Here is a detailed summary of the key points about Lyme disease and its neurologic complications:
Causative agent and transmission:
- Caused by spirochetes of the genus Borrelia, primarily Borrelia burgdorferi in North America
- Transmitted by bite of infected Ixodes tick
- Tick must typically remain attached for 24-48 hours to transmit Borrelia
• Geographic distribution:
- Highest incidence in northeastern and north-central United States
- Endemic areas include Connecticut, Vermont, Maine, Massachusetts, New Hampshire, Rhode Island, New Jersey, Pennsylvania, New York, Wisconsin, Minnesota
• Clinical manifestations:
- Initial sign is often erythema migrans rash at site of tick bite
- Can progress to systemic involvement if untreated
- Most common neurologic complications:
- Cranial neuritis (especially facial nerve palsy)
- Meningitis
- Radiculoneuritis/mononeuropathy multiplex
• Diagnosis:
- Two-step serologic testing recommended by CDC:
- Enzyme-linked immunosorbent assay (ELISA)
- If ELISA positive/borderline, Western blot for IgM and IgG
- CSF analysis may be needed in early infection or equivocal cases
- CSF typically shows lymphocytic pleocytosis in active neuroborreliosis
• Treatment:
- Oral doxycycline for most cases of neuroborreliosis
- IV antibiotics (ceftriaxone, cefotaxime, penicillin G) for severe manifestations
- Duration typically 2-4 weeks
• Post-treatment Lyme disease syndrome:
- Persistent symptoms like fatigue, pain, cognitive issues after treatment
- Not indicative of ongoing infection
- No benefit from prolonged antibiotic therapy
• Chronic Lyme disease controversy:
- Not a recognized clinical entity
- Symptoms attributed to Lyme without evidence of infection
- Long-term antibiotics not recommended
• Key points for neurologists:
- Consider Lyme in endemic areas for patients with facial palsy, meningitis, radiculitis
- Understand proper diagnostic testing and interpretation
- Recognize limitations of serology in early infection
- Be aware of guidelines for appropriate antibiotic treatment
