Dissertations / Theses on the topic 'Neuroborrelios'

Borrelios är den vanligaste fästingburna infektionen på norra halvklotet, och orsakas av spiroketer tillhörande Borrelia burgdorferi sensu lato-komplexet. Dessa bakterier kan spridas till flera organ och ge upphov till olika symptom i bland annat hud, nervsystem, leder och hjärta. Omkring 15 % utvecklar neurologiska symptom, så kallad neuroborrelios. Den bästa indikatorn på aktiv neuroborrelios är framförallt karakteristiska neurologiska symptom samt tecken på en inflammatorisk förändring i cerebrospinalvätskan (CSV) i kombination med lokalt producerade antikroppar mot Borrelia burgdorferi s.l. i CSV. Nuvarande metod för diagnostik av neuroborrelios är en immunokemisk metod, en ELISA (enzyme-linked immunosorbent assay) som bygger på en jämförelse av Borrelia-antikroppsnivåer i CSV och i serum genom beräkning av antikroppsindex (AI). Beräkning av AI kompenserar för en eventuell ospecifik överföring av antikroppar från serum, till följd av en skada på blod-hjärnbarriären. Det finns dock tecken på att den nuvarande analysmetoden har för låg sensitivitet med falskt negativa resultat, framförallt tidigt i infektionsförloppet. För diagnostik av andra former av borrelios än neuroborrelios används en typ av ELISA baserad på C6-peptid. C6-peptid ELISA visar god känslighet för detektion av B. burgdorferi s.l.-specifika antikroppar i serum. C6-antigenet utgör en starkt immunogen och konserverad region av bakteriens VlsE-ytprotein. Syftet med den här studien var att undersöka om detektion av antikroppar mot C6-peptid i CSV kan komplettera den nuvarande använda metoden och därmed förbättra den totala sensitiviteten för diagnostik av neuroborrelios. I studien analyserades 169 patientprover från unga personer, samt 18 oklara patientfall som tidigare bedömts negativa med den nuvarande metoden. Antikroppar mot C6-peptid detekterades hos åtta unga patienter samt två oklara patientfall. Av dessa hade åtminstone tre unga patienter sannolikt neuroborrelios. Resultat från den här studien tyder på att C6-peptid-ELISA på CSV-prover kan fungera som ett komplement till befintlig metod för diagnostik av neuroborrelios. En kombination av båda metoderna kan sannolikt ge en betydligt högre sensitivitet. Vid tolkning av resultat från C6-peptid-baserade analysmetoder på CSV ska hänsyn tas till eventuell ospecifik överföring av B. burgdorferi s.l.-specifika antikroppar genom blod-hjärnbarriären.
Lyme Borreliosis, caused by spirochetes of the Borrelia burgdorferi sensu lato-complex, is the most common tick-borne infection in the temperate regions of the northern hemisphere. The bacteria can infect many different organs, this can give rise to a variety of symptoms in skin, the nervous system, joints and heart. Approximately 15 % of the infected individuals show neurological symptoms referred to as neuroborreliosis. An active neuroborreliosis is indicated by inflammatory changes in the cerebrospinal fluid (CSF) and local synthesis of anti-Borrelia antibodies in CSF. The current method to diagnose neuroborreliosis is an enzyme-linked immunosorbent assay (ELISA) which compares levels of anti-Borrelia antibodies in CSF and serum by calculating an antibody index (AI). Calculations of AI compensate for unspecific leakage of antibodies from serum to CSF following an injury of the blood-brain barrier. The drawback of the current method is a low sensitivity with a high rate of false negative results in samples collected early during an infection. Another type of ELISA, based on the use of a C6 peptide, has earlier shown good sensitivity for detection of B. burgdorferi s.l.-specific antibodies in serum. The C6 antigen corresponds to a highly immunogenic and conserved region of the bacterial surface protein VlsE. The aim of this study was to investigate whether a detection of antibodies against the C6 peptide in CSF could improve the total sensitivity for the diagnostics of neuroborreliosis. In the current study, 169 samples with negative AI from young patients and 18 samples from special cases were analyzed. Antibodies against the C6 peptide were found in 8 young patients and in 2 samples from special cases. Out of these, 3 young patients were stated positive for neuroborreliosis. Results of this study show that the C6 peptide ELISA on CSF samples could act as a complement to the current serological method for diagnosing neuroborreliosis. A combination of both methods could possibly increase the overall sensitivity. However, the blod-brain barrier injury issue is a problem in the analysis and interpretation of the results of the C6 peptide-based method on CSF should take into consideration a possible dysfunction of the blood-brain barrier. In conclusion, a combination of both the current method and the C6 peptide ELISA could give a markedly improved sensitivity in diagnostics of neuroborreliosis.

