Borrelia burgdorferi sensu lato infection in patients with peripheral facial palsy

Rojko, Tereza; Bogovič, Petra; Lotrič‐Furlan, Stanka; Ogrinc, Katarina; Kišek, Tjaša Cerar; Biškup, Urška Glinšek; Petrovec, Miroslav; Ružić‐Sabljić, Eva; Kastrin, Andrej; Strle, Franc

doi:10.1016/j.ttbdis.2018.11.019

Cited by 18 publications

(15 citation statements)

References 31 publications

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“…The median interval between the first symptoms or signs to the facial palsy was 19.5 days in our study, which is consistent with previous studies. 16,27,30 As with other manifestations of Lyme disease in the US, the majority of our patients did not recall a tick bite. These clues (exposure to ticks in an endemic area, but not necessarily a history of recognized tick bite, constitutional symptoms and/or skin lesions, and presentation in the summer months) in a patient presenting with facial palsy should bring early LNB to the forefront of the clinician's differential diagnosis.…”

Section: Discussionmentioning

confidence: 54%

“…As shown in our and other studies, 6,7,11,12,16,19,[27][28][29][30] the history and clinical picture will often give clues pointing toward the diagnosis of LNB. Most cases occur in the summer months.…”

Section: Discussionmentioning

confidence: 55%

“…Of the 44 patients, 26 (59%) were male. Most patients acquired the infection in Maryland (30) and Virginia (8). Thirty-two patients were evaluated under protocol NCT00028080.…”

Section: Study Cohortmentioning

confidence: 99%

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Characteristics and outcome of facial nerve palsy from Lyme neuroborreliosis in the United States

Marques

Okpali

Liepshutz

et al. 2022

Ann Clin Transl Neurol

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Objectives: Facial palsy is the most common manifestation of Lyme neuroborreliosis (LNB) in the United States. This study aimed to describe features of patients with early LNB presenting with facial palsy and to determine if corticosteroids in addition to antibiotic therapy was associated with unfavorable outcome. Methods: Retrospective analysis of participants enrolled in clinical studies investigating Lyme disease (N = 486) identified 44 patients who had facial palsy from LNB. The House-Brackmann scale was used to quantify the facial nerve dysfunction. Results: Most patients presented in the summer months. Erythema migrans, frequently associated with systemic symptoms, occurred in 29 patients. Thirteen patients presented with bilateral facial palsy, usually with sequential involvement. Fourteen patients had painful radiculopathy. Of the 38 patients treated with antibiotics before the resolution of the palsy who had complete follow-up, 24 received both antibiotics and corticosteroids. Of these 38 patients, 34 recovered completely, 3 had nearly complete recovery, and 1 had moderate dysfunction. There were no differences between the treatment groups in achieving complete resolution of the palsy at 12 months or in time to complete recovery. Interpretation: A history of rash compatible with erythema migrans or febrile illness in the weeks preceding the palsy are helpful clues pointing toward LNB and should be actively sought when evaluating patients with acute-onset peripheral facial palsy, particularly bilateral facial palsy. Treatment with antibiotic therapy is highly effective and most patients will fully recover facial nerve function. Adjunctive corticosteroid therapy appears to not affect the speed of recovery or overall outcome in this retrospective observational study.

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 55%

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Characteristics and outcome of facial nerve palsy from Lyme neuroborreliosis in the United States

Marques

Okpali

Liepshutz

et al. 2022

Ann Clin Transl Neurol

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“…Indeed, no clinical manifestation has been associated with a female predominance in the United States, whereas in Europe, most cases of erythema migrans and ACA occur in women (39,40). Many studies (but not all) demonstrated a male predominance for Lyme neuroborreliosis and Lyme arthritis (22,35,36,41).…”

Section: Lyme Arthritismentioning

confidence: 99%

Comparison of Lyme Disease in the United States and Europe

Marques¹,

Strle²,

Wormser³

2021

Emerg. Infect. Dis.

