Skip to main content

Advertisement

SpringerLink
Log in

Active neuroborreliosis or inflammation: are the diagnostic guidelines at stake?

  • Original article
  • Published:
Acta Neurologica Belgica Aims and scope Submit manuscript

Abstract

Neuroborreliosis can induce a variety of neurological syndromes: e.g., cranial neuritis, plexitis, radiculitis, meningitis, cerebellitis, … We report on five cases of patients with a diagnosis of neuroborreliosis based on clinical symptoms, serologic tests and MR imaging results. However, neither of them fulfils the diagnostic criteria for definite neuroborreliosis. Are the diagnostic criteria still valid or is there a need to revise them? Is our diagnosis correct? Are these cases post-Lyme auto-immune neuronal inflammation, and not due to still active spirochetal infection? Do we need to consider immunosuppressive therapy instead of third-generation cephalosporins?

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Belgische commissie voor de coördinatie van het antibioticabeleid (BAPCOC). Aanbevelingen BAPCOC Lyme borreliose 2017. http://overlegorganen.gezondheid.belgie.be/nl/documenten/aanbevelingen-lyme-borreliose-2017. Accessed January 12, 2018

  2. Bleyenheuft C, Lernout T, Berger N, Rebolledo J, Leroy M, Robert A, Quoilin S (2015) Epidemiological situation of Lyme borreliosis in Belgium, 2003 to 2012. Arch Public Health 73(1):33

    Article  PubMed  PubMed Central  Google Scholar 

  3. Obsomer V, Wirtgen M, Linden A, Claerebout E, Heyman P, Heylen D, Madder M, Maris J, Lebrun M, Tack W, Lempereur L, Hance T, Van Impe G (2013) Spatial disaggregation of tick occurrence and ecology at a local scale as a preliminary step for spatial surveillance of tick-borne diseases: general framework and health implications in Belgium. Parasit Vectors 22;6:190

    Article  PubMed  PubMed Central  Google Scholar 

  4. Linard C, Tersago K, Vanwambeke S, Lambin E (2007) Determinants of the geographic distribution of Puumala virus and Lyme borreliosis infections in Belgium. International Journal of Health Geographics 6:15

    Article  PubMed  PubMed Central  Google Scholar 

  5. De Keukeleire M, Robert A, Kabamba B, Dion E, Luyasu V, Vanwambeke SO (2016) Individual and environmental factors associated with the seroprevalence of Borrelia burgdorferi in Belgian farmers and veterinarians. Infect Ecol Epidemiol 6:32793

    Article  PubMed  Google Scholar 

  6. De Keukeleire M, Vanwambeke SO, Somassè E, Kabamba B, Luyasu V, Robert A (2015) Scouts, forests, and ticks: Impact of landscapes on human-tick contacts. Ticks Tick Borne Dis 6(5):636–644

    Article  PubMed  Google Scholar 

  7. Kesteman T, Rossi C, Bastien P, Brouillard J, Avesani V, Olive N, Martin P, Delmée M (2010) Prevalence and genetic heterogeneity of Borrelia burgdorferi sensu lato in Ixodes ticks in Belgium. Acta Clin Belg 65(5):319–322

    Article  CAS  PubMed  Google Scholar 

  8. De Keukeleire M, Vanwambeke S, Kabamba B, Belkhir L, Pierre P, Luyasu V, Robert A (2017) Time trend of clinical cases of Lyme disease in two hospitals in Belgium, 2000–2013. BMC Infect Dis 17:748

    Article  PubMed  PubMed Central  Google Scholar 

  9. Jungnick S, Margos G, Rieger M, Dzaferovic E, Bent SJ, Overzier E et al (2015) Borrelia burgdorferi sensu stricto and Borrelia afzelii: population structure and differential pathogenicity. Int J Med Microbiol 305:673–681

    Article  PubMed  Google Scholar 

  10. Cerar T, Strle F, Stupica D, Ruzic-Sabljic E, McHugh G, Steere A, Strle K (2016) Differences in Genotype, Clinical Features, and Inflammatory Potential of Borrelia burgdorferi sensu stricto Strains from Europe and the United States. Emerg Infect Dis 22(5):818–827

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Hengge UR, Tannapfel A, Tyring SK, Erbel R, Arendt G, Ruzicka T (2003) Lyme Borreliosis. Lancet Infect Dis 3:489–500

