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Neurological manifestations of Lyme borreliosis

Neurologische Manifestationen der Lyme-Borreliose

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Summary

After the isolation ofBorrelia burgdorferi, the previously unknown causative agent of Lyme disease, two neurological disorders, Bannwarth's syndrome and acrodermatitis chronica atrophicans-associated neuropathy, which have been known in Europe for decades, gained new interest. With the availability of serodiagnostic tests, a chronic debilitating disorder — progressive borrelia encephalomyelitis — was found to be caused by chronic infection withB. burgdorferi. Beside these typical manifestations, a growing number of publications about various neurological phenomena appeared, which were thought to be caused byB. burgdorferi. This assumption was based in many cases on the results of serodiagnostic tests only. Considerations for causal connections were frequently lacking. While prior to the availability of serodiagnostic tests neurological manifestations of Lyme borreliosis frequently remained undiagnosed, we now face a tendency for overdiagnosis. The great variety of neurological manifestations in Lyme borreliosis — most of them can also be attributed to other conditions — and the high rate of seropositivity forB. burgdorferi amongst the population living in endemic areas require strict criteria for the correct diagnosis of new and atypical neurological manifestations.

Zusammenfassung

Seit der Entdeckung der bisher unbekannten Borrelien-Art,Borrelia burgdorferi und der ätiologischen Abklärung der Lyme-Krankheit, haben zwei in Europa vor Jahrzehnten beschriebene neurologische Krankheitsbilder, das Bannwarth Syndrom und die Acrodermatitis chronica atrophicans-assoziierte Neuropathie, neue Bedeutung gewonnen. Eine weitere neurologische Erkrankung, die zu chronischer Behinderung führende progressive Borrelienenzephalomyelitis, konnte seit der Verfügbarkeit serodiagnostischer Testmethoden identifiziert werden. Abgesehen von diesen typischen und gut charakterisierten neurologischen Krankheitsbildern, wurden in letzter Zeit in einer wachsenden Zahl von Publikationen eine Vielzahl neurologischer Krankheitsbilder einer Borrelieninfektion zugeschrieben. In vielen Fällen beruhte diese Annahme lediglich auf serodiagnostische Testresultate. Auf den kausalen Zusammenhang zwischen Testresultat und Krankheitsbild wurde nur selten eingegangen. Während vor Verfügbarkeit serodiagnostischer Testmethoden die Lyme-Borreliose häufig undiagnostiziert blieb, besteht nun die Gefahr, daß diese Diagnose zu häufig gestellt wird. Vor allem für die Diagnose atypischer Manifestationen der Lyme-Borreliose sind strenge Kriterien erforderlich, da einerseits in Endemiegebieten mit einer hohen „Seropositivität” der Bevölkerung zu rechnen ist, andererseits viele neue, der Lyme-Borreliose zugeschriebene neurologische Krankheitsbilder, auch anderen Ursachen zugerodnet werden können.

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  1. Neurologische Abteilung, Wilhelminenspital der Stadt Wien, Montleartstr. 37, A-1117, Wien, Austria

    W. Kristoferitsch

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Kristoferitsch, W. Neurological manifestations of Lyme borreliosis. Infection 19, 268–272 (1991). https://doi.org/10.1007/BF01644965

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