lyme Neuroborreliosis with CNS symptoms. Methods Patients with Lyme Neuroborreliosis who had undergone cerebrospinal fluid (CSF) sampling before and after treatment at the Department of Infectious Diseases, Sahlgrenska University Hospital, during the period 1990–2012, were included in this retrospective study. The CSF mononuclear cell count was used as a surrogate marker of treatment outcome. Comparisons of CSF mononuclear cell counts were made between patients with CNS symptoms and patients with PNS symptoms before and after treatment with oral doxycycline. Results Twenty-six patients classified as having CNS symptoms and 115 patients classified as having PNS symptoms were included. The decline in CSF mononuclear cell counts did not differ significantly between the two groups of patients. All patients with CNS disease showed a marked clinical improvement after treatment, even though 62% had remaining symptoms at the end of follow-up. Conclusion Treatment with oral doxycycline resulted in a similar decrease in CSF mononuclear cell counts in patients with Lyme Neuroborreliosis with CNS symptoms compared with patients with Lyme Neuroborreliosis with PNS symptoms. The results indicate that oral doxycycline is an effective treatment for Lyme Neuroborreliosis irrespective of the severity of symptoms.
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cerebrospinal fluid cxcl13 in Lyme Neuroborreliosis and asymptomatic hiv infection
BMC Neurology, 2013Co-Authors: Daniel Bremell, Niklas Mattsson, Mikael Edsbagge, Kaj Blennow, Ulf Andreasson, Carsten Wikkelso, Henrik Zetterberg, Lars HagbergAbstract:Background It has been suggested that cerebrospinal fluid (CSF) CXCL13 is a diagnostic marker of Lyme Neuroborreliosis (LNB), as its levels have been shown to be significantly higher in LNB than in several other CNS infections. Levels have also been shown to decline after treatment with intravenous ceftriaxone, but levels after treatment with oral doxycycline have previously not been studied. Like Borrelia burgdorferi, HIV also has neurotropic properties. Elevated serum CXCL13 concentrations have been reported in HIV patients, but data on CSF levels are limited.
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Lyme Neuroborreliosis in HIV-1 positive men successfully treated with oral doxycycline: a case series and literature review
Journal of medical case reports, 2011Co-Authors: Daniel Bremell, Christer Säll, Magnus Gisslén, Lars HagbergAbstract:Introduction: Lyme Neuroborreliosis is the most common bacterial central nervous system infection in the temperate parts of the northern hemisphere. Even though human immunodeficiency virus (HIV) -1 infection is common in Lyme borreliosis endemic areas, only five cases of co-infection have previously been published. Four of these cases presented with typical Lyme Neuroborreliosis symptoms such as meningoradiculitis and facial palsy, while a fifth case had more severe symptoms of encephalomyelitis. All five were treated with intravenous cephalosporins and clinical outcome was good for all but the fifth case Case presentations: We present four patients with concomitant presence of HIV-1 infection and Lyme Neuroborreliosis diagnosed in Western Sweden. Patient 1 was a 60-year-old Caucasian man with radicular pain and cognitive impairment. Patient 2 was a 39-year-old Caucasian man with headaches, leg weakness, and pontine infarction. Patient 3 was a 62-year-old Caucasian man with headaches, tremor, vertigo, and normal-pressure hydrocephalus. Patient 4 was a 50-year-old Caucasian man with radicular pain and peripheral facial palsy. Patients one, two, and three all had subnormal levels of CD4 cells, indicating impaired immunity. All patients were treated with oral doxycycline with good clinical outcome and normalization of CSF pleocytosis. Conclusion: Given the low HIV-1 prevalence and medium incidence of Lyme Neuroborreliosis in Western Sweden where these four cases were diagnosed, co-infection with HIV-1 and Borrelia is probably more common than previously thought. The three patients that were the most immunocompromised suffered from more severe and rather atypical neurological symptoms than are usually described among patients with Lyme Neuroborreliosis. It is therefore important for doctors treating HIV patients to consider Lyme Neuroborreliosis in a patient presenting with atypical neurological symptoms. All four patients were treated with oral doxycycline with a good outcome, further proving the efficacy of this regime.
