title: Suspected early Lyme neuroborreliosis in patients with erythema migrans.
abstract: BACKGROUND
  Our objective was to obtain data on patients with erythema migrans (EM) who have symptoms/signs suggesting nervous system involvement and to compare epidemiologic, clinical, and microbiologic findings in patients with and without cerebrospinal fluid (CSF) pleocytosis.
  
  
  METHODS
  Adult patients with EM and suspected early Lyme neuroborreliosis were included in this study.
  
  
  RESULTS
  Of 161 patients, 31 (19%) had elevated and 130 (81%) had normal CSF cell counts. In contrast to patients with normal CSF cell counts, those with pleocytosis (1) more often reported radicular pain and more often presented with meningeal signs but less frequently complained of malaise; (2) had larger EM skin lesions despite similar duration; (3) more commonly had Borrelia garinii isolated from EM skin lesions (odds ratio for pleocytosis was 31 times higher in patients with established B. garinii skin infection compared to patients with other Borrelia species isolated from their EM skin lesion) and from CSF; and (4) more frequently fulfilled microbiologic criteria for established borrelial infection of the central nervous system. The positive predictive value of pleocytosis for microbiologically proven borrelial infection of the central nervous system (defined by isolation of Borrelia from CSF and/or demonstration of intrathecal synthesis of borrelial antibodies) was 67.9%, whereas normal CSF white cell counts ruled out Lyme neuroborreliosis with a predictive value of 91.9%.
  
  
  CONCLUSIONS
  Comparison of European patients with EM who had symptoms/signs suggesting early Lyme neuroborreliosis revealed several differences in the clinical presentation and in microbiologic test results according to CSF findings.
authors.affiliation: Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia.
authors.forename: Katarina
authors.initials: K
authors.lastname: Ogrinc
authors.forename: Stanka
authors.initials: S
authors.lastname: Lotrič-Furlan
authors.forename: Vera
authors.initials: V
authors.lastname: Maraspin
authors.forename: Lara
authors.initials: L
authors.lastname: Lusa
authors.forename: Tjaša
authors.initials: T
authors.lastname: Cerar
authors.forename: Eva
authors.initials: E
authors.lastname: Ružič-Sabljič
authors.forename: Franc
authors.initials: F
authors.lastname: Strle
mesh_terms: D000328:Adult; D000368:Aged; D001898:Borrelia / Q000145:classification / Q000302:isolation & purification*; D002555:Cerebrospinal Fluid / Q000166:cytology; D042241:Early Diagnosis; D005260:Female; D005929:Glossitis, Benign Migratory / Q000175:diagnosis* / Q000473:pathology*; D006801:Humans; D020852:Lyme Neuroborreliosis / Q000175:diagnosis* / Q000473:pathology*; D008297:Male; D008875:Middle Aged
keywords: Borrelia burgdorferi sensu lato; Lyme borreliosis; Lyme neuroborreliosis; cerebrospinal fluid examination; erythema migrans