Cerebrospinal fluid findings in patients with symptoms suggesting chronic Lyme borreliosis.
BACKGROUND
Patients with non-specific long-lasting symptoms such as headache, concentration disturbances, and vertigo and who have positive serum borrelial antibody titres are often assumed to have chronic Lyme borreliosis. Because of the possibility that they may have central nervous system involvement they are frequently treated with courses of i.v. ceftriaxone. We assessed central nervous system involvement by examining cerebrospinal fluid samples in a group of such patients.


METHODS
Adult patients who qualified for the study had non-specific symptoms suggesting central nervous system involvement for longer than six months (but without overt clinical signs of such involvement) and positive serum borrelial antibody titres and/or erythema migrans prior to the onset of symptoms. Cerebrospinal fluid was examined in all patients.


RESULTS
None of the 77 patients included in the study (median duration of symptoms 18 months) had pleocytosis and there was no isolation of Borrelia burgdorferi sensu lato from cerebrospinal fluid. Mildly elevated protein concentration and intrathecal borrelial IgG antibody synthesis were demonstrated in 16 (21%) and 7 (9.1%) patients, respectively.


CONCLUSIONS
In patients with non-specific long-lasting symptoms attributed to Lyme borreliosis but with the absence of overt clinical signs suggesting central nervous system involvement, the findings of cerebrospinal fluid examination are usually in the normal range. Routine treatment of such patients with i.v. ceftriaxone is not to be encouraged.
Ogrinc
Katarina
K
Department of Infectious Diseases, University Medical Centre, Ljubljana, Slovenia. katarina.orgrinc1@guest.arnes.si
Lotric-Furlan
Stanka
S
Maraspin
Vera
V
Cimperman
Joze
J
Ruzić-Sabljić
Eva
E
Strle
Franc
F
D000328:Adult; D000368:Aged; D000907:Antibodies, Bacterial / Q000134:cerebrospinal fluid*; D025065:Borrelia burgdorferi / Q000276:immunology*; D002555:Cerebrospinal Fluid / Q000382:microbiology; D015787:Erythema Chronicum Migrans / Q000175:diagnosis / Q000276:immunology; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000134:cerebrospinal fluid; D007964:Leukocytosis / Q000134:cerebrospinal fluid; D008193:Lyme Disease / Q000175:diagnosis* / Q000276:immunology; D020852:Lyme Neuroborreliosis / Q000175:diagnosis* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D017524:Slovenia
D000907:Antibodies, Bacterial; D007074:Immunoglobulin G