EFNS guidelines on the diagnosis and management of European Lyme neuroborreliosis

Abstract

Background: Lyme neuroborreliosis (LNB) is a nervous system infection caused by Borrelia burgdorferi sensu lato (Bb). Objectives: To present evidence‐based recommendations for diagnosis and treatment. Methods: Data were analysed according to levels of evidence as suggested by EFNS. Recommendations: The following three criteria should be fulfilled for definite LNB, and two of them for possible LNB: (i) neurological symptoms; (ii) cerebrospinal fluid (CSF) pleocytosis; (iii) Bb‐specific antibodies produced intrathecally. PCR and CSF culture may be corroborative if symptom duration is <6 weeks, when Bb antibodies may be absent. PCR is otherwise not recommended. There is also not enough evidence to recommend the following tests for diagnostic purposes: microscope‐based assays, chemokine CXCL13, antigen detection, immune complexes, lymphocyte transformation test, cyst formation, lymphocyte markers. Adult patients with definite or possible acute LNB (symptom duration <6 months) should be offered a single 14‐day course of antibiotic treatment. Oral doxycycline (200 mg daily) and intravenous (IV) ceftriaxone (2 g daily) are equally effective in patients with symptoms confined to the peripheral nervous system, including meningitis (level A). Patients with CNS manifestations should be treated with IV ceftriaxone (2 g daily) for 14 days and late LNB (symptom duration >6 months) for 3 weeks (good practice points). Children should be treated as adults, except that doxycycline is contraindicated under 8 years of age (nine in some countries). If symptoms persist for more than 6 months after standard treatment, the condition is often termed post‐Lyme disease syndrome (PLDS). Antibiotic therapy has no impact on PLDS (level A).

Mielite Extensa como Manifestação de Neuroborreliose

“…1 Por outro lado, a seroconversão IgG é rara e muito variável, não sendo relevante para a confirmação do diagnóstico. 15 No presente caso, o diagnóstico de Mielite por Borrelia spp.…”

“…Apenas em 20% -30% dos casos é relatada a presença do eritema migrans. 1 A disseminação sistémica é acompanhada de sintomas pseudogripais, 2 podendo posteriormente ser acompanhada de envolvimento do sistema nervoso (síndrome Garin-Bujadoux-Bannwarth) 3 em 10% -15%, articular em 10% e cardíaco em 1% -2% dos casos. 4 Os sintomas neurológicos ocorrem geralmente entre a primeira e a décima segunda semana após picada da carraça infetada.…”

“…4 Os sintomas neurológicos ocorrem geralmente entre a primeira e a décima segunda semana após picada da carraça infetada. 1,5 As manifestações neurológicas na doença de Lyme precoce (primeiros seis meses) ocorrem em 3% -12% dos doentes, sendo a meningorradiculite a forma de apresentação mais comum, seguida da meningite linfocítica. Outros sintomas de envolvimento precoce do sistema nervoso central, como encefalomielite e mielite são raros (< 5%).…”

CXCL13 levels are more increased in cerebrospinal fluid and plasma of patients with acute infectious than in non-infectious diseases of the central nervous system

“…Researchers observed significant correlations of cytokines/chemokines in patients with impaired BBB, which suggests that they are regulated in parallel in patients with neuroinflammation [9,10].…”

Commentary on the NeBoP score - a clinical prediction test for children with Lyme neuroborreliosis

“…The diagnosis of Lyme neuroborreliosis in Europe is based on clinical symptoms and laboratory data, such as pleocytosis and anti-Borrelia antibodies in serum and CSF according to guidelines 1 . However, the decision to start antibiotic treatment on admission cannot be based on Borrelia serology since results are not available at the time of lumbar puncture.…”