Frequency and clinical significance of Lyme seropositivity in patients with isolated optic neuritis

Abstract

We evaluated antibody reactivity against Borrelia burgdorferi in 20 consecutive patients with newly diagnosed isolated optic neuritis who resided in a region endemic for Lyme disease. Four (20%) patients had positive serology. All three patients who had follow-up serologies showed rising convalescent levels of Borrelia-specific IgM. One patient refused lumbar puncture, one had normal CSF constituents except for an elevated Lyme antibody index, and two had CSF lymphocytic pleocytosis that remained unexplained after extensive evaluations for causes other than Lyme disease. We treated both patients who had CSF pleocytosis with intravenous ceftriaxone; the pleocytosis and optic nerve function improved. The other two patients received oral antibiotics and showed excellent recovery of visual acuity. We believe that serologic testing for Lyme disease is warranted for individuals with optic neuritis who reside in an endemic region, and patients with rising convalescent antibody levels or unexplained CSF pleocytosis should receive antibiotic treatment for Lyme disease.

Acute blindness in dogs: Sudden acquired retinal degeneration syndrome versus neurological disease (140 cases, 2000–2006)

“…The significance of multiple dogs with ND previously testing positive for Lyme disease is difficult to determine. Lyme disease has been implicated as a cause of optic neuritis in humans but to the author's knowledge, has not been definitively linked to optic neuritis in dogs 30 . Of the three dogs that tested positive prior to vision loss, only one was retested at the time of acute vision loss and was seropositive based on Western blot.…”

Lyme disease and optic neuritis: Long-term follow-up of seropositive patients

“…We further recommended antibiotic treatment for those seropositive patients with unexplained CSF pleocytosis, elevated CSF Lyme antibody index, or rising serum levels of Borrelia-specific antibodies. 1 Earlier laboratory kits to screen for Lyme disease, including ours, lacked specificity, contributing to overdiagnosis. 3 Since that report, 1 our laboratory instituted two changes: (1) we started using a colorimetric enzyme immunoassay (General Biometrics, San Diego, CA) with greater specificity than earlier assays for laboratory screening of Lyme disease but still highly sensitive; (2) we followed the recommendations of the Centers for Disease Control and Prevention (CDC), which specify that serologic testing for Lyme disease be performed using a two-step process.…”

“…1 Marshfield Clinic provides medical care for patients residing in an area endemic for Lyme disease. 2 Four of 20 (20%) patients were seropositive with both an indirect fluorescent assay and ELISA (table).…”

“…1 This index may be artifactually elevated if the serum level of Borrelia antibody is low. Also, she had no CSF pleocytosis and follow-up serologic testing was not performed (see the table).…”

Optic neuritis in multiple sclerosis

“…57,58 Regarding spirochetal infections, both anterior and retrobulbar optic neuritis may be seen in patients with Lyme disease. 59 In severe acute sphenoid sinusitis, the infection may spread posteriorly to the optic nerve in the orbital apex or within the optic canal causing retrobulbar optic neuritis and acute visual loss. 60 In neuroretinitis, intraocular inflammation itself may cause optic disc edema.…”