Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/05/17 16:13:37」(JST)

wiki en

Neuroborreliosis is a disorder of the central nervous system caused by infection with a spirochete of the genus Borrelia.^[1] The microbiological progression of the disease is similar to that of neurosyphilis, another spirochetal infection.^[2] Neuroborreliosis occurs as a rare manifestation of late Lyme disease, although it has also been reported during early infection.

Signs and symptoms [edit]

Neuroborreliosis is often preceded by the typical symptoms of Lyme disease, which include erythema migrans and flu-like symptoms such as fever and muscle aches. Neurologic symptoms of neuroborreliosis include the meningoradiculitis (which is more common in European patients), cranial nerve abnormalities, and altered mental status. Sensory findings may also be present. Rarely, a progressive form of encephalomyelitis may occur. In children, symptoms of neuroborreliosis include headache, sleep disturbance, and symptoms associated with increased intracranial pressure, such as papilledema, can occur. Less common childhood symptoms can include meningitis, myelitis, ataxia, and chorea. Ocular Lyme disease has also been reported, as has neuroborreliosis affecting the spinal cord, but neither of these findings are common.^[3]

Differential diagnosis [edit]

A number of diseases can produce symptoms similar to those of Lyme neuroborreliosis. They include:

Alzheimer's disease
Acute disseminated encephalomyelitis
Viral meningitis
Multiple sclerosis
Bells palsy^[4]

Neuroborreliosis presenting with symptoms consistent with amyotrophic lateral sclerosis has been described.^[5]

Treatment [edit]

In the US, neuroborreliosis is typically treated with intravenous antibiotics which cross the blood–brain barrier, such as penicillins, ceftriaxone, or cefotaxime.^[6] One relatively small randomized controlled trial suggested ceftriaxone was more effective than penicillin in the treatment of neuroborreliosis.^[7] Small observational studies suggest ceftriaxone is also effective in children.^[8] The recommended duration of treatment is 14 to 28 days.^[9]^[10]

Several studies from Europe have suggested oral doxycycline is equally as effective as intravenous ceftriaxone in treating neuroborreliosis. Doxycycline has not been widely studied as a treatment in the US, but antibiotic sensitivities of prevailing European and US isolates of Borrelia burgdorferi tend to be identical. However, doxycycline is generally not prescribed to children due to the risk of bone and tooth damage.^[6]

Discreditied or doubtful treatments for neuroborreliosis include:

Malariotherapy
Hyperbaric oxygen therapy
Colloidal silver
Injections of hydrogen peroxide and bismacine

References [edit]

^ Rupprecht TA, Koedel U, Fingerle V, Pfister HW (2008). "The pathogenesis of lyme neuroborreliosis: from infection to inflammation". Mol. Med. 14 (3–4): 205–12. doi:10.2119/2007-00091.Rupprecht. PMC 2148032. PMID 18097481.
^ Judith Miklossy, Sandor Kasas, Anne D Zurn, Shermann McCall, Sheng Yu, and Patrick L McGeer (2008). "Persisting atypical and cystic forms of Borrelia burgdorferi and local inflammation in Lyme neuroborreliosis". Journal of Neuroinflammation 5 (1): 40. doi:10.1186/1742-2094-5-40. PMC 2564911. PMID 18817547. Unknown parameter |unused_data= ignored (help)
^ http://www.ajnr.org/cgi/content/full/30/6/1079
^ http://emedicine.medscape.com/article/1168285-diagnosis
^ http://www2.lymenet.org/8525647f006e05f2/8c703fae46ce57c28525670a0009ab7e/42c29e795a2341938525650300056eea?OpenDocument
^ ^a ^b Halperin JJ (June 2008). "Nervous system Lyme disease". Infect. Dis. Clin. North Am. 22 (2): 261–74, vi. doi:10.1016/j.idc.2007.12.009. PMID 18452800.
^ Dattwyler RJ, Halperin JJ, Volkman DJ, Luft BJ (May 1988). "Treatment of late Lyme borreliosis--randomised comparison of ceftriaxone and penicillin". Lancet 1 (8596): 1191–4. PMID 2897008.
^ Bloom BJ, Wyckoff PM, Meissner HC, Steere AC (March 1998). "Neurocognitive abnormalities in children after classic manifestations of Lyme disease". Pediatr. Infect. Dis. J. 17 (3): 189–96. doi:10.1097/00006454-199803000-00004. PMID 9535244.
^ Wormser GP, Dattwyler RJ, Shapiro ED, et al. (November 2006). "The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America". Clin. Infect. Dis. 43 (9): 1089–134. doi:10.1086/508667. PMID 17029130.
^ Halperin JJ, Shapiro ED, Logigian E, et al. (July 2007). "Practice parameter: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology". Neurology 69 (1): 91–102. doi:10.1212/01.wnl.0000265517.66976.28. PMID 17522387.

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 神経系のライム病 nervous system lyme disease
2. ライム病の治療 treatment of lyme disease
3. 成人におけるライム病の臨床症状 clinical manifestations of lyme disease in adults
4. 小児における顔面神経麻痺 facial nerve palsy in children
5. ライム病の診断 diagnosis of lyme disease

English Journal

Bilateral vocal cord paralysis requiring tracheostomy due to neuroborreliosis.

Martínez-Balzano CD, Greenberg B.
Chest.Chest.2014 Nov 1;146(5):e153-5. doi: 10.1378/chest.14-0515.
Neuroborreliosis can cause multiple cranial and peripheral neuropathies; however, involvement of both recurrent laryngeal nerves is rare. We report the case of a 90-year-old man who presented with dysphonia and right upper and lower extremity weakness. His course was complicated by bilateral vocal c
PMID 25367481

Lyme neuroborreliosis: a diagnostic headache.

Sinha A1, Dietzman T2, Ross D3, Sulieman S4, Fieldston E2.
Hospital pediatrics.Hosp Pediatr.2014 Nov;4(6):400-4. doi: 10.1542/hpeds.2014-0025.
PMID 25362084

Vasculitis and stroke due to Lyme neuroborreliosis - a review.

Zajkowska J1, Garkowski A, Moniuszko A, Czupryna P, Ptaszyńska-Sarosiek I, Tarasów E, Ustymowicz A, Lebkowski W, Pancewicz S.
Scandinavian journal of infectious diseases.Scand J Infect Dis.2014 Oct 24:1-6. [Epub ahead of print]
Lyme neuroborreliosis (LNB) is a rare cause of vasculitis and stroke. It may manifest as subarachnoid hemorrhage, intracerebral hemorrhage, and most often ischemic stroke due to cerebral vasculitis. The vast majority of reported cases have been described by European authors. A high index of suspicio
PMID 25342573

Japanese Journal

Different B-cell populations are responsible for the peripheral and intrathecal antibody production in neuroborreliosis

LAKOS Andras,FERENCZI Emoke,KOMOLY Samuel,GRANSTROM Marta
International immunology 17(12), 1631-1637, 2005-12-01
NAID 10016811586

Up-regulation of Borrelia-specific IL-4- and IFN-γ-secreting cells in cerebrospinal fluid from children with Lyme neuroborreliosis

WIDHE Mona,SKOGMAN Barbro Hedin,JAREFORS Sara,EKNEFELT Mattias,ENESTROM Gunilla,NORDWALL Maria,EKERFELT Christina,CRONER Stefan,BERGSTROM Sven,FORSBERG Pia,ERNERUDH Jan
International immunology 17(10), 1283-1291, 2005-10-01
NAID 10016810781