Self Cite

158

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L yme disease, or Lyme borreliosis, is the most common tickborne disease in both the United States and Europe; an estimated ≈476,000 cases are diagnosed and treated per year in the United States and >200,000 cases per year in western Europe (1-3). The principal tick vector in the United States is Ixodes scapularis, followed by I. pacifi cus; in Europe, most cases are transmitted by I. ricinus, followed by I. persulcatus ticks (Table 1). The etiologic agent, Borrelia burgdorferi, was discovered in 1982 in the United States. Later, it became recognized that strains of B. burgdorferi in Europe were more heterogenous than strains in North America. B. burgdorferi sensu lato was then classifi ed into 3 main genospecies. The originally discovered genospecies was named B. burgdorferi sensu stricto.The second genospecies was named Borrelia garinii sp. nov., and the third was named Borrelia afzelii sp. nov. Recently, the taxonomy of the family Borreliaceae (and the genus Borrelia) has been revised into 2 main genera, Borrelia and Borreliella (4). The spirochetes that cause relapsing fever retained the genus name Borrelia, and spirochetes that cause Lyme disease have been renamed Borreliella (hereafter referred to as Lyme borrelia). However, these changes have been challenged (5).Most cases of Lyme disease in the United States occur in the mid-Atlantic, Northeast, and Upper Midwest regions. B. burgdorferi s.s., which also is found in Europe, causes most human infections in the United States (1,2); the newly recognized species B. mayonii (which is not known to exist in Europe) is an infrequent cause of human illness in the Upper Midwest region of the United States (6). The incidence of Lyme disease in Europe is highest in the Scandinavian and Baltic states in northern Europe and in Austria, the Czech Republic, Germany, and Slovenia in central Europe. B. afzelii and B. garinii are the genospecies most frequently detected in I. ricinus and I. persulcatus ticks and cause most cases of Lyme disease in Europe (1,2). Neither genospecies is found in the United States. Transmission of B. burgdorferi s.s. by I. scapularis or by I. pacifi cus ticks is very infrequent during the fi rst 36 hours after tick attachment; in contrast, transmission of B. afzelii by I. ricinus ticks may occur within 24 hours (Table 1) (7). Erythema Migrans and Other Skin ManifestationsAfter Lyme borrelia are deposited in the skin by the bite of an infected Ixodes tick, an infection is typically established at that site, which causes the characteristic skin lesion, erythema migrans (Figure 1). Erythema migrans is the most common clinical manifestation of Lyme disease in the United States and Europe, occurring in >80% of patients in both geographic areas (2). Overall, US patients with erythema migrans caused by B. burgdorferi s.s. are less likely than patients in Europe with erythema migrans caused by B. afzelii or B. garinii to remember a tick bite at the site of the lesion (25% vs. 60% for B. afzelii or 64% for B. garinii) but more likely to have concomitant ...

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“…Early Lyme neuroborreliosis usually presents days to weeks after a tick bite, as a lymphocytic meningitis, cranial neuritis, or radiculoneuritis 3688. Cranial neuritis most commonly affects the facial nerve, which may be bilateral in up to 25% of individuals 8889. Involvement of other cranial nerves may occur, leading to diplopia, pain, hearing loss, or vertigo.…”

Section: Clinical Manifestations and Diagnosismentioning

confidence: 99%

Lyme borreliosis: diagnosis and management

Kullberg

Vrijmoeth

Schoor

et al. 2020

BMJ

113

118

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Lyme borreliosis is the most common vectorborne disease in the northern hemisphere. It usually begins with erythema migrans; early disseminated infection particularly causes multiple erythema migrans or neurologic disease, and late manifestations predominantly include arthritis in North America, and acrodermatitis chronica atrophicans (ACA) in Europe. Diagnosis of Lyme borreliosis is based on characteristic clinical signs and symptoms, complemented by serological confirmation of infection once an antibody response has been mounted. Manifestations usually respond to appropriate antibiotic regimens, but the disease can be followed by sequelae, such as immune arthritis or residual damage to affected tissues. A subset of individuals reports persistent symptoms, including fatigue, pain, arthralgia, and neurocognitive symptoms, which in some people are severe enough to fulfil the criteria for post-treatment Lyme disease syndrome. The reported prevalence of such persistent symptoms following antimicrobial treatment varies considerably, and its pathophysiology is unclear. Persistent active infection in humans has not been identified as a cause of this syndrome, and randomized treatment trials have invariably failed to show any benefit of prolonged antibiotic treatment. For prevention of Lyme borreliosis, post-exposure prophylaxis may be indicated in specific cases, and novel vaccine strategies are under development.

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Borrelia burgdorferi sensu lato infection in patients with peripheral facial palsy

Cited by 18 publications

References 31 publications

Characteristics and outcome of facial nerve palsy from Lyme neuroborreliosis in the United States

Characteristics and outcome of facial nerve palsy from Lyme neuroborreliosis in the United States

Comparison of Lyme Disease in the United States and Europe

Lyme borreliosis: diagnosis and management

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