RESUMO
La enfermedad de Lyme es la infección transmitida por garrapatas más común en Norteamérica y Europa. Sin embargo, en América Latina se han reportado pocos datos. Borrelia burgdorferi es capaz de invadir el sistema nervioso central causando la neuroborreliosis de Lyme. Se comunica el caso de una mujer joven con encefalitis y síndrome cerebeloso, una presentación poco frecuente, que se manifestó con cefalea, marcha atáxica, nistagmo y ptosis palpebral. Se realizó el diagnóstico con serología positiva por Western blot para Borrelia burgdorferi en suero. Recibió tratamiento con mejoría clínica. El diagnóstico de neuroborreliosis es difícil, ya que no existen hallazgos neurológicos o de imagen específicos. Se recomienda tener un mayor nivel de vigilancia epidemiológica en Latinoamérica, así como los antecedentes recreativos o viajes, que deben incluirse en la historia clínica para mejorar la aproximación diagnóstica.
Lyme disease is the most common tick-borne disease in North America and Europe. However, in Latin America, few data have been reported. Borrelia burgdorferi is capable of invading the central nervous system causing Lyme neuroborreliosis. This is a case report of a female with encephalitis and cerebellar syndrome, a rare manifestation, presented with generalized headache ataxic gait, nystagmus and palpebral ptosis. Serologic diagnosis was made for Borrelia burgdorferi and treatment was initiated with clinical improvement. Neuroborreliosis is a very difficult diagnosis, since there are no neurologic or imaging findings specific. It is recommended to physicians to have an enhanced level of surveillance in Latin America, as well as recreational/travel history of the patient, which should be included in the clinical record to improve the diagnostic approach.
Assuntos
Humanos , Feminino , Adulto Jovem , Doenças Cerebelares/etiologia , Neuroborreliose de Lyme/complicações , Encefalite/etiologia , Imageamento por Ressonância Magnética , Neuroborreliose de Lyme/tratamento farmacológico , Neuroborreliose de Lyme/diagnóstico por imagem , Antibacterianos/uso terapêuticoRESUMO
History A 24-year-old right-handed woman presented to a neuro-ophthalmology clinic in Massachusetts in the summer with acute binocular diplopia when looking down and to the left, which started about 1 month earlier. Her medical history was notable for Raynaud syndrome, recurrent streptococcal pharyngitis, and an allergy to amoxicillin. Three days prior to developing diplopia, she presented to an outside emergency department due to fever, chills, and back pain. She received ciprofloxacin for presumed urinary tract infection based on urinalysis, which demonstrated few bacteria and was negative for leukocyte esterase, nitrites, and white blood cells. She then presented again to an outside emergency department for diplopia evaluation. Initial MRI and MR angiography of the brain at that time did not demonstrate any relevant findings, and the patient was referred to our department for neuro-ophthalmic evaluation, where she was seen 4 weeks later. Neuro-ophthalmic examination revealed 20/20 visual acuity in both eyes, and a right hypertropia in left gaze, downgaze and right head tilt, with right eye excyclotorsion. There were no ocular signs of myasthenia gravis or thyroid eye disease, nor did the patient report ocular or systemic symptoms. She denied recent travel. High-spatial-resolution MRI of the brain and orbit were performed.
Assuntos
Neuroborreliose de Lyme/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Antibacterianos/uso terapêutico , Diagnóstico Diferencial , Doxiciclina/uso terapêutico , Feminino , Humanos , Neuroborreliose de Lyme/tratamento farmacológico , Adulto JovemRESUMO
Borrelia burgdorferi infection (Lyme disease) is one of the few identifiable causes of neuralgic amyotrophy. Bilateral diaphragmatic paralysis is considered rare in borreliosis, and the pattern of long-term recovery of diaphragm function is also uncertain. Transdiaphragmatic pressure is the gold standard for diagnosis of bilateral diaphragmatic paralysis, a study that has been reported on few occasions. We present a case of neuralgic amyotrophy associated with Borrelia infection and bilateral diaphragmatic paralysis that provides a detailed follow-up of the spirometric evolution, of the maximum static pressures in the mouth and of transdiaphragmatic pressure from the onset of symptoms and the long term. This case allows us to know one of the possible evolutionary profiles of diaphragmatic dysfunction in neuralgic amyotrophy due to borreliosis.
