TUTKIMUS: NEUROBORRELIOOSI

[Bb]

Lähettäjä: Soijuv Lähetetty: 4.2.2005 9:32

5 potilaan tapausselostus: Potilailla oli fatiikkia, päänsärkyä, lihaskipuja, pientä kuumeilua, lieviä mielialahäiriöitä. Muutamalla potilaalla oli lisäksi sytomegalovirus, C-hepatiitti, verisuonitulehdus, kilpirauhasen vajaatoimintaa ja/tai elektrolyyttitasapainon häiriöitä. Potilaat saivat hoidoksi useita antibioottihoitoja ym. hoitoja, mm. gansikloviiria sytomegalovirusinfektion hoitoon ja kuntoutusta:


Lyme neuroborreliosis, viral co-infections and collateral conditions ? a case series in a teaching hospital of infectious diseases

Abstract number: 903_r2040 Tatulescu D.

Objectives:

To present diagnostic difficulties and treatment hints in neuroborreliosis.
Methods:

Chronic Lyme disease was diagnosed based upon the known criteria (duration ? more than 1 year, persistent neurological involvement, active infection with Borrrelia burgdorferi) and meeting the surveillance CDC ranking for Lyme borreliosis highly likely of more than seven points.

Between 2000 and 2003 we studied five patients (age range 22?57 years) in the Cluj-Napoca Teaching Hospital of Infectious Diseases presenting evidence of immunity to Borrelia burgdorferi: immunoflurescence, IgM antibodies (ELISA) and polymerase chain reaction and chronic neurological manifestations with no other identifiable cause. Neurological involvement was clinically evaluated and pathological findings were completed through analysis of cerebrospinal fluid, electroencephalograms, electromyographies and magnetic resonance tomographies. A great number of other laboratory tests were performed including evaluation of endocrine abnormalities, viral co-infections and autoimmune disorders.
Results:

The neurological manifestations were represented by leucoencephalitis with epileptic manifestations, encephalomyelitis with symmetric spastic tetraplegia and in the remaining three cases polyneuropathies with cranial nerves involvement.

All cases experienced fatigue, headache, poor stamina, myalgia, low-grade fever and mild psychiatric disorders. In two cases active cytomegalovirus infection coincident with reactivation of neuroborreliosis was found and in another case hepatitis C virus infection with vasculitis was detected.

Endocrine abnormalities were demonstrated in two cases in the presence of clinical hypothyroidism. Electrolytes disorders were refractary to therapy in one case. Treatment and retreatment with intravenous ceftriaxone 2 g/day, 3?4 weeks was performed in all cases. In one case Jarish-Herxheimer reaction was observed after 3 days of treatment involving short time relapse in neurological manifestations. Combination therapy with macrolides and ciprofloxacin was considered in one case. Orally ganciclovir was administered if primary cytomegalovirus coinfection was present.

Improvement occurred during the first treatment cycle, all cases were considered cured after 2?4 treatment cycles, other therapies and rehabilitation were also performed.
Conclusion:

Diagnosis and treatment of late Lyme neuroborreliosis are difficult, antibiotic treatment greatly improves the prognosis.