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Der Nervenarzt

, Volume 75, Issue 6, pp 553–557 | Cite as

Verlauf der akuten und chronischen Neuroborreliose nach Behandlung mit Ceftriaxon

  • R. Kaiser
Originalien

Zusammenfassung

Zwischen 1990 und 2000 wurden insgesamt 101 Patienten mit einer klinisch und liquordiagnostisch (Pleozytose, erhöhter borrelienspezifischer Antikörper-Index) gesicherten akuten (N=86) bzw. chronischen (N=15) Neuroborreliose über jeweils 2 bzw. 3 Wochen mit 2 g Ceftriaxon i.v. pro Tag behandelt. Die Patienten wurden nach 3, 6 und 12 Monaten klinisch und serologisch nachuntersucht. Nach 6 Monaten war die Erkrankung bei 93% der Patienten mit akuter und bei 20% der Patienten mit chronischer Neuroborreliose ausgeheilt. Nach einem Jahr betrug die Heilungsrate bei der akuten Neuroborreliose 95% und bei der chronischen Neuroborreliose 66%: Bei 4 Patienten mit akuter Neuroborreliose bestanden noch leichte Fazialisinnervationsstörungen, bei 5 Patienten mit chronischer Neuroborreliose noch Störungen der Motorik und Koordination. Fazit: Die Häufigkeit residualer Symptome bei der akuten Neuroborreliose entspricht der Spontanprognose idiopathischer Fazialisparesen, die Prognose der chronischen Neuroborreliose ist meist ungünstiger und korreliert mit der Dauer der Symptomatik bis zur Diagnosestellung.

Schlüsselwörter

Neuroborreliose Borrelia burgdorferi s.l. Ceftriaxon 

Clinical courses of acute and chronic neuroborreliosis following treatment with ceftriaxone

Summary

Between 1990 and 2000, a total of 101 patients with acute (n=86) or chronic (n=15) neuroborreliosis (proven by clinical data, pleocytosis in the CSF, and elevated Borrelia burgdorferi-specific antibody indices) were treated with 2 g of ceftriaxone per day for either 2 or 3 weeks. The patients were reexamined clinically and serologically after 3, 6, and 12 months. Six (12) months after the antibiotic treatment, about 93% (95%) of the patients with acute neuroborreliosis and 20% (66%) of the patients with chronic neuroborreliosis were cured. One year after treatment, four patients with acute neuroborreliosis still suffered from facial palsy and five with chronic neuroborreliosis still had moderate spastic ataxic gait disturbance. The prognosis of facial palsy in neuroborreliosis is quite similar to that in idiopathic facial palsy, while that in chronic neuroborreliosis largely depends on the time elapsed before diagnosis.

