title: Detection of Borrelia burgdorferi DNA and complement membrane attack complex deposits in the sural nerve of a patient with chronic polyneuropathy and tertiary Lyme disease.
abstract: We report a patient who developed a chronic sensory-motor polyneuropathy and a progressive myelopathy 4 years after a tick bite. An increased serum antibody titer to Borrelia burgdorferi suggested a diagnosis of Lyme neuroborreliosis, although a concomitant cervical spondylosis probably contributed to spinal cord damage. Treatment with ceftriaxone resulted in a marked improvement of neuropathic symptoms, providing indirect evidence of spirochetal infection. Search for B. burgdorferi DNA by polymerase chain reaction amplification on sural nerve confirmed the diagnosis, demonstrating that the spirochete localized in the peripheral nervous system. The presence of complement membrane attack complex deposits and macrophage infiltrates around epineurial vessels and within the endoneurium suggests that the neuropathy in our patient was immune-mediated.
authors.affiliation: Institute of Neurological Sciences, University of Siena, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Maimone
authors.forename: M
authors.initials: M
authors.lastname: Villanova
authors.forename: G
authors.initials: G
authors.lastname: Stanta
authors.forename: S
authors.initials: S
authors.lastname: Bonin
authors.forename: A
authors.initials: A
authors.lastname: Malandrini
authors.forename: G C
authors.initials: GC
authors.lastname: Guazzi
authors.forename: P
authors.initials: P
authors.lastname: Annunziata
mesh_terms: D000368:Aged; D000907:Antibodies, Bacterial / Q000097:blood; D001706:Biopsy; D015748:Borrelia burgdorferi Group / Q000235:genetics* / Q000302:isolation & purification; D002462:Cell Membrane / Q000276:immunology / Q000382:microbiology; D003165:Complement System Proteins / Q000276:immunology*; D004269:DNA, Bacterial / Q000032:analysis; D005677:G(M1) Ganglioside / Q000276:immunology; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D008193:Lyme Disease / Q000150:complications / Q000276:immunology* / Q000503:physiopathology; D008297:Male; D008833:Microcirculation / Q000276:immunology; D008854:Microscopy, Electron; D009413:Nerve Fibers, Myelinated / Q000276:immunology / Q000382:microbiology / Q000473:pathology; D016133:Polymerase Chain Reaction; D011115:Polyneuropathies / Q000276:immunology / Q000382:microbiology*; D013497:Sural Nerve / Q000098:blood supply / Q000382:microbiology* / Q000648:ultrastructure
chemical_list: D000907:Antibodies, Bacterial; D004269:DNA, Bacterial; D007074:Immunoglobulin G; D005677:G(M1) Ganglioside; D003165:Complement System Proteins