Summary
Five patients with chronic meningitis were hospitalized several times for progressive neurological symptoms. The clinical manifestations included cranial neuritis, radiculoneuritis, myelitis and encephalitis. In two cases cerebral infarction occurred. The course was commonly characterized by a tendency to deteriorate. From the clinical point of view, it was repeatedly difficult to exclude multiple sclerosis or tuberculous meningitis. Finally, specific antibodies against Borrelia burgdorferi were detected by indirect immunofluorescence assay. The diagnosis of a borreliosis was not considered initially because there was no history of tick-bite or erythema chronicum migrans, and the neurological involvement of the central nervous system seemed unusual. The latency between the first symptoms and diagnosis varied from 3 months to 5 years. After a parenteral, high-dose therapy with penicillin, there was a significant improvement in all patients. In two cases, there was evidence of intrathecally produced antibodies to myelin basic protein.
References
Ackermann R, Hörstrup P, Schmidt R (1984) Tick-borne meningopolyneuritis (Garin-Bujadoux, Bannwarth). Yale J Biol Med 57:485–490
Ackermann R, Gollmer E, Rehse-Küpper B (1985) Progressive Borrelien-Enzephalomyelitis. Dtsch Med Wochenschr 110:1039–1042
Barbour AG, Tessier SL, Stoenner HG (1982) Variable major proteins of Borrelia hermsii. J Exp Med 156:1312–1324
Barbour AG, Burgdorfer W, Grunwaldt E, Steere AC (1983) Antibodies of patients with Lyme disease to components of the Ixodes dammini spirochete. J Clin Invest 72:504–515
Benach JL, Bosler EM, Hanrahan JP, Coleman JL, Habicht GS, Bast TF, Cameron DJ, Ziegler JL, Barbour AG, Burgdorfer W, Edelman R, Kaslow AR (1983) Spirochetes isolated from the blood of two patients with Lyme disease. N Engl J Med 308:740–742
Borel JF, Ryffel B (1985) The mechanism of action of cyclosporin: a continuing puzzle. In: Schindler R (ed) Ciclosporin in autoimmune diseases. Springer, Berlin Heidelberg New York, pp 24–32
Graft JE, Grodzicki RL, Shrestha M, Fischer DK, Garcia-Blanco M, Steere AC (1984) The antibody response in Lyme disease. Yale J Biol Med 57:561–565
Hardin JA (1984) Clinical features (part one). Yale J Biol Med 57:479
Malawista SE (1984) Clinical features (part two). Yale J Biol Med 57:505–506
Mertz LE, Wobig GH, Duffy J, Katzmann JA (1985) Ticks, spirochetes, and new diagnostic tests for Lyme disease. Mayo Clin Proc 60:402–406
Meyerhoff J (1983) Lyme disease. Am J Med 75:663–670
Moffat CM, Sigal LH, Steere AC, Freemann DH, Dwyer JM (1984) Cellular immune findings in Lyme disease. Am J Med 77:625–632
Pachner AR, Steere AC (1984) Neurological findings of Lyme disease. Yale J Biol Med 57:481–483
Pachner AR, Steere AC (1985) The triad of neurologic manifestations of Lyme disease: meningitis, cranial neuritis and radiculoneuritis. Neurology 35:47–53
Page N, Perruisseau G, Steck AJ (1983) Binding properties of cerebrospinal fluid IgG in multiple sclerosis and other neurological diseases. J Neurol Sci 60:23–30
Reik L, Steere AC, Bartenhagen NH, Shope RE, Malawista SE (1979) Neurologic abnormalities of Lyme disease. Medicine 58:281–294
Ryberg B (1984) Bannwarth's syndrome (lymphocytic meningoradiculitis) in Sweden. Yale J Biol Med 57:499–503
Schmidt R, Ackermann R (1985) Durch Zecken übertragene Meningo-Polyneuritis (Garin-Bujadoux, Bannwarth) Erythemachronicum-migrans-Krankheit des Nervensystems. Fortschr Neurol Psychiatr 53:145–153
Sköldenberg B, Garde A, Carlström A, Stiernstedt G, Kolmodin G, Nord CE (1983) Chronic meningitis caused by a penicillin-sensitive microorganism? Lancet II:75–78
Steck AJ, Murray N, Meier C, Page N, Perruisseau G (1983) Demyelinating neuropathy and monoclonal IgM antibody to myelin-associated glycoprotein. Neurology 33:19–23
Steere AC, Malawista SE, Newman JH, Spieler PN, Bartenhagen NH (1980) Antibiotic therapy in Lyme disease. Ann Intern Med 93:1–8
Steere AC, Grodzicki RL, Kornblatt AN, Craft JE, Barbour AG, Burgdorfer W, Schmidt GP, Johnson E, Malawista SE (1983) The spirochetal etiology of Lyme disease. N Engl J Med 308:733–740
Steere AC, Pachner AR, Malawista SE (1983) Neurologic abnormalities of Lyme disease: successful treatment with high-dose intravenous penicillin. Ann Intern Med 99:767–772
Steere AC, Malawista SE, Bartenhagen NH, Spieler PN, Newman JH, Rahn DW, Hutchinson GJ, Green J, Syndman DR, Taylor E (1984) The clinical spectrum and treatment of Lyme disease. Yale J Biol Med 57:453–461
Stiernstedt G (1985) Tick-borne Borrelia infection in Sweden. Scand J Inf Dis [Suppl] 45:1–70
Suchanek G, Kristoferitsch W, Stanek G, Bernheimer H (1985) Anti-myelin-antibodies (AMA) in patients with meningopolyneuritis Garin-Bujadoux-Bannwarth (GBB). In: Compendium of abstracts. Second international symposium on Lyme disease and related disorders. Vienna, p 20
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Weder, B., Wiedersheim, P., Matter, L. et al. Chronic progressive neurological involvement in Borrelia burgdorferi infection. J Neurol 234, 40–43 (1987). https://doi.org/10.1007/BF00314008
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DOI: https://doi.org/10.1007/BF00314008