| Abstract [eng] |
Lyme disease is a zoonotic disease caused by Gram negative Borrelia burgdorferi sensu lato complex bacteria, most commonly B. burgdorferi sensu stricto, B. afzelii, B. spielmanii, B. garinii and B. bavariensis. It is the most common vector-borne disease in the temperate zone of the Northern Hemisphere. The pathogen is transmitted by ticks of the Ixodes ricinus complex. Incidence in Lithuania, other European countries and in some states of the USA is hyperendemic. In the wake of climate change, the burden of disease and the economic burden caused by Lyme disease continue to grow. Lyme disease can affect various organ systems, in return having received the name 'the new great imitator'. The form affecting the nervous system is called Lyme neuroborreliosis. This form of the disease occurs in ~3-12% of Lyme disease patiens in Europe and the USA. Bannwarth (Garin-Bujadoux-Bannwarth) syndrome is the most common manifestation in the early disseminated stage of Lyme and usually presents as lymphocytic meningitis, painful radiculoneuritis, and often cranial neuropathies. Nevertheless, neuroborreliosis has a wide clinical spectrum, being able to damage central and / or peripheral nervous systems and imitate various other neurologic, as well as neuroophthalmologic, otorhinolaryngologic, rheumatologic, paraneoplastic, autoimmune, endocrinologic, gastroenterologic and neuropsychiatric conditions. Additionally, coinfection with other tick-borne pathogens is possible. Atypical presentation may interfere with timely diagnosis and treatment, which may lead to an unfavorable clinical outcome. The diagnosis is primarily based on laboratory methods, namely cerebrospinal fluid analysis and serological testing of serum and cerebrospinal fluid. Imaging studies help to differentiate neuroborreliosis from other possible conditions. Some patients with neuroborreliosis, even after treatment with antibiotics, have persistent subjective neurologic symptoms, such as memory loss; it is not always possible to objectify them during the neurological examination. In this thesis, the various clinical manifestations of neuroborreliosis and its diagnostic modalities are discussed, with some case reports of the past 5 years that were published in the international literature databases being presented, in order to inform and raise awareness of the heterogeneity of this disease. |