Lyme borreliosis (LB) is caused by spirocheter of Borrelia burgdorferi sensu lato. There are different types of borrelia species and some differ in their ability to survive in the presence of the complement system. B. afzelii is complementresistant while B. garinii is complementsensitive. This is based on the ability to recruit immune regulators, such as factor H to the bacterial surface and prevent activation of the complement system. Some individuals may show anti-Borrelia antibodies without having developed clinical symptoms. This may indicate a more effective immune response against spirochetes. The aim of this study was to investigate differences in complement activation by measuring C3a and sC5b-9 with sandwich ELISA between two previously Borrelia-exposed groups; individuals with previous subclinical Lyme borreliosis (SB) and patients previously diagnosed with neuroborreliosis (NB), and a control group without signs of LB exposure. Samples analyzed in this study consisted of controls (Ctrl, n = 8st), SB (n = 60st) and NB (n = 22st). Plasma from the groups were activated with ACA1 and Lu59. To compare the relative increase between the groups, complement factor C3a and the soluble terminal complement complex, sC5b-9, were analyzed using sandwich-ELISA.The analysis of C3a and sC5b-9 showed higher activation with Lu59 than ACA1, which is consistent with previous studies. According to C3a-analysis, no significant differences were observed between the groups for neither ACA1 nor Lu59. According to sC5b-9-analysis, a significant difference between SB and Ctrl (p= 0,0081) for Lu59 was observed. Conclusion of the studie was that further studies are required to interpret how this complement activation affects LB from a clinical prespective.

Lyme Borreliosisis is a multi-organ infectious disease caused by the spirochete Borrelia burgdorferi. The spirochete is transmitted to humans by tick bites. Neuroborreliosis (NB) is a disseminated form of the disease, in which the spirochetes invade the nervous system. In children, subacute meningitis and facial nerve palsy are typical clinical manifestations of NB. The aim of this thesis was to study clinical, immunological and laboratory characteristics in children being evaluated for NB in a Lyme endemic area of Sweden, in order to identify factors of importance for prognosis and clinical recovery. A total of 250 patients and 220 controls were included during 1998-2005, with a prospective and a retrospective part. Less than half (41%) of children with signs and symptoms indicative of NB get the diagnosis confirmed by detection of Borrelia specific flagella antibodies in CSF (clinical routine method). Surprisingly few patients were diagnosed as having other infectious or neurologic diseases and consequently, many patients ended up with an uncertain diagnosis. However, four new Borrelia antigens (DbpA, BBK32, OspC, IR6) were evaluated and performed well in laboratory diagnostics. If they were combined in a panel, together with the flagella antigen, the sensitivity was 82% and the specificity 100%, leading to improved diagnostic accuracy in children with NB, as compared to using the routine flagella antibody test alone. Clinical recovery at the 6-month follow-up (n=177) was generally good and nonspecific symptoms, such as headache and fatigue, were not more frequently reported in patients than in controls. No patient was found to have recurrent or progressive neurologic symptoms. However, permanent facial nerve palsy was found in 22% of patients at the 2-year follow-up, with consequences such as eye-closing problems, excessive tear secretion, pronunciation difficulties and cosmetic complaints. When cellular immune responses were investigated, the number of Borrelia-specific IL-4 and IFN-γ secreting cells in CSF was found to be more prominent in children with NB than in controls. Furthermore, a much stronger IL-4 response in CSF was seen in children as compared to adults with NB. This cytokine profile of children with NB is believed to represent an effective and balanced type1/type2 response in a relevant compartment, and could contribute to the less severe course of the disease seen in children as compared to adults with NB. No prognostic factors were found to influence the outcome in patients with “Confirmed NB” or facial nerve palsy. Nor was any specific cytokine profile, or antibody response to new Borrelia antigens in CSF, correlated to a less favorable clinical outcome. An NB prediction score test, based on clinical variables at admission, is suggested to help physicians to determine whether to start early antibiotic treatment, before results from Borrelia antibody tests are available. Results in this thesis support the notion that mononuclear pleocytosis in CSF, in patients being evaluated for NB, indicates that they are true NB cases despite the fact that an antibody response cannot yet be visualized. with the routine flagella test. Consequently, early antibiotic treatment in NB seems to be the correct course of action and over-treatment is not a substantial problem.
