title: Evaluation of central nervous system involvement in Lyme borreliosis patients with a solitary erythema migrans lesion.
abstract: To determine whether early dissemination of Borrelia burgdorferi to the central nervous system occurs in stage I of Lyme borreliosis, neurological and cerebrospinal fluid examination was performed in 48 consecutive patients in whom the only sign of infection was a solitary erythema migrans lesion. Long-term follow-up after treatment with tetracycline was carried out by telephone interview. At presentation, neurological findings were normal in all 48 patients. Cerebrospinal fluid samples were obtained from 29 (60%) patients. Mild pleocytosis and mild impairment of the blood-brain barrier were present in four and one of these patients, respectively. No significant amount of tumor necrosis factor or interleukin 6 was found in the cerebrospinal fluid samples. Culture results of 13 cerebrospinal fluid samples were negative. Borrelia burgdorferi DNA was only detected by the polymerase chain reaction in one of two aliquots of the cerebrospinal fluid sample of one patient. None of 46 patients who were interviewed 12 to 51 (median 25) months after antibiotic treatment developed manifestations consistent with disseminated or chronic Lyme borreliosis. Thus, no compelling evidence was found for the presence of asymptomatic central nervous system involvement in patients with clinically localized Lyme borreliosis.
authors.affiliation: Department of Neurology, Academisch Medisch Centrum, University of Amsterdam, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Kuiper
authors.forename: B M
authors.initials: BM
authors.lastname: de Jongh
authors.forename: A P
authors.initials: AP
authors.lastname: van Dam
authors.forename: D E
authors.initials: DE
authors.lastname: Dodge
authors.forename: A C
authors.initials: AC
authors.lastname: Ramselaar
authors.forename: L
authors.initials: L
authors.lastname: Spanjaard
authors.forename: J
authors.initials: J
authors.lastname: Dankert
mesh_terms: D000328:Adult; D000368:Aged; D015748:Borrelia burgdorferi Group / Q000302:isolation & purification; D002493:Central Nervous System Diseases / Q000134:cerebrospinal fluid* / Q000209:etiology* / Q000382:microbiology; D015787:Erythema Chronicum Migrans / Q000188:drug therapy / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015850:Interleukin-6 / Q000134:cerebrospinal fluid; D008193:Lyme Disease / Q000134:cerebrospinal fluid* / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D012698:Serologic Tests; D013752:Tetracycline / Q000627:therapeutic use; D014409:Tumor Necrosis Factor-alpha / Q000134:cerebrospinal fluid
chemical_list: D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D013752:Tetracycline