    Article  PubMed  Google Scholar 

  12. Hildenbrand P, Craven DE, Jones R, Nemeskai P (2009) Lyme Neuroborreliosis: manifestations of a rapidly emerging zoonosis. Am J Neuroradiol 30:1079–1987

    Article  CAS  PubMed  Google Scholar 

  13. Kříž B, Malý M, Daniel M (2017) Neuroborreliosis in patients hospitalised for Lyme borreliosis in the Czech Republic in 2003–2013. Epidemiol Mikrobiol Imunol 66(3):115–123

    PubMed  Google Scholar 

  14. Mygland A, Ljøstad U, Fingerle V, Rupprecht T, Schmutzhard E, Steiner I (2010) European Federation of Neurological Societies. EFNS guidelines on the diagnosis and management of European Lyme neuroborreliosis. Eur J Neurol 17(1):8–16, e1-4

    Article  CAS  PubMed  Google Scholar 

  15. Stanek G, Fingerle V, Hunfeld KP, Jaulhac B, Kaiser R, Krause A, Kristoferitsch W, O’Connell S, Ornstein K, Strle F, Gray J (2011) Lyme borreliosis: clinical case definitions for diagnosis and management in Europe. Clin Microbiol Infect 17(1):69–79

    Article  CAS  PubMed  Google Scholar 

  16. Dessau RB, van Dam AP, Fingerle V, Gray J, Hovius JW, Hunfeld KP, Jaulhac B, Kahl O, Kristoferitsch W, Lindgren PE, Markowicz M, Mavin S, Ornstein K, Rupprecht T, Stanek G, Strle F. To test or not to test? Laboratory support for the diagnosis of Lyme borreliosis: a position paper of ESGBOR, the ESCMID study group for Lyme borreliosis. Clin Microbiol Infect. 2017. pii: S1198-743X(17)30488-3

  17. Belman AL, Reynolds L, Preston T, Postels D, Grimson R, Coyle PK (1997) Cerebrospinal fluid findings in children with Lyme disease-associated facial nerve palsy. Arch Pediatr Adolesc Med 151(12):1224–1228

    Article  CAS  PubMed  Google Scholar 

  18. Tumani H, Nölker G, Reiber H (1995) Relevance of cerebrospinal fluid variables for early diagnosis of neuroborreliosis. Neurology 45(9):1663–1670

    Article  CAS  PubMed  Google Scholar 

  19. Djukic M, Schmidt-Samoa C, Lange P, Spreer A, Neubieser K, Eiffert H, Nau R, Schmidt H (2012) Cerebrospinal fluid findings in adults with acute Lyme neuroborreliosis. J Neurol 259(4):630–636

    Article  CAS  PubMed  Google Scholar 

  20. Ljøstad U, Skarpaas T, Mygland A (2007) Clinical usefulness of intrathecal antibody testing in acute Lyme neuroborreliosis. Eur J Neurol 14(8):873–876

    Article  PubMed  Google Scholar 

  21. Eckman EA, Pacheco-Quinto J, Herdt AR, Halperin JJ (2018) Neuroimmunomodulators in neuroborreliosis and Lyme encephalopathy. Clin Infect Dis. https://doi.org/10.1093/cid/ciy019

    Article  PubMed  Google Scholar 

  22. De Cauwer H, Declerck S, De Smet J, Matthyssen Ph, Pelzers E, Eykens L (2009) K. Lagrou. Motor neuron disease features in a patient with neuroborreliosis. Acta clinica belgica 64:225–227

    Article  PubMed  Google Scholar 

  23. Charles V, Duprez TP, Kabamba B, Ivanoiu A, Sindic CJM (2007) Poliomyelitis-like syndrome with matching magnetic resonance features in a case of Lyme neuroborreliosis. J Neurol Neurosurg Psychiatry 78:1160–1161

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Siao Tick Chong P, Vucic S, Cros DP (2003) Multiple sclerosis presenting as lower motor neuron wasting and weakness of the distal upper extremity. Neurology 61(9):1303–1304

    Article  CAS  PubMed  Google Scholar 

  25. Lodewyckx AA, De Cauwer H (2015) Intramedullaire neurosarcoïdose: casusbespreking en overzicht van de literatuur. Tijdschrift voor geneeskunde 71(8):527–532

    Google Scholar 

  26. Nardone R, Versace V, Brigo F, Tezzon F, Zuccoli G, Pikija S, Hauer L, Sellner J (2017) Herpes Simplex Virus Type 2 Myelitis: Case Report and Review of the Literature. Front Neurol 8:199