Borrelia-infektion hos barn och vuxna är den vanligaste fästingburna infektionen i Sverige och orsakas av en bakterie som heter Borrelia burgdorferi. Den sprids till människa via fästingbett och kan orsaka besvär från hud, leder, hjärtmuskel och nervsystem. När nervsystemet är infekterat kallas det Neuroborrelios. Denna avhandling handlar om Neuroborrelios hos barn i syd-östra Sverige, ett område med hög Borrelia-förekomst. Jag har studerat symtom, laborativa provsvar och tillfrisknande hos 250 barn med misstänkt Neuroborrelios under åren 1998-2005 och jämfört med friska barn. Dessutom har jag tittat närmare på vissa signalsubstanser inom immunförsvaret i blod och ryggvätska och vilken roll signalsubstanserna spelar för förlopp och utläkning av infektionen. Avhandlingen innehåller också en utvärdering av fyra nya diagnostiska test vid misstänkt Neuroborrelios hos barn. Det visar sig att mindre än hälften (41%) av barnen med misstänkt Neuroborrelios får diagnosen säkerställd med det befintliga Borrelia-testet (baserat på ett protein som kallas flagellin) som används rutinmässigt. Dock förblir diagnosen oklar för många barn (59%). De fyra nya Borrelia-testen (baserade på protein som kallas DbpA, BBK32, OspC och IR6) visar sig fungera bra och om man kombinerar dem med befintligt Borrelia-test, kan man säkerställa Neuroborrelios hos 82% av barnen med misstänkt infektion. Jag hoppas att dessa nya Borrelia-test i framtiden kan leda till förbättrad diagnostik hos barn som utreds för misstänkt Neuroborrelios. Immunförsvarets signalsubstanser, som analyserades i ryggvätska och blod, visade sig ha en viss profil hos barn med Neuroborrelios jämfört med barn utan Borrelia-infektion, men även jämfört med vuxna med Neuroborrelios. De immunologiska T cellerna producerade två olika sorters signalsubstanser, som kallas ”Interferon-γ” och ”Interleukin-4”. Denna immunologiska profil verkar fördelaktig och kan möjligen bidra till den i allmänhet goda utläkning av Neuroborrelios som man ser hos barn jämfört med vuxna. De vanligaste symtomen vid en Borrelia-infektion i nervsystemet är huvudvärk, trötthet, dålig aptit, feber och ont i nacken. Ansiktsförlamning är det vanligaste specifika neurologiska symtomet. Antibiotikabehandling ges till 69% av barnen och vid en 6 månaders uppföljning rapporterar patienterna god utläkning av de olika symtomen. Inget barn hade återkommande eller allvarliga neurologiska symtom vid uppföljningen. Däremot, barn med ansiktsförlamning visade sig få kvarstående besvär i viss utsträckning. När de undersöktes 2 år efter sin ansiktsförlamning förekom mild till måttlig kvarstående förlamning i 22% av fallen. Patienterna uppgav besvär av ökat tårflöde, sluddrigt tal, svårigheter med att stänga ögat och dessutom rapporterade många patienter att snedheten i ansiktet var kosmetiskt störande. Inga specifika symtom, laborativa prov, immunologiska signalsubstanser eller diagnostiska test visade sig vara kopplade till ökad risk för kvarstående besvär efter Neuroborrelios i allmänhet och inte eller hos patienter med ansiktsförlamning. En checklista har utarbetats med olika symtom som är typiska för barn med Neuroborrelios. Den föreslås kunna användas som beslutsunderlag för start av tidig antibiotikabehandling, redan innan svar på Borrelia-testen finns tillgängliga.

