Lyme neuroborreliosis—epidemiology, diagnosis and management

• Published in: Nature reviews. Neurology Vol. 11; no. 8; pp. 446 - 456
• Main Authors: Koedel, Uwe, Fingerle, Volker, Pfister, Hans-Walter
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.08.2015; Nature Publishing Group
• Subjects: 692/1807/1693; 692/617/375/1367; 692/699/1670/3/1615; Algorithms; Anti-Infective Agents - therapeutic use; Antibiotics; Antibodies, Bacterial - blood; Biomarkers - metabolism; Borrelia burgdorferi - immunology; Care and treatment; Chemokine CXCL13 - metabolism; Chronic Disease; Diagnosis; Distribution; Epidemiology; Erythema; Europe - epidemiology; Humans; Infections; Lyme disease; Lyme Neuroborreliosis - diagnosis; Lyme Neuroborreliosis - epidemiology; Lyme Neuroborreliosis - therapy; Magnetic Resonance Imaging; Medicine & Public Health; Microscopy, Electron, Scanning; Neurology; North America - epidemiology; Patients; review-article; Time Factors; North America; Europe; United States > US; Germany
• ISSN: 1759-4758; 1759-4766
• DOI: 10.1038/nrneurol.2015.121

Key Points Diagnosis of Lyme neuroborreliosis is made by history taking, clinical examination, cerebrospinal fluid (CSF) analysis, and Borrelia burgdorferi antibody testing B. burgdorferi antibody testing should be performed only in patients presenting with clinical signs suggestive of infection CSF levels of the chemokine CXCL13 might be useful as a complementary diagnostic tool for early Lyme neuroborreliosis Patients with post-treatment Lyme disease syndrome do not have ongoing B. burgdorferi infection and, thus, do not benefit from additional (for example, long-term) antibiotic therapy Alternative treatment options must be established for patients with post-treatment Lyme disease syndrome Chronic Lyme disease is a poorly defined term, used by some practitioners for patients with a wide variety of subjective complaints that can often be attributed to other illnesses Up to 12% of patients with Lyme disease develop neurological symptoms. This syndrome, Lyme neuroborreliosis, can manifest soon after the initial infection or months to years after the event. Koedel and colleagues discuss the diagnosis and treatment of early and late Lyme neuroborreliosis, and review the controversies surrounding post-treatment Lyme disease syndrome and chronic Lyme disease. Lyme disease, caused by the Borrelia burgdorferi bacterium, is the most common vector-borne disease in the northern hemisphere. The clinical presentation varies with disease stage, and neurological manifestations (often referred to as Lyme neuroborreliosis) are reported in up to 12% of patients with Lyme disease. Most aspects of the epidemiology, clinical manifestation and treatment of Lyme neuroborreliosis are well known and accepted; only the management of so-called chronic Lyme disease is surrounded by considerable controversy. This term is used for disparate patient groups, including those who have untreated late-stage infection (for example, late neuroborreliosis), those with subjective symptoms that persist after treatment (termed 'post-treatment Lyme disease syndrome' [PTLDS]), and those with unexplained subjective complaints that may or may not be accompanied by positive test results for B. burgdorferi infection in serum (here called 'chronic Lyme disease'). The incidence of PTLDS is still a matter of debate, and its pathogenesis is unclear, but there is evidence that these patients do not have ongoing B. burgdorferi infection and, thus, do not benefit from additional antibiotic therapy. Chronic Lyme disease lacks an accepted clinical definition, and most patients who receive this diagnosis have other illnesses. Thus, a careful diagnostic work-up is needed to ensure proper treatment.