Invasion of the central nervous system by Borrelia burgdorferi in acute disseminated infection.
OBJECTIVE
To determine central nervous system (CNS) involvement in acutely disseminated Borrelia burgdorferi infection by measurement of borrelia-specific DNA using the polymerase chain-reaction (PCR) assay and to compare the results of this with standard serological tests.


METHODS
Prospective study with laboratory investigators blinded to clinical data.


METHODS
Multicenter office practice with a central reference laboratory.


METHODS
Cerebrospinal fluid (CSF) was collected from 12 patients with acute disseminated Lyme borreliosis with less than 2 weeks of active disease. The normal control specimens came from 16 patients whose CSF samples had been sent to the clinical laboratory for tests unrelated to the present study.


METHODS
Clinical evidence of disease and laboratory abnormalities.


RESULTS
Eight of the 12 patients (four of six with multiple areas of erythema migrans and four of six with cranial neuritis without erythema migrans) had B burgdorferi-specific DNA in their CSF. Among the 12 patients studied, nine had acute cranial neuritis and six had multiple erythema migrans lesions. Just four of the eight who were found to have spirochetal DNA in their CSF had complaints suggestive of CNS infection. In three of the PCR-positive CSF samples, no other abnormalities were noted. None of 16 samples from controls were positive in the PCR assay.


CONCLUSIONS
B burgdorferi can invade the CNS early in the course of infection. Careful consideration should be given to choosing antibiotics that achieve adequate CSF levels in patients with disseminated infection.
Luft
B J
BJ
Department of Medicine, SUNY at Stony Brook 11794-8153.
Steinman
C R
CR
Neimark
H C
HC
Muralidhar
B
B
Rush
T
T
Finkel
M F
MF
Kunkel
M
M
Dattwyler
R J
RJ
D000907:Antibodies, Bacterial / Q000032:analysis; D001483:Base Sequence; D015748:Borrelia burgdorferi Group / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D002493:Central Nervous System Diseases / Q000134:cerebrospinal fluid / Q000382:microbiology*; D002555:Cerebrospinal Fluid / Q000382:microbiology; D004269:DNA, Bacterial / Q000032:analysis; D006801:Humans; D008193:Lyme Disease / Q000134:cerebrospinal fluid / Q000382:microbiology*; D008969:Molecular Sequence Data; D016133:Polymerase Chain Reaction; D011446:Prospective Studies
D000907:Antibodies, Bacterial; D004269:DNA, Bacterial