Neurológia pre prax 3/2009

Current trends in diagnosing and treatment of neuroborreliosis

Currently, Lyme borreliosis is the most common tick-borne disease in our country. For a vector-to-human transmission to occur, an infected tick has to be attached for at least 12–24 hours. The disease may frequently be manifested by nonspecific symptoms, which may commonly result in misdiagnosis. In particular stages of borreliosis, many patients may present with both typical and atypical symptoms. In the first stage, approximately 60 % of infected individuals present with erythema migrans (EM), other typical symptoms include headache, joint ache, muscle ache, and fatigue. The second stage of early disseminated infection follows several weeks later, with neurological, cardiovascular, or articular involvement. The third, late stage of Lyme borreliosis, is characterized by mono- or oligoarthritis, most commonly of the knee joint, acrodermatitis chronica atrophicans, chronic encephalomyelitis, polyneuritis, or progressive encephalo(myelo)pathy. The diagnosis of neuroborreliosis is mostly based on the patient's history, clinical presentation, imaging techniques (MRI, SPECT) and by using direct and indirect serological and cerebrospinal fluid analyses. The drug of choice in the treatment of neuroborreliosis is parenteral ceftriaxone.

Keywords: neuroborreliosis, Borrelia burgdorferi, Ixodes ricinus.