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The diagnostic spectrum in patients with suspected chronic Lyme neuroborreliosis - The experience from one year of a university hospital's Lyme neuroborreliosis outpatients clinic – Source: European Journal of Neurology, Oct 27, 2010

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By M Djukic, et al. • • October 29, 2010

Background and purpose: Studies addressing the diagnostic relevance of anti-Borrelia burgdorferi (BB) serum antibodies in patients with non-specific symptoms and suspected chronic Lyme neuroborreliosis (LNB) are scarce. [Note: LNB involves chronic symptoms involving the central nervous system/brain, such as mental problems, headache, sleep disturbance, effects of increased intracranial pressure, meningitis, or, rarely, effects on the eyes or spinal cord.]

Methods: In this study, we enrolled within 1 year 122 patients with suspected chronic LNB.

• 114 patients had previously tested positive for BB.

• All patients had previously received antibiotic treatment.

Each patient received a clinical examination and measurement of BB-specific antibodies. The diagnosis of neuroborreliosis was made according to the national guidelines of the German Society of Neurology.

• Nine patients had acute borreliosis. One of the nine met the criteria of acute LNB.

• Of the remaining 113 patients, 85 patients underwent a lumbar puncture.

• Ten seronegative subjects without lumbar puncture were also considered.

In 61.8% of these 95 patients the quality of life, of sleep, mood, and anxiety were assessed.

Results: Of 95 patients:

• 25.3% had symptoms without a somatic cause or evidence of borreliosis,

• 38.9% had a well-defined illness unrelated to BB infection,

• And 29.5% suffered from symptoms without a detectable somatic cause, displaying antibodies against BB.

• Six patients were grouped as post-LNB syndrome.

Most common symptoms in all categories were arthralgia [joint pain], myalgia [muscle pain], dysaesthesia [nerve pain, e.g., burning sensation], depressive mood and chronic fatigue.

Conclusion: Patients with persistent symptoms with elevated serum antibodies against BB but without signs of cerebrospinal fluid inflammation require further diagnostic examinations to exclude ongoing infection and to avoid co-infections and other treatable conditions (e.g., autoimmune diseases).

One patient with acute LNB, who was treated with ceftriaxone for 3 weeks suffered from LNB with new headaches and persistent symptoms 6 months later.

These data should encourage further studies with new experimental parameters.

Source: European Journal of Neurology, Oct 27, 2010. DOI: 10.1111/j.1468-1331.2010.03229.x, by Djukic M, Schmidt-Samoa C, Nau R, Von Steinbüchel N, Eiffert H, Schmidt H. Department of Neurology, University of Goettingen Department of Geriatrics; Evangelisches Krankenhaus Weende Medical Psychology and Medical Sociology, University of Goettingen Department of Neuropathology; University of Goettingen Medical Microbiology, Goettingen, Germany.

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