Keywords

Neuroborreliosis Borrelia burgdorferi Ceftriaxone 

Literatur

  1. 1.
    Aberer E, Breier F, Stanek G, Schmidt B (1996) Success and failure in the treatment of acrodermatitis chronica atrophicans. Infection 24:85–87PubMedGoogle Scholar
  2. 2.
    Dattwyler RJ, Halperin JJ, Pass H, Luft BJ (1987) Ceftriaxone as effective therapy in refractory Lyme disease. J Infect Dis 155:1322–1325PubMedGoogle Scholar
  3. 3.
    Dotevall L, Hagberg L (1999) Successful oral doxycycline treatment of Lyme disease-associated facial palsy and meningitis. Clin Infect Dis 28:569–574PubMedGoogle Scholar
  4. 4.
    Engelter S, Lyrer P, Radu EW, Steck AJ (1996) Acute infectious disorders of the spinal cord and its roots with gadolinium-DTPA enhancement in magnetic resonance imaging. J Neurol 243:191–195PubMedGoogle Scholar
  5. 5.
    Hammers-Berggren S, Hansen K, Lebech AM, Karlsson M (1993) Borrelia burgdorferi-specific intrathecal antibody production in neuroborreliosis: a follow-up study. Neurology 43:169–175PubMedGoogle Scholar
  6. 6.
    Hammers-Berggren S, Lebech A M, Karlsson M, Svenungsson B, Hansen K, Stiernstedt G.1994.Serological follow-up after treatment of patients with erythema migrans and neuroborreliosis. J Clin Microbiol 32:1519–1525PubMedGoogle Scholar
  7. 7.
    Hansen K, Lebech AM (1992) The clinical and epidemiological profile of Lyme neuroborreliosis in Denmark 1985–1990. A prospective study of 187 patients with Borrelia burgdorferi specific intrathecal antibody production. Brain 115 (Pt 2): 399–423PubMedGoogle Scholar
  8. 8.
    Hauser U, Lehnert G, Wilske B (1999) Validity of interpretation criteria for standardized Western blots (immunoblots) for serodiagnosis of Lyme borreliosis based on sera collected throughout Europe. J Clin Microbiol 37:2241–2247PubMedGoogle Scholar
  9. 9.
    James DG (1997) Differential diagnosis of facial nerve palsy. Sarcoidosis Vasc Diffuse Lung Dis 14:115–120PubMedGoogle Scholar
  10. 10.
    Kaiser R (1994) Variable CSF findings in early and late Lyme neuroborreliosis: a follow-up study in 47 patients. J Neurol 242:26–36PubMedGoogle Scholar
  11. 11.
    Kaiser R (1998) Neuroborreliosis. J Neurol 245:247–255CrossRefPubMedGoogle Scholar
  12. 12.
    Kaiser R (2000) False-negative serology in patients with neuroborreliosis and the value of employing of different borrelial strains in serological assays. J Med Microbiol 49:911–915PubMedGoogle Scholar
  13. 13.
    Kaiser R, Rauer S (1999) Advantage of recombinant borrelial proteins for serodiagnosis of neuroborreliosis. J Med Microbiol 48:5-10PubMedGoogle Scholar
  14. 14.
    Kaiser R, Rauer S (1999) Serodiagnosis of neuroborreliosis: comparison of reliability of three confirmatory assays. Infection 27:177–182PubMedGoogle Scholar
  15. 15.
    Karkkonen K, Stiernstedt SH, Karlsson M (2001) Follow-up of patients treated with oral doxycycline for Lyme neuroborreliosis. Scand J Infect Dis 33:259–262CrossRefPubMedGoogle Scholar
  16. 16.
    Karlsson M, Hammers-Berggren S, Lindquist L, Stiernstedt G, Svenungsson B (1994) Comparison of intravenous penicillin G and oral doxycycline for treatment of Lyme neuroborreliosis. Neurology 44:1203–1207PubMedGoogle Scholar
  17. 17.
    Kristoferitsch W, Baumhackl U, Sluga E, Stanek G, Zeiler K (1987) High-dose penicillin therapy in meningopolyneuritis Garin-Bujadoux-Bannwarth. Clinical and cerebrospinal fluid data. Zentralbl Bakteriol Mikrobiol Hyg [A] 263:357–364Google Scholar
  18. 18.
    Kruger H, Kohlhepp W, Konig S (1990) Follow-up of antibiotically treated and untreated neuroborreliosis. Acta Neurol Scand 82:59–67PubMedGoogle Scholar
  19. 19.
    Mantienne C, Albucher JF, Catalaa I, Sevely A, Cognard C, Manelfe C (2001) MRI in Lyme disease of the spinal cord. Neuroradiology 43:485–488CrossRefPubMedGoogle Scholar
  20. 20.
    Medical Research Council (1976) Aids to the examination of the peripheral nervous system. Her Majesty's Stationary Office, LondonGoogle Scholar
  21. 21.
    Mullegger RR, Millner MM, Stanek G, Spork KD (1991) Penicillin G sodium and ceftriaxone in the treatment of neuroborreliosis in children--a prospective study. Infection 19:279–283PubMedGoogle Scholar
  22. 22.
    Niemann G, Koksal MA, Oberle A, Michaelis R (1997) Facial palsy and Lyme borreliosis: long-term follow-up of children with antibiotically untreated "idiopathic" facial palsy. Klin Padiatr 209:95–99PubMedGoogle Scholar
  23. 23.
    Noya M, Pardo J (1997) [Diagnosis and treatment of facial palsy] Diagnostico y tratamiento de la paralisis facial. Neurologia 12:23–30PubMedGoogle Scholar
  24. 24.
    Pfister HW, Preac-Mursic V, Wilske B, Schielke E, Sorgel F, Einhaupl KM (1991) Randomized comparison of ceftriaxone and cefotaxime in Lyme neuroborreliosis. J Infect Dis 163:311–318PubMedGoogle Scholar
  25. 25.
    Treib J, Fernandez A, Haass A, Grauer M T, Holzer G, Woessner R (1998) Clinical and serologic follow-up in patients with neuroborreliosis. Neurology 51:1489–1491PubMedGoogle Scholar
  26. 26.
    Wang ZY, Hansen K, Siden A, Cruz M (1993) Intrathecal synthesis of anti-Borrelia burgdorferi antibodies in neuroborreliosis: a study with special emphasis on oligoclonal IgM antibody bands. Scand J Immunol 37:369–376PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  1. 1.Neurologische KlinikStädtisches Klinikum Pforzheim
  2. 2.Neurologische KlinikStädtisches Klinikum Pforzheim Pforzheim

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