Peripheral facial palsy as an initial symptom of Lyme neuroborreliosis in an Austrian endemic area

Kindler, Wolfgang; Wolf, Hubert; Thier, K.; Oberndorfer, Stefan

doi:10.1007/s00508-014-0685-3

Cited by 13 publications

(6 citation statements)

References 11 publications

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“…This study showed a seasonal distribution of patients with facial palsy due to LNB with a peak in July, August and September. This has been reported in previous studies [20, 28]. In summer months, both tick activity and exposition to ticks increase due to the warmer weather.…”

Section: Discussionsupporting

confidence: 84%

Incidence and characteristics of Lyme neuroborreliosis in adult patients with facial palsy in an endemic area in the Netherlands

et al. 2019

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Making a distinction between facial palsy due to Lyme neuroborreliosis (LNB) and idiopathic facial palsy (IFP) is of importance to ensure timely and adequate treatment. The study objective was to assess incidence and patient characteristics of facial palsy due to LNB. Hospital records were reviewed of adult patients with facial palsy visiting the departments of neurology and/or otorhinolaryngology of Gelre hospitals between June 2007 and December 2017. Gelre hospitals are located in an area endemic for Lyme borreliosis. Patients with LNB had pleocytosis and intrathecal antibody production or pleocytosis with positive IgG serology. Patients with IFP had negative serology. Clinical characteristics were compared between patients with LNB and patients with IFP. Five hundred and fifty-nine patients presented with facial palsy, 4.7% (26) had LNB and 39.4% (220) IFP. The incidence of facial palsy due to LNB was 0.9/100 000 inhabitants/year. Over 70% of patients with facial palsy due to LNB did not report a recent tick bite and/or erythema migrans (EM). Patients with facial palsy due to LNB presented more often in July to September (69.2% vs. 21.9%, P < 0.001), and had more often headache (42.3% vs. 15.5%, P < 0.01). To reduce the risk of underdiagnosing LNB in an endemic area, we recommend testing for LNB in patients with facial palsy in summer months especially when presenting with headache, irrespective of a recent tick bite and/or EM.

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Section: Discussionsupporting

confidence: 84%

Incidence and characteristics of Lyme neuroborreliosis in adult patients with facial palsy in an endemic area in the Netherlands

et al. 2019

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“…In line with these findings, we found that serum lactate was elevated 2 weeks after initial diagnosis of Borrelia infection. Furthermore, lactate levels in cerebral spinal fluid (CSF) were previously shown to be strongly increased in 63% of Lyme patients with facial palsy, while CSF lactate was normal in patients with facial palsy due to other infections (Kindler et al, 2015). Similarly, CSF lactate was elevated in patients with acute Lyme neuroborreliosis, but not in patients with neurosyphilis (Djukic et al, 2012).…”

Section: Discussionmentioning

confidence: 98%

Functional and Genomic Architecture of Borrelia burgdorferi -Induced Cytokine Responses in Humans

Oosting

Kerstholt

Horst

et al. 2016

Cell Host & Microbe

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Despite the importance of immune variation for the symptoms and outcome of Lyme disease, the factors influencing cytokine production during infection with the causal pathogen Borrelia burgdorferi remain poorly understood. Borrelia infection-induced monocyte- and T cell-derived cytokines were profiled in peripheral blood from two healthy human cohorts of Western Europeans from the Human Functional Genomics Project. Both non-genetic and genetic host factors were found to influence Borrelia-induced cytokine responses. Age strongly impaired IL-22 responses, and genetic studies identified several independent QTLs that impact Borrelia-induced cytokine production. Genetic, transcriptomic, and functional validation studies revealed an important role for HIF-1α-mediated glycolysis in the cytokine response to Borrelia. HIF-1α pathway activation and increase in glycolysis-derived lactate was confirmed in Lyme disease patients. In conclusion, functional genomics approaches reveal the architecture of cytokine production induced by Borrelia infection of human primary leukocytes and suggest a connection between cellular glucose metabolism and Borrelia-induced cytokine production.

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“…In the pediatric population, the proportion of LNB among cases of PFNP is even higher [26][27][28][29]. Several authors recommend in the differential diagnosis of PFNP routine realization of lumbar puncture and examination of intrathecal synthesis of Bb antibodies, especially if the PFNP is diagnosed at the time of increased occurrence of LNB from May to October [30][31][32]. One of the reasons is the different management of idiopathic PFNP and LNB and the concern that corticoid treatment recommended for idiopathic PFNP may in some cases worsen the course of LNB [33,34].…”

Section: Discussionmentioning

confidence: 99%

Socio-demographic Characteristics of Tick Bite and Erythema migrans not associated with the Diagnosis of Neuroboreliosis

Koscalova¹,

Holeckova²,

Gazdikova³

et al. 2022

CSWHI

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Introduction Lyme neuroborreliosis (LNB) is a tick-borne infection caused by bacteria Borrelia burgdorferi sensu lato that accounts for 10-15% of all Lyme borreliosis cases in Europe. LNB can present with a variety of neurological manifestations. We aimed to describe the typical anamnestic, clinical and laboratory features of patients diagnosed with LNB and to describe the differences between paediatric and adult cases. Additionally, we assessed the factors associated with definite LNB. Methods We retrospectively evaluated data of patients with suspected LNB had undergone lumbar puncture and were admitted to the Infectious diseases department of University hospital Bratislava, Slovakia, between September 2019 and May 2022. Patients were divided into three categories according to the diagnostic criteria of European Federation of Neurological Societies: A) cases with definite LNB, B) cases with possible LNB, C) non-LNB controls. Results In total, 139 patients were included in the analysis. 32 individuals were classified as definite LNB, 23 as possible LNB and 84 as non-LNB controls. 55.5% were females and 35.3% were children aged<18 years. 56.3% of patients with definite LNB reported a history of tick bite, and 21.9% a history of erythema migrans (EM). Peripheral facial nerve palsy (PFNP) was the most common clinical symptom in patients with definite LNB (65.6%), followed by headache (50.0%), fever (21.9%) and radicular pain (18.8%). In a univariate and multivariable analyses neither history of tick bite nor history of EM were significantly associated with definite LNB. Factors independently associated with definite LNB in multivariable analyses were (i) age < 18 years (aOR 7.89, 95% CI 2.00-31.03, p < 0,003), (ii) female gender (OR 6.34; 95% CI 1.66-24.17, p < 0.007), and (iii) facial nerve palsy (OR 10.54; 95% CI 2.41-55.19, p < 0.002). Conclusion We found that peripheral facial nerve palsy is the strongest predictor of definite LNB, and that the children<18 years and females in our study were more likely to be diagnosed with LNB. Our study also suggests that anamnestic data on history of tick bite and EM contribute little to the diagnosis of LNB and that the examination of CSF is essential for the diagnosis of LNB.

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Peripheral facial palsy as an initial symptom of Lyme neuroborreliosis in an Austrian endemic area

Cited by 13 publications

References 11 publications

Incidence and characteristics of Lyme neuroborreliosis in adult patients with facial palsy in an endemic area in the Netherlands

Incidence and characteristics of Lyme neuroborreliosis in adult patients with facial palsy in an endemic area in the Netherlands

Functional and Genomic Architecture of Borrelia burgdorferi -Induced Cytokine Responses in Humans

Socio-demographic Characteristics of Tick Bite and Erythema migrans not associated with the Diagnosis of Neuroboreliosis

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