Lyme neuroborreliosis in adults: A nationwide prospective cohort study

Nordberg, Cecilie Lerche; Bodilsen, Jacob; Knudtzen, Fredrikke Christie; Storgaard, Merete; Brandt, Christian; Wiese, Lothar; Hansen, Birthe; Andersen, Åse Bengård; Nielsen, Henrik; Lebech, Anne‐Mette

doi:10.1016/j.ttbdis.2020.101411

Cited by 28 publications

(25 citation statements)

References 22 publications

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“…In comparison, in a study of 194 adult patients diagnosed with LNB in Denmark from 2015 to 2017, 70% of the patients had radicular pain and 43% had facial nerve palsy. 7 Interestingly, the prevalence of radicular pain in our study was similar to studies assessing patients with LNB-associated facial palsy in Slovenia 30 and Poland 32 ; radicular pain was present in 13 of 64 (20%) and 13 of 38 patients (34%), respectively.…”

Section: Discussionsupporting

confidence: 88%

“…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%

“…4 Lyme neuroborreliosis (LNB) occurs in about 15% of untreated patients in the US, 5 and it is the most frequent extracutaneous manifestation of Lyme disease in Europe. 6,7 LNB is divided between early and late manifestations (duration of signs and symptoms for more than 6 months), as well as between central and peripheral nervous system manifestations. 8 The most common manifestations of early (or acute) LNB are cranial neuropathy (particularly facial palsy), lymphocytic meningitis, and radiculoneuritis.…”

Section: Introductionmentioning

confidence: 99%

“…Peripheral facial palsy is the most common presentation in the US, while adult patients with early LNB acquired in Europe (mostly associated with B. garinii infection) usually present with Bannwarth syndrome, a subacute meningoradiculoneuritis characterized by painful radiculitis and lymphocytic pleocytosis, sometimes accompanied by cranial nerve involvement (most often peripheral facial palsy). 7,[9][10][11][12] Despite LNB being a relatively frequent manifestation of Lyme disease in the US, there have been few published studies describing the course and outcome in adults since the early descriptive series. [13][14][15][16][17][18][19] Moreover, two recent studies of US patients with facial palsy due to LNB raised concern that adjunctive corticosteroid treatment may lead to a worse outcome.…”

Section: Introductionmentioning

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: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 55%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

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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“…Most cases of early Lyme neuroborreliosis in Europe are caused by B. garinii and B. bavariensis; in adult patients, painful meningoradiculitis is most common (19,20). In a study of 194 adult patients with Lyme neuroborreliosis in Denmark during 2015-2017, radicular pain affected 70% of the patients and facial nerve palsy 43%; intrathecal production of IgG or IgM against Lyme borrelia was found in 87% (21). Similar results were found in a retrospective series of 431 Lyme neuroborreliosis patients in Denmark, which included 126 children.…”

Section: Neurologic Manifestationsmentioning

confidence: 99%

Comparison of Lyme Disease in the United States and Europe

Marques¹,

Strle²,

Wormser³

2021

Emerg. Infect. Dis.

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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