| Abstract [eng] |
Relevance of the Thesis. Lyme disease is a multisystem infectious disease caused by several bacterial species belonging to the Borrelia burgdorferi sensu lato complex. In recent years, epidemiological data from European countries have shown a noticeable increase in the incidence of Lyme disease. One clinical form of borreliosis is Lyme neuroborreliosis (LNB), which develops when Borelia burgdorferi affects the nervous system. Because the disease often leads to residual symptoms, delayed diagnosis and late initiation of treatment continue to pose important clinical challenges. For this reason, greater attention should be paid to the different clinical presentations of Lyme neuroborreliosis, its epidemiology, and the difficulties associated with accurate diagnosis. Furthermore, a better understanding of the pathogenic mechanisms of the disease and the virulence factors of Borrelia burgdorferi remains essential. Objective. To conduct a literature review on the etiology, pathogenesis, clinical presentation, and diagnosis of Lyme neuroborreliosis, and to evaluate the epidemiological, clinical, and laboratory characteristics of this disease in the study sample. Subjects and Methods. A retrospective analytical study was conducted, including patients hospitalized with Lyme disease at the Center of Infectious diseases and the Center of Neurology of Vilnius University Hospital Santaros Klinikos between 2010 and 2021. The study analyzed demographic, clinical, epidemiological, and laboratory data of patients. The diagnosis of Lyme neuroborreliosis was established according to the European Federation of Neurological Societies (EFNS) diagnostic criteria. Patients diagnosed with neuroborreliosis were divided into two age groups (< 60 years and ≥ 60 years) and by sex. A statistical comparison of medical data was performed between these groups. Results. 170 patients were included in the study, of whom 103/170 (60.6%) were diagnosed with Lyme neuroborreliosis. The median age of patients with this disease was 60 years. Early Lyme neuroborreliosis was diagnosed in 100/103 (97.1%) patients, and late Lyme neuroborreliosis in 3/103 (2.9%). The most common clinical manifestation of early neuroborreliosis was polyradiculitis (75/100 (75%)), followed by peripheral facial palsy (53/100 (53%)). Encephalitis was diagnosed in 9/100 (9%) cases, and myelitis in 2/100 (2%) cases. Comparison of the < 60 and ≥ 60 years age groups showed that meningopolyradiculitis alone was significantly more common in older patients (p = 0.013), whereas the facial nerve neuropathy was more common in younger patients (p = 0.044). It was found that bilateral facial neuropathy was significantly more common in men (p = 0.006), while women were more likely to present with meningopolyradiculitis alone (p = 0.003). Patients whose first manifestation of the disease was polyradiculitis, were admitted to the hospital significantly later than patients whose initial manifestation of LNB was peripheral facial palsy (p < 0.001) or signs of encephalitis/meningitis (p = 0.009). Conclusions. The results of the study confirm that Lyme neuroborreliosis is most commonly diagnosed in middle-aged and older adults, and the most characteristic clinical syndrome of the disease is meningopolyradiculitis. Among patients with neuroborreliosis, women were older, had a higher prevalence of comorbidities, and were more frequently diagnosed with meningopolyradiculitis alone, while men were more often diagnosed with bilateral facial neuropathy. Older patients (≥ 60 years) were more likely to have comorbidities and were more frequently diagnosed with meningopolyradiculitis alone. In addition, lower pleocytosis and longer hospital stays were observed in the older patients group. Facial nerve neuropathy was more common in younger individuals (< 60 years). A significant delay (20 days) in diagnosing neuroborreliosis was observed. |
