Characteristics of patients consulted for suspected Lyme neuroborreliosis in an endemic area

IF 3.1 2区医学 Q2 INFECTIOUS DISEASES Ticks and Tick-borne Diseases Pub Date : 2024-05-17 DOI:10.1016/j.ttbdis.2024.102353

Hélène Frahier , Timothée Klopfenstein , Anne-Sophie Brunel , Catherine Chirouze , Kevin Bouiller

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Abstract

Introduction

Some patients with unexplained neurological symptoms sought care for presumed Lyme neuroborreliosis (LNB). We aimed to compare patients’ characteristics with and without LNB.

Material and methods

All patients consulting for LNB suspicion and having a lumbar puncture between 2014 and 2020 in a high endemic area of Lyme borreliosis were included in the study.

Results

One hundred fifty-five patients were included. Forty-five patients (29 %) had LNB (mean age: 57.6 years, 28.9 % of women) including 17 with isolated intrathecal synthesis. One hundred and ten patients had no LNB (mainly neurological (29 %) and rheumatological diseases (19 %)).

Non-neurological symptoms were similar in patients with LNB and patients with no LNB (asthenia, 31 % vs. 46 %, p = 0.14, arthralgia 20 % vs. 31 %, p = 0.14) with the exception of myalgia, which was less frequent in patients with LNB (4.4 % vs. 19.1 % p = 0.02). In multivariable analysis, factors associated with LNB were presence of facial nerve palsy (OR = 5.7), radiculopathy (OR = 11.3), positive Lyme serology (OR = 5.4) and duration of symptoms less than 3 months (OR = 4.48). Patients with isolated intrathecal synthesis had a longer duration of symptoms (3 vs 1 months) than patients with pleocytosis. Asthenia (5.9 % vs. 32.1 %), headaches (0 % vs. 39.3 %) neuropathic pain (17.6 % vs. 50 %) and facial palsy (11.8 % vs. 39.3 %) were less frequent in patients with isolated intrathecal synthesis than patients with pleocytosis. The presence of isolated subjective neurological symptoms (paresthesia, memory disorders, insomnia, irritability, asthenia, headaches) was reported in 7/17 (41 %) of patients with isolated intrathecal synthesis, 2/28 (7.1 %) in patients with pleocytosis and 75/110 (68 %) in patients without LNB (p < 0.001).

Conclusion

More than one quarter of patients consulted for suspected LNB had non-neurologic symptoms, whether or not they have a LNB. Concerning patients with isolated intrathecal synthesis, the question of presence of sequelae with a spontaneously cured disease or an active Lyme borreliosis requiring antibiotic remain.

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地方病流行地区疑似莱姆神经源性疾病就诊患者的特征。

导言一些不明原因的神经系统症状患者因假定患有莱姆神经源性疾病（LNB）而寻求治疗。我们旨在比较有 LNB 和无 LNB 患者的特征：研究纳入了 2014 年至 2020 年期间在莱姆病高流行区因怀疑患有 LNB 而就诊并进行腰椎穿刺的所有患者：结果：共纳入了155名患者。45名患者（29%）患有LNB（平均年龄：57.6岁，28.9%为女性），其中17名患者有孤立的鞘内合成。110名患者没有 LNB（主要是神经系统疾病（29%）和风湿病（19%））。LNB 患者和无 LNB 患者的非神经系统症状相似（气喘 31% 对 46%，p = 0.14；关节痛 20% 对 31%，p = 0.14），但肌痛在 LNB 患者中发生率较低（4.4% 对 19.1%，p = 0.02）。在多变量分析中，与 LNB 相关的因素有面神经麻痹（OR = 5.7）、根病（OR = 11.3）、莱姆血清学阳性（OR = 5.4）和症状持续时间少于 3 个月（OR = 4.48）。孤立的鞘内合成患者的症状持续时间（3 个月对 1 个月）长于胸水患者。孤立的鞘内合成患者出现气喘（5.9% 对 32.1%）、头痛（0% 对 39.3%）、神经性疼痛（17.6% 对 50%）和面瘫（11.8% 对 39.3%）的频率低于多核细胞增多症患者。7/17（41%）例孤立性鞘内合成患者出现孤立性主观神经症状（麻痹、记忆障碍、失眠、烦躁、气喘、头痛），2/28（7.1%）例多血症患者出现这些症状，75/110（68%）例无 LNB 患者出现这些症状（P < 0.001）：超过四分之一的疑似 LNB 患者有非神经系统症状，无论他们是否患有 LNB。对于有孤立的鞘内合成物的患者，是否存在自发治愈的后遗症或需要使用抗生素的活动性莱姆包虫病仍然是个问题。

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来源期刊

Ticks and Tick-borne Diseases INFECTIOUS DISEASES-MICROBIOLOGY

CiteScore

6.90

自引率

12.50%

发文量

185

审稿时长

6-12 weeks

期刊介绍： Ticks and Tick-borne Diseases is an international, peer-reviewed scientific journal. It publishes original research papers, short communications, state-of-the-art mini-reviews, letters to the editor, clinical-case studies, announcements of pertinent international meetings, and editorials. The journal covers a broad spectrum and brings together various disciplines, for example, zoology, microbiology, molecular biology, genetics, mathematical modelling, veterinary and human medicine. Multidisciplinary approaches and the use of conventional and novel methods/methodologies (in the field and in the laboratory) are crucial for deeper understanding of the natural processes and human behaviour/activities that result in human or animal diseases and in economic effects of ticks and tick-borne pathogens. Such understanding is essential for management of tick populations and tick-borne diseases in an effective and environmentally acceptable manner.