Research explores the clinical presentations of Lyme neuroborreliosis

New research out of Lithuania highlights the importance of keeping the neurological manifestations of Lyme neuroborreliosis (LNB) on the radar for patients and clinicians, particularly for those working in family practice, emergency medicine, neurology, and infectious diseases.

Patients in this latest research experienced many neurological manifestations of LNB, the two main manifestations being polyradiculitis, mainly in the lower back, shoulder girdle, legs, chest, arms and neck, and cranial neuritis, most often manifested as facial palsy. Encephalitis and myelitis were also noted, but less frequently, and one third of the patients from the study experienced both polyradiculitis and facial palsy. 

The study also highlights the importance of looking for, recognizing and treating an early Lyme rash. In this study, up to 91% of the patients with an erythema migrans rash were not treated with antibiotics, and went on to develop Lyme neuroborreliosis. 

When interpreting all of the evidence (national and international) around Lyme disease/Borreliosis, it’s important to note that, although different strains of the Lyme bacteria Borrelia can lead to variations in clinical presentation, many of these symptoms are common across strains and across the globe.

Citation

Radzišauskienė, D., Urbonienė, J., Jasionis, A. et al. Clinical and epidemiological features of Lyme neuroborreliosis in adults and factors associated with polyradiculitis, facial palsy and encephalitis or myelitis. Sci Rep 13, 19881 (2023). https://doi.org/10.1038/s41598-023-47312-4

Abstract

The clinical course of Lyme neuroborreliosis (LNB) is highly variable. Delayed diagnosis and treatment still remain actual challenges. Moreover, there is a lack of studies analyzing the factors associated with different LNB syndromes. We aimed to analyze clinical and epidemiological features of LNB in hospitalized adults in eastern Lithuania. A retrospective study was performed for patients presenting in the years 2010–2021. A total of 103 patients were included in the study, 100 with early, and three with late LNB. Patients with early LNB most often presented polyradiculitis [75/100, (75%)], which was also the most common initial neurological syndrome. Peripheral facial palsy was diagnosed in 53/100 (53%) patients, in 16/53 (30.2%) cases both facial nerves were affected. Encephalitis or myelitis was diagnosed in 14% of patients with LNB. A total of 76/103 (73.8%) patients were discharged with residual symptoms or signs. One patient presenting encephalomyelitis died because of bacterial complications. The absence of observed erythema migrans (EM) was the predictor of peripheral facial palsy, while female sex and EM untreated with antibiotics were predictors of isolated polyradiculitis. A fever of ≥ 38 ° °C and pleocytosis of ≥ 300 × 10⁶/l were associated with the development of encephalitis or myelitis in patients with early LNB.