LB in neurootological patients in Helsinki

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Yvonne
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LB in neurootological patients in Helsinki

Post by Yvonne » Sat 3 Nov 2007 10:58

LYME BORRELIOSIS IN NEUROOTOLOGICAL PATIENTS

Even in the early clinical studies neu-
rootological symptoms were re-
ported for patients with LB. Cranial
nerve neuropathies are common
manifestations of neuroborreliosis in
both Europe and North America. The
facial nerve is the most commonly affected cranial nerve, but the dise-
ase can also affect other cranial ner-
ves, including the vestibulocochlear
nerve.

. Neurootological manifestations
of Lyme borreliosis

Facial nerve paralysis

Sudden sensorineural hearing loss

Vertigo

1. LB is an important infectious cau
se of FP (I) and especially in FP in
children (II) in southern Finland. It
is advisable to screen patients with
FP for antibodies to B. burgdorferi in
endemic areas like southern Finland
In the diagnosis of LB, special atten
tion must be paid to the history of
the patient and clinical signs and fin
dings related to LB. Suspicion of LB
in a patient with FP is an indication
for the analysis of the CSF. Fever
headache, pharyngalgia, enlarged
cervical lymph nodes and arthralgia
were more frequent in patients with
LB-related FP than in other FP patients.
Suspicion of LB as the cause of
FP must be especially high during
late summer and autumn. Strict cri-
teria must be applied to the diagnosis of LB.

2. SHL can be caused by LB (III). The
prevalence of antibodies to B. burgdor-
feriin patients with SHL was six-fold
higher than the corresponding preva-
lence in the general population. No
special signs or symptoms were found
to explain the occurrence of LB in the-
se patients. Serological screening for
antibodies to B. burgdorferi is recom-
mended in patients with SHL in areas
endemic for LB.

3. LB can, although rarely, present
with vertigo. Vertigo caused by LB
may mimic the symptoms of
Menière´s disease. The prevalence of
antibodies to B. burgdorferi in unse-
lected patients with vertigo was
equal to the corresponding prevalen-
ce in the general population. There-
fore, the routine screening for anti-
bodies against B. burgdorferi in pati-
ents with vertigo is not recommen-
dable.

4. Although the neurootological ma-
nifestations of LB seem to have a fa-
vorable outcome even without treat-
ment, patients with definite LB
should be treated with appropriate
antimicrobials.

5. The present study demonstrates
that I. ricinus ticks are abundant in
the vicinity of the city center of Hel-
sinki. In contrast to previous studies,
the occurrence of ticks was confir-
med in the absence of large mammals
like deer and elk. Of the three genos-
pecies of B. burgdorferi causing LB in
Europe, one, B. burgdorferi sensu
stricto, was absent in the ticks in Hel-
sinki. This finding may explain the
rarity of frank arthritis in the patie-
nts with LB in the present study. Al-
together 32% of the ticks in Helsinki
harbored the spirochete B. burgdorferi.

http://ethesis.helsinki.fi/julkaisut/la ... meborr.pdf
Listen to all,
plucking a feather from every passing goose,
but follow no one absolutely

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