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clinical characteristics and cerebrospinal fluid parameters in patients with peripheral facial palsy caused by Lyme Neuroborreliosis compared with facial palsy of unknown origin bell s palsy
BMC Infectious Diseases, 2011Co-Authors: Daniel Bremell, Lars HagbergAbstract:Background: Bell’s palsy and Lyme Neuroborreliosis are the two most common diagnoses in patients with peripheral facial palsy in areas endemic for Borrelia burgdorferi. Bell’s palsy is treated with corticosteroids, while Lyme Neuroborreliosis is treated with antibiotics. The diagnosis of Lyme Neuroborreliosis relies on the detection of Borrelia antibodies in blood and/or cerebrospinal fluid, which is time consuming. In this study, we retrospectively analysed clinical and cerebrospinal fluid parameters in well-characterised patient material with peripheral facial palsy caused by Lyme Neuroborreliosis or Bell’s palsy, in order to obtain a working diagnosis and basis for treatment decisions in the acute stage. Methods: Hospital records from the Department of Infectious Diseases, Sahlgrenska University Hospital, for patients with peripheral facial palsy that had undergone lumbar puncture, were reviewed. Patients were classified as Bell’s palsy, definite Lyme Neuroborreliosis, or possible Lyme Neuroborreliosis, on the basis of the presence of Borrelia antibodies in serum and cerebrospinal fluid and preceding erythema migrans. Results: One hundred and two patients were analysed; 51 were classified as Bell’s palsy, 34 as definite Lyme Neuroborreliosis and 17 as possible Lyme Neuroborreliosis. Patients with definite Lyme Neuroborreliosis fell ill during the second half of the year, with a peak in August, whereas patients with Bell’s palsy fell ill in a more evenly distributed manner over the year. Patients with definite Lyme Neuroborreliosis had significantly more neurological symptoms outside the paretic area of the face and significantly higher levels of mononuclear cells and albumin in their cerebrospinal fluid. A reported history of tick bite was uncommon in both groups. Conclusions: We found that the time of the year, associated neurological symptoms and mononuclear pleocytosis were strong predictive factors for Lyme Neuroborreliosis as a cause of peripheral facial palsy in an area endemic for Borrelia. For these patients, we suggest that ex juvantibus treatment with oral doxycycline should be preferred to early corticosteroid treatment. Background Peripheral facial palsy occurs in the general population, with an annual incidence of 20-53 per 100,000 [1,2]. In areas endemic for Borrelia burgdorferi (Bb), Lyme Neuroborreliosis (LNB) is estimated to cause 2-25% of peripheral facial palsy cases [3-6]. The remaining cases are caused by a wide range of diagnoses, such as Ramsay Hunt syndrome, sarcoidosis, Sjogren’s syndrome, tumours and acute idiopathic peripheral facial palsy, also known as Bell’s palsy (BP). Of these, BP constitutes by far the largest group, causing 60-75% of cases of peripheral facial palsy [2,7]. While LNB is treated with oral doxycycline or intravenous ceftriaxone, early treatment (within 72 hours) with corticosteroids improves the outcome in BP [8-12]. In order to choose the right treatment, it is important to differentiate between these two conditions. Antibodies to Bb in serum and cerebrospinal fluid (CSF) are often helpful in
Franc Strle - One of the best experts on this subject based on the ideXlab platform.
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Lyme Neuroborreliosis in a patient treated with TNF-alpha inhibitor.
Infection, 2015Co-Authors: Maja Ivartnik Merkac, Janez Tomazic, Franc StrleAbstract:A 57-year-old woman, receiving TNF-alpha inhibitor adalimumab for psoriasis, presented with early Lyme Neuroborreliosis (Bannwarth’s syndrome). Discontinuation of adalimumab and 14-day therapy with ceftriaxone resulted in a smooth course and favorable outcome of Lyme borreliosis. This is the first report on Lyme Neuroborreliosis in a patient treated with TNF-alpha inhibitor.