La infección por Borrelia burgdorferi (enfermedad de Lyme) es una de las pocas causas identificables de amiotrofia neurálgica. La parálisis diafragmática bilateral es considerada rara en la borreliosis y el patrón de recuperación a largo plazo de la función del diafragma también es incierto. La presión transdiafragmática es el patrón de oro para el diagnóstico de parálisis diafragmática bilateral, un estudio que ha sido informado en pocas ocasiones. Se presenta un caso de amiotrofia neurálgica asociado a infección por Borrelia y parálisis diafragmática bilateral, que aporta un seguimiento detallado de la evolución espirométrica, de las presiones estáticas máximas en la boca y de la presión transdiafragmática desde el inicio de los síntomas y a largo plazo. Este caso permite conocer uno de los posibles perfiles evolutivos de la disfunción diafragmática en la amiotrofia neurálgica por borreliosis.
Assuntos
Neurite do Plexo Braquial , Neuroborreliose de Lyme , Paralisia Respiratória , Diafragma/diagnóstico por imagem , Seguimentos , Humanos , Neuroborreliose de Lyme/complicações , Neuroborreliose de Lyme/diagnóstico , Paralisia Respiratória/diagnóstico , Paralisia Respiratória/etiologiaRESUMO
Abstract Borrelia burgdorferi infection (Lyme disease) is one of the few identifiable causes of neuralgic amyotrophy (AN). Bilateral diaphragmatic paralysis is considered rare in borreliosis, and the pattern of long-term recovery of diaphragm function is also uncertain. Transdiaphragmatic pressure is the gold standard for diagnosing bilateral diaphragmatic paralysis, a study that has been reported on a few occasions. We pres ent a case of AN associated with borrelia infection and bilateral diaphragmatic paralysis that provides a detailed follow-up of the spirometric evolution, the maximum static pressures in the mouth, and the transdiaphragmatic pressure from the onset of symptoms and in the long term. This case allows us to know one of the possible evolutionary profiles of diaphragmatic dysfunction in AN due to borreliosis.
Resumen La infección por Borrelia burgdorferi (enfermedad de Lyme) es una de las pocas causas identificables de amiotrofia neurálgica. La parálisis diafragmática bilateral es considerada rara en la borreliosis y el patrón de recuperación a largo plazo de la función del diafragma también es incierto. La presión transdiafragmática es el patrón de oro para el diagnóstico de parálisis diafragmática bilateral, un estudio que ha sido informado en pocas ocasiones. Se presenta un caso de amiotrofia neurálgica asociado a infección por Borrelia y parálisis diafrag mática bilateral, que aporta un seguimiento detallado de la evolución espirométrica, de las presiones estáticas máximas en la boca y de la presión transdiafragmática desde el inicio de los síntomas y a largo plazo. Este caso permite conocer uno de los posibles perfiles evolutivos de la disfunción diafragmática en la amiotrofia neurálgica por borreliosis.
Assuntos
Humanos , Paralisia Respiratória/diagnóstico , Paralisia Respiratória/etiologia , Neurite do Plexo Braquial , Neuroborreliose de Lyme/complicações , Neuroborreliose de Lyme/diagnóstico , Diafragma/diagnóstico por imagem , SeguimentosAssuntos
Encéfalo/diagnóstico por imagem , Neuroborreliose de Lyme/diagnóstico , Meningites Bacterianas/diagnóstico , Mielite/diagnóstico , Medula Espinal/diagnóstico por imagem , Administração Intravenosa , Adolescente , Antibacterianos/uso terapêutico , Ceftriaxona/uso terapêutico , Viroses do Sistema Nervoso Central/diagnóstico , Diagnóstico Diferencial , Diarreia , Rubor/fisiopatologia , Síndrome de Guillain-Barré/diagnóstico , Cefaleia/fisiopatologia , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Humor Irritável , Neuroborreliose de Lyme/líquido cefalorraquidiano , Neuroborreliose de Lyme/fisiopatologia , Neuroborreliose de Lyme/terapia , Imageamento por Ressonância Magnética , Masculino , Meningites Bacterianas/líquido cefalorraquidiano , Meningites Bacterianas/fisiopatologia , Meningites Bacterianas/terapia , Mielite/líquido cefalorraquidiano , Mielite/fisiopatologia , Mielite/terapia , Cervicalgia/fisiopatologia , Parestesia/fisiopatologia , Neuropatias Fibulares/fisiopatologia , Pneumonia Bacteriana , Reflexo Anormal , Sudorese , Retenção Urinária/fisiopatologia , Febre do Nilo Ocidental/diagnósticoRESUMO
Resumo A doença de Lyme é uma infecção sistêmica causada pela espiroqueta Borrelia burgdorferi e transmitida pelo carrapato do gênero Ixodes sp. e espécie Amblyomma cajennense. A doença costuma se manifestar em três estágios clínicos distintos, que podem variar de acordo com as características de cada hospedeiro. O objetivo deste trabalho é relatar o caso de uma paciente de 33 anos com doença de Lyme que apresentou como manifestações neuroftalmológicas diplopia, lagoftalmo paralítico e ceratite punctata, com exames laboratoriais negativos. Embora a espiroqueta Borrelia burgdorferi tenha maior tropismo pelos tecidos da pele, sistema nervoso e articulações, o acometimento ocular não deve ter sua importância diminuída, sendo descrito neste relato de caso, que abordou os aspectos mais pertinentes à doença para auxiliar seu diagnóstico e tratamento.