Lyme borreliosis (LB) is the most common vector-borne disease in the Northern Hemisphere. The infection is caused by spirochetes belonging to the Borrelia burgdorferi sensu lato complex, and it is transmitted to humans by ticks. LB is associated with several clinical manifestations, of which erythema migrans (EM) and neuroborreliosis (NB) are the most common inEurope. The course of the disease is usually benign, but can vary between individuals. The underlying pathogenic mechanisms are not fully understood, but the prognosis is probably determined by a complex interplay between the bacteria and the host’s immune response. Previous studies have indicated that a strong initial T helper (Th) 1-response followed by a Th2 response is beneficial for the clinical outcome in LB. The aims of this thesis were to follow the incidence of NB inJönköping County,Sweden, over time, to search for clinical and laboratory markers associated with the risk of developing long-lasting post-treatment symptoms, and to explore the role of the complement system as well as the relative balance between Th-associated cytokine/chemokine responses in LB. The number of NB cases, diagnosed by cerebrospinal fluid (CSF) analysis, increased from 5 to 10/100,000 inhabitants/year in Jönköping County during 2000-2005. Post-treatment symptoms persisting more than 6 months occurred in 13 %, and were associated with higher age, longer-lasting symptoms prior to treatment, higher levels of Borrelia-specific IgG in CSF, and reported symptoms of radiculitis. Facial palsy, headache and fever were frequent manifestations in children, whereas unspecific muscle and joint pain were the most commonly reported symptoms in older patients. Complement activation occurred both locally in the skin in EM and in CSF of NB patients. However, no activation could be detected in blood in NB patients. Elevated levels of C1q, C4 and C3a in CSF, along with correlation between C1q and C3a levels, suggest complement activation via the classical pathway locally in the central nervous system in NB. In vitro experiments with two clinical Borrelia isolates revealed that B. garinii LU59 induced higher complement activation in human plasma compared to B. afzelii K78 that recruited more of complement regulator factor H. To elucidate the role of complement in the phagocytosis process, experiments were performed using whole blood from healthy donors incubated with fluorescence-labelled spirochetes and different complement inhibitors. The results illustrated a central role of complement for phagocytosis of Borrelia spirochetes. We also studied the relative contribution of different Th-associated cytokines/chemokine responses in NB. The results support the notion that early NB is dominated by a Th1 response, eventually accompanied by a Th2 response. IL-17A was increased in CSF in half of the patients with confirmed NB, suggesting a hitherto unknown role of Th17 in NB. In conclusion, the risk of developing long-lasting post-treatment symptoms tend to increase mainly with age and duration of symptoms prior to treatment in NB. The complement system seems to play an important role in host defence to recognize and kill Borrelia spirochetes. However, complement activation in inappropriate sites or to an excessive degree may cause tissue damage, and therefore, the role of complement in relation to disease course needs to be studied further. Likewise, the role of Th17 in LB pathogenesis and host defence should be further evaluated in prospective studies.