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suspected early Lyme Neuroborreliosis in patients with erythema migrans
Clinical Infectious Diseases, 2013Co-Authors: Katarina Ogrinc, Tjaša Cerar, Stanka Lotricfurlan, Vera Maraspin, Lara Lusa, Eva Ružicsabljic, Franc StrleAbstract:Background Our objective was to obtain data on patients with erythema migrans (EM) who have symptoms/signs suggesting nervous system involvement and to compare epidemiologic, clinical, and microbiologic findings in patients with and without cerebrospinal fluid (CSF) pleocytosis. Methods Adult patients with EM and suspected early Lyme Neuroborreliosis were included in this study. Results Of 161 patients, 31 (19%) had elevated and 130 (81%) had normal CSF cell counts. In contrast to patients with normal CSF cell counts, those with pleocytosis (1) more often reported radicular pain and more often presented with meningeal signs but less frequently complained of malaise; (2) had larger EM skin lesions despite similar duration; (3) more commonly had Borrelia garinii isolated from EM skin lesions (odds ratio for pleocytosis was 31 times higher in patients with established B. garinii skin infection compared to patients with other Borrelia species isolated from their EM skin lesion) and from CSF; and (4) more frequently fulfilled microbiologic criteria for established borrelial infection of the central nervous system. The positive predictive value of pleocytosis for microbiologically proven borrelial infection of the central nervous system (defined by isolation of Borrelia from CSF and/or demonstration of intrathecal synthesis of borrelial antibodies) was 67.9%, whereas normal CSF white cell counts ruled out Lyme Neuroborreliosis with a predictive value of 91.9%. Conclusions Comparison of European patients with EM who had symptoms/signs suggesting early Lyme Neuroborreliosis revealed several differences in the clinical presentation and in microbiologic test results according to CSF findings.
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Diagnostic value of cytokines and chemokines in Lyme Neuroborreliosis.
Clinical and vaccine immunology : CVI, 2013Co-Authors: Tjaša Cerar, Katarina Ogrinc, Stanka Lotric-furlan, J. Kobal, S. Levičnik-stezinar, Franc Strle, Eva Ružić-sabljićAbstract:The aims of the present study were to assess the concentrations of different cytokines and chemokines in blood serum and cerebrospinal fluid (CSF) samples of patients with Lyme Neuroborreliosis and to identify the possible marker(s) that would enable a distinction between clinically evident and suspected Lyme Neuroborreliosis, as well as between Lyme Neuroborreliosis and tick-borne encephalitis (TBE). Our additional interest was to evaluate the relationship between cytokine and chemokine concentrations and Borrelia burgdorferi sensu lato isolation from CSF, as well as intrathecal synthesis of specific borrelial antibodies. We found that higher concentrations of CXCL13 and lower concentrations of interleukin 10 (IL-10) in serum were associated with higher odds for clinically evident Lyme Neuroborreliosis compared to suspected Lyme Neuroborreliosis, as well as to TBE. The concentrations of IL-2, IL-5, IL-6, IL-10, and CXCL13 in the CSF were higher in patients with evident Lyme Neuroborreliosis than in those who were only suspected to have the disease. A comparison of CSF cytokine and chemokine levels in patients with and without intrathecal synthesis of specific borrelial antibodies revealed that CXCL13 CSF concentration is significantly associated with intrathecal synthesis of borrelial antibodies. A comparison of the cytokine and chemokine CSF concentrations in patients with clinically evident Lyme Neuroborreliosis according to CSF culture results revealed that higher concentrations of gamma interferon (IFN-γ) were associated with lower odds of Borrelia isolation. Although several differences in the blood serum and CSF concentrations of various cytokines and chemokines between the groups were found, the distinctive power of the majority of these findings is low. Further research on well-defined groups of patients is needed to appraise the potential diagnostic usefulness of these concentrations.
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Humoral Immune Responses in Patients with Lyme Neuroborreliosis
Clinical and vaccine immunology : CVI, 2010Co-Authors: Tjaša Cerar, Katarina Ogrinc, Franc Strle, Eva Ruzic-sabljicAbstract:The aim of this study was to analyze and compare the humoral immune responses in serum and cerebrospinal fluid (CSF) for 34 adult patients with clinically evident Lyme Neuroborreliosis, 27 patients with clinically suspected Lyme Neuroborreliosis, and 32 patients with tick-borne encephalitis. Additionally, we wanted to compare the findings of two methods for the detection of intrathecally synthesized borrelial antibodies: the IDEIA Lyme Neuroborreliosis test using flagellar antigen and an approach based on the Liaison indirect chemiluminescence immunoassay using the OspC and VlsE antigens. Borrelial IgM and IgG antibodies were detected by at least one of these methods in the sera of 22/34 (64.7%) and 28/34 (82.4%) patients with clinically evident Lyme Neuroborreliosis, respectively, and in the cerebrospinal fluid of 22/34 (64.7%) and 20/34 (58.8%) of these patients, respectively. Intrathecal synthesis of borrelial IgM and/or IgG was found in 19/34 (55.9%) patients: IgM in 17/34 (50%) patients and IgG in 15/34 (44.1%) patients. The relatively low proportion of intrathecal synthesis of borrelial antibodies and the high ratio of IgM positivity could be explained by the short duration of neurological disease as evidenced by reported symptoms (median, 10 days). Assessment of the humoral immune response in the sera and CSF of patients with early Lyme Neuroborreliosis confirmed previous findings on the relationship between the duration of illness and the proportion of patients with detectable responses.
