Clinical association: Lyme disease and Guillain-Barre syndrome

Patel, K.; Shah, Siddharth; Subedi, Dinesh

doi:10.1016/j.ajem.2017.07.030

Cited by 22 publications

(13 citation statements)

References 8 publications

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“… [23] Antibiotic treatment combined with a specific treatment for the demyelinating neuropathy, such as immunoglobulins, is recommended in this case. [ 24 25 ]…”

Section: Discussionmentioning

confidence: 99%

“…This ultimately results in multifocal axonal loss of the nerve roots and distal nerve segments, and loss of both myelinated and unmyelinated fibers. [ 19 24 34 35 36 37 38 39 ] This cell loss might also be due to the direct action of spirochetes and infiltrating cells. [ 40 41 ] Moreover, the presence of cross-reactive antibodies to self-antigens (antibodies directed against epitopes of Borrelia with cross-reaction with epitopes of peripheral nerve) has been described.…”

Section: Discussionmentioning

confidence: 99%

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Confirmed cases of Neuroborreliosis with involvement of peripheral nervous system

et al. 2020

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The manifestations of borreliosis in the peripheral nervous system (PNS) remain poorly described. As the symptoms of neuroborreliosis can be reversed with timely introduction of antibiotics, early identification could avoid unnecessary axonal loss. Our aim was to describe the characteristics of confirmed neuroborreliosis cases involving the PNS diagnosed between 2007 and 2017 in our neuromuscular disease center in a nonendemic area (La Pitié-Salpêtrière Hospital, Paris, France). Neuroborreliosis was defined as follows: compatible neurological symptoms without other cause of neuropathy; cerebrospinal fluid and serum analysis (positive serological tests with ELISA, confirmed by Western Blot); and improvement of symptoms with adapted antibiotherapy. All the patients consulting in our center between 2007 and 2017 underwent electrophysiological study. Sixteen confirmed cases of neuroborreliosis involving the PNS were included: 10 cases of meningoradiculoneuritis, 4 of axonal neuropathy, and 2 of demyelinating neuropathy (one acute and one chronic). Only 4 (25%) patients reported tick bites. Meningoradiculoneuritis was characterized by lymphocytic meningitis, intense pain, cranial nerve palsy, and contrast enhancement of nerve roots on imagery. The patients with axonal neuropathy presented sensory symptoms with intense pain but no motor deficit and meningitis was rare. Nerve biopsy of 1 patient revealed lymphocytic vasculitis. Electrophysiological testing showed sensory or sensorimotor axonal neuropathy (3 subacute and 1 chronic) of the lower limbs, with asymmetrical neuropathy in 1 patients, symmetrical neuropathy in one and monomelic sensory mononeuritis multiplex in another. We also found 1 case of acute demyelinating neuropathy, treated with antibiotherapy and immunoglobulins, and 1 chronic demyelinating neuropathy. Overall, diaphragmatic paralysis was frequent (18.6%). Antibiotherapy (mostly ceftriaxone 3–4 weeks) resulted in symptom resolution. This series gives an updated overview of the peripheral complications of neuroborreliosis to help identify this disease so that timely treatment could avoid axonal loss.

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“… [23] Antibiotic treatment combined with a specific treatment for the demyelinating neuropathy, such as immunoglobulins, is recommended in this case. [ 24 25 ]…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Confirmed cases of Neuroborreliosis with involvement of peripheral nervous system

et al. 2020

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“…Uzajamna veza ova dva entiteta nije još uvek jasna, ima dokaza o imunološkom mehanizmu odgovora na patogen, pri čemu imuni kompleksi ili neke komponente spiroheta deluju kao antigeni dovodeći do razvoja antigangliozidnih antitela. S obzirom na različitu strategiju lečenja, izuzetno je značajno diferencijalno dijagnostički razgraničiti ih (16)(17)(18). Lajmska bolest treba da se razmotri kod svakog pacijenta sa simptomima i znacima GBS sprovođenjem detaljne anamneze i imunološke pretrage onih koji navode ubod krpelja u prethodnim mesecima, gde važnu ulogu ima lekar u primarnoj zdravstvenoj zaštiti (19,20).…”