In Europe, Lyme disease is caused by the species Borrelia (B.) burgdorferi sensu stricto, B. garinii and B. afzelii. The disease is the most common vector-borne infection in Europe and the United States, and the resulting manifestation can involve the skin, nervous system, heart and joints. The symptoms that arise are associated with the Borrelia species causing the infection. The species most associated with neuroborreliosis is B. garinii whilst B. burgdorferi sensu stricto is associated with arthritis and B. afzelii is associated with dermatological symptoms. Lyme disease normally has three phases in untreated patients. The first phase is characterised by erythema migrans, a reddening of the skin around the area of the tick bite. If the disease develops to the second phase the patient will suffer from neuroborreliosis which is characterised by neurological symptoms such as headache and peripheral facial paralysis. Cerebrospinal fluid (CSF) analysis is used to diagnose neuroborreliosis. The diagnosis is complicated by variations between the different Borrelia species and that many healthy individuals have antibodies directed against Borrelia. Antibodies in CSF can be found in different diseases. The antibodies can be produced in the central nervous system or come across the blood-brain barrier and thus derive originally from the blood. By measuring the concentration of total albumin in serum and in CSF it can be determined if the antibodies present in the CSF have been produced in the central nervous system or if they originate from the blood. The typical manifestation in the last phase of Lyme disease is severe arthritis. The aim of this examination project was to compare two ELISAs for detection of antibodies directed to Borrelia. Indirect ELISAs from DAKO and Euroimmun were compared for the diagnosis of neuroborreliosis in 100 individuals. Borrelia specific antibodies of class IgM or IgG were found in 16 of 100 patients by DAKO’s ELISA and in 20 of the same 100 patients by Euroimmun’s ELISA. The reason that Euroimmun’s method detected more cases of neuroborreliosis is probably that this method detects antibodies directed to all three pathological species of Borrelia while DAKO’s method only detects antibodies directed to B. burgdorferi. In conclusion, this study indicates that Euroimmun’s method to detect antibodies of class IgM and IgG directed to Borrelia is superior to DAKO’s method. The obtained results were confirmed by Western blot analysis which gave results in accordance with those of Euroimmun’s ELISA.

Hintergrund: Die Neuroborreliose ist eine bei etwa 10-15% der Patienten auftretende Folge der Infektion mit Borrelien. Die typische Klinik im Erwachsenenalter besteht zumeist aus einer polyradikulitischen Symptomatik, die als Bannwarth-Syndrom bezeichnet wird. Dagegen manifestiert sich die Neuroborreliose im Kindes- und Jugendalter meist mit einer monolateralen fazialen Parese oder einer Meningitis. Während im Erwachsenenalter neuropsychologische Langzeitfolgen nach stattgehabter Neuroborreliose anzunehmen sind, ist das mögliche Ausmaß von Langzeitfolgen im Kindes- und Jugendalter bislang noch unklar. Methoden: Das untersuchte Patientenkollektiv bestand aus 29 Patienten, die im Kindes- oder Jugendalter im Zentrum für Kinderheilkunde und Jugendmedizin der Universitätsmedizin Göttingen mit der Diagnose einer Neuroborreliose stationär behandelt wurden. Zum Zeitpunkt der Diagnose betrug das mittlere Alter der Patienten 9,0 ± 2,9 Jahre und es waren durchschnittlich 14,7 ± 3,4 Jahre zwischen Diagnosestellung und Testung vergangen. Das Patientenkollektiv wurde mit einer alters-, bildungs-, und geschlechtsgenormten, gesunden Kontrollgruppe (n=29) verglichen. Die Untersuchung setzte sich aus einer medizinischen Anamnese, einer neurologischen Untersuchung, Fragebögen zur psychiatrischen Beurteilung und einer neuropsychologischen Testbatterie zusammen. Den einzelnen neuropsychologischen Tests wurden Domänen zugeordnet. In der neuropsychologischen Testbatterie wurden die Domänen Aufmerksamkeit, Arbeitsgedächtnis, verbales Lernen und Gedächtnis, non-verbales Lernen und Gedächtnis, visuo-konstruktive Funktionen und frontale Exekutivfunktionen geprüft. Ergebnisse: Die Probanden zeigten signifikant häufiger milde neurologische Einschränkungen. Am Häufigsten fand sich eine residuelle faziale Parese. Hierbei korrelierten die Ergebnisse der neurologischen Untersuchung nicht mit den Ergebnissen der neuropsychologischen Testung. In der neuropsychologischen Testbatterie fanden sich keine signifikanten Unterschiede zur gesunden Kontrollgruppe. Fazit: Im Gegensatz zur durchgemachten Neuroborreliose im Erwachsenenalter, scheint die Erkrankung im Kindes- und Jugendalter nicht mit relevanten neuropsychologischen Langzeitfolgen einherzugehen.

