Lyme disease

Abstract

Peripheral nerve dysfunction was demonstrated in 36% of patients with late Lyme disease. Of 36 patients evaluated, 14 had prominent limb paresthesias. Thirteen of these had neurophysiologic evidence of peripheral neuropathy; neurologic examinations were normal in most. Repeat testing following treatment documented rapid improvement in 11 of 12. We conclude that this neuropathy, which is quite different from the infrequent peripheral nerve syndromes previously described in this illness, is commonly present in late Lyme disease. This neuropathy presents with intermittent paresthesias without significant deficits on clinical examination and is reversible with appropriate antibiotic treatment. Neurophysiologic testing provides a useful diagnostic tool and an important measure of response to treatment.

Simultaneous expression of Borrelia OspA and OspC and IgM response in cerebrospinal fluid in early neurologic Lyme disease.

“…This bacterial infection is due to a tick-borne spirochete, Borrelia burgdorferi (Bb) 1 (2). The nervous system is a very common target organ (3)(4)(5)(6)(7)(8)(9). The behavior of the invading Bb within the central nervous system (CNS) and the immune response in the cerebrospinal fluid (CSF) have not been described sufficiently.…”

Infectious Diseases Causing Neuropathy

“…However, in the earliest (<4 weeks) and latest (years) stages of the disease, such assays may be falsely negative (Reik 1993 ). Antibiotic treatment is highly effective in both early-and late-stage disease (Reik 1993 ;Halperin et al 1987 ).…”

“…The discussion below is based on a review of the nerve biopsy literature in Lyme disease (Meurers et al 1990 ;Vallat et al 1987 ;Meier et al 1989 ;Camponovo and Meier 1986 ;Kristoferitsch et al 1988 ;Halperin et al 1987 ;Tezzon et al 1991 ;Hansen et al 2013 ). Lyme organisms have never been reported in peripheral nerve.…”

“…An infl ammatory and axonal process has almost invariably been described, although no infl ammation was present in two patients, one who was biopsied 4 weeks after the beginning of antibiotic treatment (Meurers et al 1990 ) and another with a minimal neuropathy who also was treated prior to biopsy (Halperin et al 1987 ). The infi ltrate centers around epineurial (most often), perineurial, and endoneurial vessels, and a few randomly scattered lymphocytes may be seen within the fascicle.…”

Lyme disease: a growing threat to urban populations.

“…Cerebrospinal fluid may show elevated total protein, intrathecal antibody production to B. burgdorferi (53), or a positive PCR test result for borrelial DNA sequences (54,55). Most patients with subacute encephalopathy also have an axonal polyneuropathy manifested by spinal radicular pain or by numbness and tingling in the hands or feet (50,51). Electromyography generally shows extensive abnormalities of proximal and distal nerve segments (51).…”