    Article  PubMed  PubMed Central  Google Scholar 

  27. Ramesh G, Didier PJ, England JD, Santana-Gould L, Doyle-Meyers LA, Martin DS, Jacobs MB, Philipp MT (2015) Inflammation in the pathogenesis of lyme neuroborreliosis. Am J Pathol 185(5):1344–1360

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Embers ME, Hasenkampf NR et al (2017) Variable manifestations, diverse seroreactivity and post-treatment persistence in non-human primates exposed to Borrelia burgdorferi by tick feeding. PLoS One 12(12):e0189071

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Crossland NA, Alvarez X, Embers ME. Late Disseminated Lyme Disease: Associated Pathology and Spirochete Persistence Post-Treatment in Rhesus Macaques. Am J Pathol. 2017

  30. Rothstein JD, Patel S, Regan MR, Haenggeli C, Huang YH, Bergles DE, Jin L, Dykes Hoberg M, Vidensky S, Chung DS, Toan SV, Bruijn LI, Su ZZ, Gupta P, Fisher PB (2005) Beta-lactam antibiotics offer neuroprotection by increasing glutamate transporter expression. Nature 433(7021):73–77

    Article  CAS  PubMed  Google Scholar 

  31. Hsieh MH, Meng WY, Liao WC, Weng JC, Li HH, Su HL, Lin CL, Hung CS, Ho YJ (2017) Ceftriaxone reverses deficits of behavior and neurogenesis in an MPTP-induced rat model of Parkinson’s disease dementia. Brain Res Bull 132:129–138

    Article  CAS  PubMed  Google Scholar 

  32. Krzyzanowska W, Pomierny B, Budziszewska B, Filip M, Pera J (2016) N-Acetylcysteine and Ceftriaxone as Preconditioning Strategies in Focal Brain Ischemia: Influence on Glutamate Transporters Expression. Neurotox Res 29(4):539–550

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Cui C, Cui Y, Gao J, Sun L, Wang Y, Wang K, Li R, Tian Y, Song S, Cui J (2014) Neuroprotective effect of ceftriaxone in a rat model of traumatic brain injury. Neurol Sci 35(5):695–700

    Article  PubMed  Google Scholar 

  34. Jeannet N, van den Hoogen BG, Schefold JC, Suter-Riniker F, Sommerstein R (2017) Cerebrospinal Fluid Findings in an Adult with Human Metapneumovirus-Associated Encephalitis. Emerg Infect Dis 23(2):370

    Article  PubMed  PubMed Central  Google Scholar 

  35. Mohammad SS, Dale RC (2018) Principles and approaches to the treatment of immune-mediated movement disorders. Eur J Paediatr Neurol 22(2):292–300

    Article  PubMed  Google Scholar 

  36. Akins PT, Belko J, Uyeki TM, Axelrod Y, Lee KK, Silverthorn J (2010) H1N1 encephalitis with malignant edema and review of neurologic complications from influenza. Neurocrit Care 13(3):396–406

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, AZ St Dimpna, Geel, Belgium

    Harald De Cauwer, Evelien Coeckelbergh & Jo Leenders

  2. Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium

    Harald De Cauwer & Evelien Coeckelbergh

  3. Department of Microbiology and Immunology, Laboratory of Clinical Bacteriology and Mycology, KU Leuven-University of Leuven, Leuven, Belgium

    Katrien Lagrou

  4. Clinical Laboratory, Laboratory of Microbiology, AZ St Dimpna, Geel, Belgium

    Ann Bogaerts

  5. Department of Neuroradiology, AZ St Dimpna, Geel, Belgium

    Dieter Vanneste

  6. Department of Neuroradiology, University Hospital Gasthuisberg, Leuven, Belgium

    Dieter Vanneste

Authors
  1. Harald De Cauwer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Katrien Lagrou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Evelien Coeckelbergh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ann Bogaerts
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jo Leenders
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Dieter Vanneste
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Harald De Cauwer.

Ethics declarations

Conflict of interest

All the authors report no disclosure or conflict of interest relevant to the manuscript.

Ethical approval

This manuscript does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study. Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

De Cauwer, H., Lagrou, K., Coeckelbergh, E. et al. Active neuroborreliosis or inflammation: are the diagnostic guidelines at stake?. Acta Neurol Belg 119, 207–214 (2019). https://doi.org/10.1007/s13760-018-01067-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13760-018-01067-2

Keywords

Search

Navigation