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2020
A Neuroborreliose de Lyme (NBL) é a forma neurológica da Borreliose de Lyme, causada pelas espiroquetas de Borrelia burgdorferi sensu lato complex transmitidas pela mordida da Ixodes ricinus (‘’carraça’’). Na Europa, a NBL é causada principalmente pela espécie Borrelia garinii, em áreas endémicas, tendo maior incidência durante o verão, em crianças dos 5-14 anos e adultos dos 40-50 anos. Em crianças, apesar da NBL geralmente se apresentar como uma doença ligeira, por vezes, em casos raros, pode estar associada a vasculopatia ou mesmo AVC isquémico. Deste modo, tendo em conta que a sua incidência está a aumentar e o facto de que quando diagnosticada e tratada adequadamente tem um prognóstico muito favorável, é essencial que os profissionais de saúde estejam alerta para a existência destes casos singulares, de modo a reconhecer e tratar a doença. Assim, com este objetivo, é exposto um caso clínico de uma criança previamente saudável, com alterações da consciência, as quais, após realização de RM-CE, se admitem como resultado de um AVC isquémico. Após investigação etiológica do AVC, concluise como causa a NBL que propiciou uma vasculopatia. Com a implementação da terapêutica adequada o doente teve remissão do quadro clínico.
Lyme Neuroborreliosis (LNB) is the neurological form of Lyme Borreliosis, caused by Borrelia burgdorferi sensu lato complex spirochetes transmitted by the bite of Ixodes ricinus (“tick”). In Europe, LNB is caused mainly by the species Borrelia garinii, in endemic areas, having a higher incidence during the summer, in children aged 5-14 years and adults aged 40-50 years. In children, although LNB generally presents as a mild disease, sometimes, in rare cases, it can be associated with vasculopathy or even ischemic stroke. Therefore, taking into consideration that its incidence is increasing and the fact that when diagnosed and treated appropriately has a very favorable prognosis, it is essential that health professionals be aware of the existence of these unique cases, in order to recognize and administer the appropriate therapy for the disease. Thus, with this objective in mind, a clinical case of a previously healthy child is reported. This child presents with alterations of his consciousness, which, after performing MRI, are admitted as a result of an ischemic stroke. After the etiological investigation of the stroke, it is concluded that it was LNB that caused a vasculopathy. With the implementation of appropriate therapy, the patient had a remission of the clinical condition.

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2017
A borreliose de Lyme (BL) é uma doença infecciosa multissistémica, causada por espiroquetas da espécie Borrelia sensu lato (s.l.), e que são transmitidas por carraças infectadas do género Ixodes. Embora seja uma doença endémica em vários países da Europa, Portugal tem das incidências mais baixas, facto provavelmente relacionado com o facto de ser uma doença subdiagnosticada, existindo uma fraca adesão à declaração obrigatória. As suas manifestações dividem-se em precoces e tardias, sendo as precoces subdivididas em locais ou disseminadas. Dentro das manifestações precoces disseminadas, é de especial importância pela sua frequência, a afecção do sistema nervoso, sob a forma de neuroborreliose. O sintoma mais frequentemente relatado é a paralisia do nervo facial, embora uma variedade de outras manifestações neurológicas possam surgir, incluindo meningite, radiculite dolorosa, entre outras, geralmente em associação ao envolvimento de um nervo craniano. A BL pode ocorrer tanto em crianças como em adultos. Embora as manifestações clínicas sejam semelhantes em ambos os grupos etários, o diagnóstico pediátrico tende a ser mais complicado pela similaridade do quadro clínico com outras patologias. Apesar das semelhanças das manifestações, a neuroborreliose revela-se mais frequente na idade pediátrica (17-38% das crianças vs 15% dos adultos), mantendo-se a predominância da apresentação do quadro neurológico com a paralisia do nervo facial e podendo associar-se a outras manifestações neurológicas, como a meningite. O presente estudo foca-se num caso clínico com uma manifestação atípica da BL, sendo descrito o caso duma criança de nove anos que se apresenta com meningite asséptica de forma isolada.
