Nervous System Lyme Disease

Halperin, John J.

doi:10.1016/j.cll.2015.07.002

Cited by 24 publications

(16 citation statements)

References 66 publications

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“…Lyme meningitis has not previously been attributed to any particular risk group. However, an increase in intracranial pressure accompanying meningitis caused by B burgdorferi infection is recognized predominantly in children [26]. There are several potential explanations for a propensity of Lyme meningitis to affect children and young men.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Clinician-Diagnosed Lyme Arthritis, Facial Palsy, Carditis, and Meningitis in Patients From High-Incidence States

Kwit

Nelson

Max

et al. 2017

Open Forum Infectious Diseases

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BackgroundClinical features of Lyme disease (LD) range from localized skin lesions to serious disseminated disease. Information on risk factors for Lyme arthritis, facial palsy, carditis, and meningitis is limited but could facilitate disease recognition and elucidate pathophysiology.MethodsPatients from high-incidence states treated for LD during 2005–2014 were identified in a nationwide insurance claims database using the International Classification of Diseases, Ninth Revision code for LD (088.81), antibiotic treatment history, and clinically compatible codiagnosis codes for LD manifestations.ResultsAmong 88022 unique patients diagnosed with LD, 5122 (5.8%) patients with 5333 codiagnoses were identified: 2440 (2.8%) arthritis, 1853 (2.1%) facial palsy, 534 (0.6%) carditis, and 506 (0.6%) meningitis. Patients with disseminated LD had lower median age (35 vs 42 years) and higher male proportion (61% vs 50%) than nondisseminated LD. Greatest differential risks included arthritis in males aged 10–14 years (odds ratio [OR], 3.5; 95% confidence interval [CI], 3.0–4.2), facial palsy (OR, 2.1; 95% CI, 1.6–2.7) and carditis (OR, 2.4; 95% CI, 1.6–3.6) in males aged 20–24 years, and meningitis in females aged 10–14 years (OR, 3.4; 95% CI, 2.1–5.5) compared to the 55–59 year referent age group. Males aged 15–29 years had the highest risk for complete heart block, a potentially fatal condition.ConclusionsThe risk and manifestations of disseminated LD vary by age and sex. Provider education regarding at-risk populations and additional investigations into pathophysiology could enhance early case recognition and improve patient management.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Clinician-Diagnosed Lyme Arthritis, Facial Palsy, Carditis, and Meningitis in Patients From High-Incidence States

Kwit

Nelson

Max

et al. 2017

Open Forum Infectious Diseases

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“…Instead, diagnosis is based on the presence of compatible clinical features and demonstration of B. burgdorferi-specific intrathecal antibody synthesis (12,13). Briefly, CSF and normalized serum are tested by a B. burgdorferi-specific ELISA, and intrathecal antibody production is established by calculating an antibody index (AI) from the ELISA results.…”

Section: Serologic Testing For Lyme Disease: a Historical Perspectivementioning

confidence: 99%

The Past, Present, and (Possible) Future of Serologic Testing for Lyme Disease

Theel

2016

J Clin Microbiol

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Lyme disease prevails as the most commonly transmitted tick-borne infection in the United States, and serologic evaluation for antibodies to Borrelia burgdorferi remains the recommended modality for diagnosis. This review presents a brief historical perspective on the evolution of serologic assays for Lyme disease and provides a summary of the performance characteristics for the currently recommended two-tiered testing algorithm (TTTA). Additionally, a recently proposed alternative to the traditional TTTA is discussed, and novel methodologies, including immuno-PCR and metabolic profiling for Lyme disease, are outlined.

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“…Several theories exist to account for the pathophysiology of the syndrome. It has been proposed that shifts in electrolyte composition and the presence of inflammatory mediators such as cytokines during systemic inflammatory states have an effect on the brain that can lead to cognitive dulling [6]. Another study has examined cross reactivity between the outer surface protein A (OspA) protein expressed by B. burgdorferi and human neural proteins and found that cross-reactivity indeed exists between OspA and proteins expressed in brain, spinal cord, and dorsal root ganglia cells.…”

Section: Introductionmentioning

confidence: 99%

“…TME has been reported in a plethora of other inflammatory and infectious processes. Examples include viral and bacterial infections, as well as autoimmune disorders [5,6]. For reasons not completely understood, Lyme disease has a more chronic manifestation of TME which may have led to its recognition as a separate constellation of symptoms unique to Lyme disease.…”

Section: Introductionmentioning

confidence: 99%

“…For reasons not completely understood, Lyme disease has a more chronic manifestation of TME which may have led to its recognition as a separate constellation of symptoms unique to Lyme disease. It has been published that TME may actually affect approximately 2% of the general population at any given time regardless of underlying disease processes [5,6]. Conclusive data regarding the pathophysiologic overlap between Lyme encephalopathy and TME has yet to be published.…”

Section: Introductionmentioning

confidence: 99%

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