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validation of cultivation and pcr methods for diagnosis of Lyme Neuroborreliosis
Journal of Clinical Microbiology, 2008Co-Authors: Tjaša Cerar, Katarina Ogrinc, Franc Strle, Stanka Lotricfurlan, Joze Cimperman, Eva RužicsabljicAbstract:Borrelial infection may manifest with a wide range of clinical signs, and in many cases, microbiological findings are essential for a proper diagnosis. This study included 48 patients with a working clinical diagnosis of Lyme Neuroborreliosis, 45 patients with a working clinical diagnosis of suspected Lyme Neuroborreliosis, and a control group comprising 42 patients with tick-borne encephalitis and 21 neurosurgical patients. The aim of the study was to analyze and compare findings of two PCR methods and Borrelia burgdorferi sensu lato culture results by examination of prospectively collected cerebrospinal fluid (CSF) and blood specimens from patients with clinical features of Lyme Neuroborreliosis. Borrelial DNA was detected with at least one of the PCR approaches in 16/135 (11.9%) blood samples and 24/156 (15.4%) CSF samples. Using MseI restriction of PCR products of the amplified rrf-rrl region, we identified the majority of strains as Borrelia afzelii. Borreliae were isolated from 1/135 (0.7%) blood samples and from 5/156 (3.2%) CSF specimens. Using MluI restriction for characterization of isolated strains, Borrelia garinii was identified in all CSF isolates. Our study revealed that different approaches for direct demonstration of borrelial infection give distinct results, that there is an urgent need for standardization of the methods for direct detection of borrelial infection, and that the design of studies evaluating the validation of such methods should include appropriate control group(s) to enable assessment of both sensitivity and specificity.
Leif Dotevall - One of the best experts on this subject based on the ideXlab platform.
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oral doxycycline for Lyme Neuroborreliosis with symptoms of encephalitis myelitis vasculitis or intracranial hypertension
European Journal of Neurology, 2014Co-Authors: Daniel Bremell, Leif DotevallAbstract:Background and purpose The treatment recommendation for Lyme Neuroborreliosis with central nervous system (CNS) symptoms is intravenous ceftriaxone, according to current American and European guidelines. For Lyme Neuroborreliosis with peripheral nervous system (PNS) symptoms, treatment with intravenous ceftriaxone and oral doxycycline is considered equally effective. The purpose of this study was to evaluate the efficacy of oral doxycycline in the treatment of Lyme Neuroborreliosis with CNS symptoms. Methods Patients with Lyme Neuroborreliosis who had undergone cerebrospinal fluid (CSF) sampling before and after treatment at the Department of Infectious Diseases, Sahlgrenska University Hospital, during the period 1990–2012, were included in this retrospective study. The CSF mononuclear cell count was used as a surrogate marker of treatment outcome. Comparisons of CSF mononuclear cell counts were made between patients with CNS symptoms and patients with PNS symptoms before and after treatment with oral doxycycline. Results Twenty-six patients classified as having CNS symptoms and 115 patients classified as having PNS symptoms were included. The decline in CSF mononuclear cell counts did not differ significantly between the two groups of patients. All patients with CNS disease showed a marked clinical improvement after treatment, even though 62% had remaining symptoms at the end of follow-up. Conclusion Treatment with oral doxycycline resulted in a similar decrease in CSF mononuclear cell counts in patients with Lyme Neuroborreliosis with CNS symptoms compared with patients with Lyme Neuroborreliosis with PNS symptoms. The results indicate that oral doxycycline is an effective treatment for Lyme Neuroborreliosis irrespective of the severity of symptoms.
