http://cid.oxfordjournals.org/content/e ... 9.abstract
Clin Infect Dis. (2016)
First published online: May 8, 2016
Course and Outcome of Early European Lyme Neuroborreliosis (Bannwarth's Syndrome) – Clinical and Laboratory Findings
Katarina Ogrinc1, Lara Lusa2, Stanka Lotrič-Furlan1, Petra Bogovič1, Daša Stupica1, Tjaša Cerar3, Eva Ružić-Sabljić3, and Franc Strle1
- Author Affiliations
1 Department of Infectious Diseases, University Medical Center Ljubljana, Slovenia
2 Institute for Biostatistics and Medical Informatics, Medical Faculty, University of Ljubljana, Slovenia
3 Institute of Microbiology and Immunology, Medical Faculty, University of Ljubljana, Slovenia
Information on the course and outcome of early European Lyme neuroborreliosis is limited.
The study comprised 77 patients (38 males, 39 females; median age 58 years) diagnosed with painful meningoradiculitis (Bannwarth's syndrome) who were followed-up for one year at a single center.
Duration of neurological symptoms before diagnosis was 30 (IQR 14–50) days. The most frequent symptoms/signs were radicular pain (100%), sleep disturbances (75.3%), erythema migrans (59.7%), headache (46.8%), fatigue (44.2%), malaise (39%), paresthesias (32.5%), peripheral facial palsy (36.4%), meningeal signs (19.5%), and pareses (7.8%). Cerebrospinal fluid (CSF) analysis revealed lymphocytic/monocytic pleocytosis, elevated protein concentration, and intrathecal synthesis of borrelial IgM and IgG antibody in 100%, 81.1%, 63%, and 88.7% of patients, respectively. Borreliae (predominantly Borrelia garinii) were isolated from CSF, skin, and blood in 15.6%, 40.6%, and 2.7% of patients, respectively. The outcome after 14-day treatment with ceftriaxone was favorable in 87.8% of patients. Control CSF examination at three months showed decreased leukocyte counts in all patients; however, 23.3% still had pleocytosis (>10x106 cells/L). A model based on pretreatment data and the findings at the end of 14-day antibiotic treatment accurately predicted which patients would have an unfavorable outcome 6 or 12 months after treatment.
Our patients had fewer pretreatment neurological complications (peripheral facial palsy, pareses) than reported for Bannwarth's syndrome decades ago, probably as the result of earlier recognition and prompt antibiotic treatment. Unfavorable outcome was rare and was predicted by the continued presence of symptoms 14 days after commencement of treatment.
There's an editorial commentary from Dr. John J. Halperin that I'm still trying to find:
John J. Halperin
Neuroborreliosis – what is it, what isn't it?
Clin Infect Dis. first published online May 8, 2016 doi:10.1093/cid/ciw303