Lyme borreliosis (LB) is a multisystemic disease, caused by spirochetes of the Borrelia s.l. specie and transmitted by an infected tick bite. Although LB is considered an endemic disease in numerous European countries, Portugal has one of the lowest incidence rates, probably due to the disease’s underdiagnosis and low report rate, even though it’s considered a mandatory report disease. LB usually presents with early and late manifestations. The early manifestations can classically be divided in local or disseminated. Concerning the early disseminated manifestations, it is of special importance the nervous system involvement in the form of neuroborreliosis due to its morbidity. The most common neurological symptom is a facial nerve paralysis, even though a variety of other neurological manifestations may also be present, usually in association, like meningitis, painful radiculitis and others. LB can occur both in children and adults. Although the clinical characteristics resemble those observed in adults, the diagnosis in children tends to be more complicated due to the similarities of symptoms compared to other pediatric diseases. Nevertheless, neuroborreliosis is usually more frequent in children (17-38% in children vs. 15% in adults), but the most common neurological symptom is also facial nerve paralysis, which may be accompanied by other neurological manifestations, such as meningitis. The present study describes a case report of an unusual presentation of LB in a nine year old child that presented with isolated aseptic meningitis.

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2020
A Doença de Lyme é a doença transmitida por carraças mais prevalente na Europa. Em 5-10% dos casos ocorre Neuroborreliose, sendo a hipoacúsia neurossensorial uma das possíveis manifestações. O propósito desta revisão de literatura é apelar à consideração da Doença de Lyme no diagnóstico diferencial de hipoacúsia. Isto por se tratar de uma causa reversível e que, na ausência de tratamento pode evoluir para doença grave. Para este efeito o presente trabalho caracteriza o quadro de apresentação de hipoacúsia por Doença de Lyme, e revê os exames complementares de diagnóstico e o tratamento de Neuroborreliose. A hipoacúsia é neurossensorial e mais frequentemente descrita como unilateral, sendo que se pode apresentar como surdez súbita ou ter um decurso insidioso. Frequentemente acompanha-se por outros sintomas otorrinológicos. A presença de paralisia facial periférica ou radiculopatia dolorosa deve fazer suspeitar Neuroborreliose. Para o diagnóstico procuram-se sinais inflamatórios no LCR, bem como a produção intratecal de anticorpos específicos. A antibioterapia deve ter em conta a fase da doença, sendo ceftriaxona I.V ou doxiciclina oral opções a considerar.
Lyme Disease is the most common tickborne disease in Europe. In 5-10% of cases, there is involvement of the central or peripheral nervous system, being sudden onset of sensorineural hearing loss a possible presenting symptom. This review aims to increase awareness of Borreliosis as na aetiological factor in sensorineural hearing loss, since it’s a reversible cause that with adequate treatment may provide total recovery and prevent more severe forms of Lyme Disease. In this work it’s described the otological manifestations, such as hearing loss of Neuroborreliosis, its diagnostic approach and therapeutics options. The hearing loss is sensorineural, unilateral (in most cases) and can have a sudden onset or a progressive course. It is frequently associated with other otolaryngological symptoms. The presence of peripheral facial palsy or painful radiculopathy should raise the suspicion of Neuroborreliosis. For the diagnosis, inflamatory signs in the CSF and intrathecal production of specific antybodies should be searched. The stage of Lyme Disease influences the antybiotic choice, being IV ceftriaxone or oral doxycycline possible treatments.