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intravenous ceftriaxone compared with oral doxycycline for the treatment of Lyme Neuroborreliosis
Scandinavian Journal of Infectious Diseases, 2005Co-Authors: Rebecca Borg, Lars Hagberg, Leif Dotevall, Stanka Lotricfurlan, Vera Maraspin, Joze Cimperman, Franc StrleAbstract:This prospective, open-label, non-randomized trial at the University Departments of Infectious Diseases in Ljubljana, Slovenia, and Goteborg, Sweden, was conducted to compare the kinetics of the cerebrospinal fluid (CSF) mononuclear cell count after 10-14 d of ceftriaxone or doxycycline for treatment of Lyme Neuroborreliosis. 29 patients were treated with intravenous ceftriaxone 2 g daily in Ljubljana and 36 patients with oral doxycycline 400 mg daily in Goteborg. The study protocol included lumbar puncture before and 6-8 weeks after treatment initiation. There was a marked decrease (1.2 log10 x 10(6)/l) of the median CSF mononuclear cell count following treatment. With the assumption of a linear regression of the logarithmic mononuclear cell counts between the 2 lumbar punctures, no significant difference between the 2 antibiotic treatments could be found. All patients were clinically much improved after treatment. At 6 months follow-up 23 (79%) of the ceftriaxone- and 26 (72%) of the doxycycline-treated patients were completely recovered. Intravenous ceftriaxone or oral doxycycline was found to be effective, safe, and convenient for treatment of Lyme Neuroborreliosis.
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Pain as presenting symptom in Lyme Neuroborreliosis
European journal of pain (London England), 2003Co-Authors: Leif Dotevall, Lars Hagberg, Tore Eliasson, Clas MannheimerAbstract:Neurogenic pain with radiculitis is often the starting symptom in adult patients with tick-borne Lyme Neuroborreliosis and in some cases the only clinical manifestation. Cranial paresis and other neurologic signs usually occur after the onset of pain. The present paper describes four patients who had severe pain as the main presenting symptom of Lyme Neuroborreliosis. Opioids had good short-term effect in two of the cases. Oral doxycycline treatment was used successfully to eliminate the infection.
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Astroglial and neuronal proteins in cerebrospinal fluid as markers of CNS involvement in Lyme Neuroborreliosis.
European journal of neurology, 1999Co-Authors: Leif Dotevall, Lars Hagberg, Jan-erik Karlsson, Lars RosengrenAbstract:Is Lyme Neuroborreliosis, even in its early phase, a parenchymatous disorder in the central nervous system (CNS), and not merely a meningitic process? We quantified cerebrospinal fluid (CSF) levels of four nerve and glial cell marker proteins in Lyme Neuroborreliosis patients with pretreatment durations of 7-240 days. All 23 patients had meningoradiculitis, and six had objective signs of encephalopathy. Glial fibrillary acidic protein (GFAp) pretreatment levels in CSF, and the light subunit of neurofilament protein (NFL) levels were related to clinical outcome and declined significantly after treatment (P < 0.001 and P < 0.01, respectively). NFL was detectable in 11 out of 22 patients, and pre- and post-treatment NFL levels were associated with the duration of neurological symptoms within 100 days prior to treatment. Neuron-specific enolase (NSE) concentrations also decreased after therapy (P < 0.001), while CSF levels of glial S-100 protein remained unchanged. The pretreatment duration of disease was related to postinfectious sequelae. GFAp, NSE and NFL levels in CSF are unspecific indicators of astroglial and neuronal involvement in CNS disease. The findings in the present study are in agreement with the hypothesis that early and late stages of Lyme Neuroborreliosis damage the CNS parenchyma.
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Increased cerebrospinal fluid levels of glial fibrillary acidic protein (GFAp) in Lyme Neuroborreliosis.
Infection, 1996Co-Authors: Leif Dotevall, Lars Rosengren, Lars HagbergAbstract:Glial fibrillary acidic protein (GFAp), the main protein constituent of the intermediate filaments of astrocytes, was analysed in the cerebrospinal fluid (CSF) of 20 patients with Lyme Neuroborreliosis as a marker of the astroglial reaction. The mean GFAp level before antibiotic treatment in the study group was significantly elevated (592 pg/ml +/- 596 [SD]) compared to that in 24 healthy controls (121 +/- 87 [SD]) (p < 0.01). The highest CSF-GFAp levels were seen in the patients with the most severe disease, but the levels were also increased in patients with peripheral paresis, such as facial palsy with no or only minor encephalitic symptoms. This implies that the infection was not limited to radix dorsalis or the meningeal tissues, but affected the central nervous system as well. Furthermore, the astroglial reaction seemed to occur early in Lyme Neuroborreliosis since CSF-GFAp levels were elevated also in patients with recent (< 3 weeks) onset of disease. After antibiotic treatment, the GFAp levels decreased. It is suggested the CSF-GFAp concentrations might be useful for monitoring CNS involvement in Lyme Neuroborreliosis.
Andrew R. Pachner - One of the best experts on this subject based on the ideXlab platform.