Section: Diskusijaunclassified

Polyradiculopathy in lyme disease: A case report

Knežević¹,

Gajović²,

Dordević³

et al. 2019

Medicinski časopis

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UVOD Gilen Bareov sindrom (GBS) jeste retka bolest sa incidencom 0,8-1,9 na 100.000 stanovnika. Nešto je veća učestalost kod muškaraca i ona raste s godinama starosti (1, 2). GBS se manifestuje progresivnom, simetričnom mišićnom slabošću nogu i ruku sa oslabljenim ili potpuno odsutnim dubokim tetivnim refleksima. Bolesnici se javljaju lekaru nakon nekoliko dana od početka simptoma, koji variraju od blage nemogućnosti hoda do kompletne paralize svih udova, facijalnih, bulbarnih i respiratornih mišića (3). Parestezije ruku i nogu, udružene sa slabošću mišića, pojavljuju se kod više od 80% bolesnika. Najpre se javljaju parestezije i arefleksija, nakon toga dominiraju PRIKAZ SLUČAJA SAŽETAK Uvod. Cilj rada je da prikaže dileme u kliničkoj praksi kada je Lajmska bolest uzročnik poliradikulopatije što može da predstavlja diferencijalno dijagnostički problem sa Gilen Bareovim sindromom. Prikaz slučaja. Pacijent je došao u pratnji rodbine, s bolom u leđima i potkolenicama, trnjenjem i mravinjanjem od natkolenica naniže, najizraženije na spoljašnjoj strani nogu. Intenzitet bola se pojačavao iz dana u dan. Sfinktere je kontrolisao. Ubrzo nije mogao da hoda (bez nivoa senzibiliteta), plantarni refleksi uz potencijaciju bili su ugašeni, mišićna snaga oslabljena. Objektivnim pregledom utvrđeno je da je vrat slobodan, da su meningealni znaci negativni, kranijalni nervi uredni, tonus, trofika i mišićna snaga gornjih ekstremiteta sniženi kao i na donjim ektremitetima. Noge nije fiksirao prilikom izvođenja Mingacinijeve probe. Mišićni refleksi bili su ugašeni, a Lazarevićev znak pozitivan obostrano na 45 stepeni. Postojala je slabost dorzalne i plantarne fleksije prstiju stopala. Pacijent je neurološki opserviran, urađene su virusološke analize, enzimski imunoadsorpcioni test na Boreliju burgdorferi koji je bio pozitivan i započeta je antibiotska, imunoglobulinska, analgetska i rehabilitaciona terapija. Vremenom se potpuno oporavio. Zaključak. Lajmska bolesti može u drugoj ili trećoj fazi često da zahvata nervno tkivo prezentujući se kao poliradikuloneuritis, akutni meningoencefalitis i kranijalna neuropatija i drugo. Lekari u praksi moraju da diferenciraju ovo oboljenje od Gilen Bareovog sindroma uzimajući takođe u obzirir epidemiološke podatke i druge kliničke simptome i znake.

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“…Other causes that have been documented include cytomegalovirus, Epstein-Barr virus, human immunodeficiency virus (HIV), and more recently, Zika virus [2]. There have been limited reports of GBS caused by tick-borne pathogens such as Borrelia burgdorferi [3][4][5][6]. The typical presentation of GBS is an acute progression of limb weakness one to two weeks after immune stimulation with a peak in the weakness at about two to four weeks [7].…”

Section: Introductionmentioning

confidence: 99%

Guillain-Barre Syndrome, Neuroborreliosis, or Both

Owens¹,

Filatov²,

Husain-Wilson³

2020

Cureus

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Guillain-Barre syndrome (GBS) is an acute paralytic neuropathy. Limited reports of GBS caused by tickborne pathogens exist. Lyme disease is a tick-borne infectious disease that is commonly caused by Borrelia burgdorferi. The nervous system may be involved and is called neuroborreliosis. In this case, we report a 30-year-old female who presented to the emergency department with one week of diffuse, increasing weakness in the upper/lower extremities and face after a recent gastrointestinal illness and travel to the Northeastern United States. Areflexia was noted in bilateral lower extremities. Lumbar puncture results together with clinical presentation were consistent with a diagnosis of GBS. Lab results later revealed a possible Lyme infection in cerebrospinal fluid, which along with recent travel to endemic area gave high suspicion for Lyme disease. The patient was treated for both diseases with significant improvement. Taking a good history is an essential first step in diagnosis, as travel history was key in testing for Lyme.

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Clinical association: Lyme disease and Guillain-Barre syndrome

Cited by 22 publications

References 8 publications

Confirmed cases of Neuroborreliosis with involvement of peripheral nervous system

Confirmed cases of Neuroborreliosis with involvement of peripheral nervous system

Polyradiculopathy in lyme disease: A case report

Guillain-Barre Syndrome, Neuroborreliosis, or Both

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