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Lyme Neuroborreliosis infection immunity and inflammation
Lancet Neurology, 2007Co-Authors: Andrew R. Pachner, Israel SteinerAbstract:Summary Lyme Neuroborreliosis (LNB), the neurological manifestation of systemic infection with the complex spirochaete Borrelia burgdorferi , can pose a challenge for practising neurologists. This Review is a summary of clinical presentation, diagnosis, and therapy, as well as of recent advances in our understanding of LNB. Many new insights have been gained through work in experimental models of the disease. An appreciation of the genetic heterogeneity of the causative pathogen has helped clinicians in their understanding of the diverse presentations of LNB.
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Intrathecal antibody production in a mouse model of Lyme Neuroborreliosis.
Journal of Neuroimmunology, 2006Co-Authors: Kavitha Narayan, Elena Pak, Andrew R. PachnerAbstract:Intrathecal antibody (ITAb) production is a common feature of neurological diseases, yet very little is known about its mechanisms. Because ITAb is prominent in human Lyme Neuroborreliosis (LNB), in the present study we established a mouse model of LNB to study ITAb production. We injected different strains of Borrelia burgdorferi into a variety of mouse strains by the intracerebral (i.c.) route to develop the model. Spirochetal infection and ITAb production were identified by complementary methods. This study demonstrates that the mouse model of LNB can be utilized to test hypotheses related to the mechanisms of ITAb production.
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The Therapy of Lyme Neuroborreliosis.
Current treatment options in neurology, 2005Co-Authors: Andrew R. PachnerAbstract:The challenge for the neurologist in the treatment of Lyme Neuroborreliosis is not in the treatment per se, but in the diagnosis. Neurological manifestations of Lyme disease can present in many forms, and diagnostic techniques which detect the spirochete directly; the culture or poLymerase chain reaction of the spirochete in cerebrospinal fluid, are of disappointingly low yield. Therefore, the diagnosis is frequently not easy. After the diagnosis is made, antibiotic therapy is straightforward; Lyme Neuroborreliosis should be treated with at least 2 weeks of antibiotics. In the United States, intravenous therapy with ceftriaxone or penicillin for 2 weeks is the standard, whereas in Europe oral doxycycline therapy is commonly administered. Either is effective, and my choice of therapy generally depends on the patient. Many patients have symptoms which continue after antibiotic therapy referable to persistent inflammation, and, for those patients, I will commonly prescribe nonsteroidal anti-inflammatory medications.
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The rhesus model of Lyme Neuroborreliosis.
Immunological reviews, 2001Co-Authors: Andrew R. PachnerAbstract:Similarity of pathology and disease progression make the non-human primate (NHP) model of Lyme Neuroborreliosis appropriate and valuable. In the NHP model of Lyme Neuroborreliosis, spirochetal density in the nervous system and other tissues has been measured by poLymerase chain reaction and correlated to anti-Borrelia burgdorferi antibody in the serum and cerebrospinal fluid and to inflammation in tissues. Despite the demonstrable presence of Borrelia burgdorferi, the causative agent of Lyme borreliosis, only minor inflammation of the central nervous system occurs, though inflammation can be demonstrated in other tissues. Infected animals also develop anti-Borrelia burgdorferi antibody in the serum, although increased amplitude of antibody is not predictive of higher levels of infection. The NHP model continues to provide important insight into the disease process in humans.
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The poLymerase chain reaction in the diagnosis of Lyme Neuroborreliosis
Annals of Neurology, 1993Co-Authors: Andrew R. Pachner, E. DelaneyAbstract:The poLymerase chain reaction is sensitive and specific in the detection of defined DNA sequences and holds promise for diagnosing the presence of fastidious microorganisms in human infectious diseases. We developed a methodology for nested poLymerase chain reaction and hybridization analysis of the cerebrospinal fluid using primers from a genomic Borrelia burgdorferi sequence and applied it to the cerebrospinal fluid (CSF) of patients suspected of having Lyme Neuroborreliosis and other diseases. PoLymerase chain reaction and hybridization demonstrated extremely high sensitivity for spirochetal DNA, and was highly specific, with a false-positivity rate of less than 3%. However, the results were negative or indeterminate in 54% of CSF samples from patients with definite or probable disease, indicating an absence, or extremely low level, of spirochetes or spirochetal DNA in a significant percentage of patients with Lyme Neuroborreliosis. PoLymerase chain reaction and hybridization of the CSF can thus be considered a useful adjunct in diagnosis, but its negativity does not rule out Lyme Neuroborreliosis.