Abstract Lyme disease is a systemic infection caused by the spirochete Borrelia burgdorferi and transmitted by the tick of the genus Ixodes sp. and species Amblyomma cajennense. The disease usually manifests itself in three distinct clinical stages, which may vary according to the characteristics of each host. The objective of this paper is to report the case of a 33-year-old patient with Lyme disease who presented as neuro-ophthalmological manifestations diplopia, paralytic lagophthalmos and punctate keratitis, with negative laboratory tests. Although the spirochete Borrelia burgdorferi has a greater tropism in the tissues of the skin, nervous system and joints, the ocular involvement should not be diminished, being described in this case report, which approached the most pertinent aspects to the disease to aid its diagnosis and treatment.
Assuntos
Humanos , Feminino , Adulto , Doença de Lyme/complicações , Diplopia/etiologia , Oftalmopatias/etiologia , Paralisia Facial/etiologia , Infecções por Borrelia/transmissão , Ceftriaxona/administração & dosagem , Doença de Lyme/diagnóstico , Doença de Lyme/tratamento farmacológico , Grupo Borrelia Burgdorferi/isolamento & purificação , Ixodes , Neuroborreliose de Lyme/complicações , Amblyomma , Doenças do Sistema Nervoso/etiologiaRESUMO
OBJECTIVE: To describe clinical cases with neurological manifestations associated with Borrelia burgdorferi infection in a large cohort of children and adults from Mexico. MATERIAL AND METHODS: Patients with neurological manifestation (cranial neuritis, radiculoneuritis, meningitis and encephalomyelitis) were recruited in one pediatric and two general hospitals, during January 2006-December 2015. Blood and cerebrospinal fluid (CSF) samples were drawn from each patient at inclusion. IgM and IgG antibodies against B. burgdorferi were detected using a commercial ELISA test, and confirmed by Western-Blot test (WB) using three different antigens from Borrelia burgdorferi complex. Following CDC criteria were considered true cases with both positive tests. RESULTS: Of 606 patients recruited, 403 (66.5%) were adults and 203 (33.4%) children, 50.5% were male. B. burgdorferi infection was diagnosed in 168 patients (27.7%), 97 adults, mean age 42 ± 14.7 years and 71 children, mean age 9.6 ± 5 years; early disseminated disease occurred in 130 cases (77.4 %) and chronic stage in 38 (22.6 %). A previous tick bite was reported by 21% cases, and 5% recalled an erythema migrans lesion. Polyradiculoneuropathy and encephalomyelitis were the most common manifestations, whereas 14.8% presented an initial Guillain-Barré Syndrome. B. burgdorferi sensu stricto was identified in 142 (84%) cases, B. garinii in 14 (8%), B. afzelii in three, and nine cases presented coinfection with two species. CONCLUSION: Lyme neuroborreliosis is a frequent condition in patients with neurological diseases in Mexico.
Assuntos
Borrelia burgdorferi/isolamento & purificação , Encefalomielite/patologia , Neuroborreliose de Lyme/epidemiologia , Neuroborreliose de Lyme/patologia , Meningite/patologia , Neurite (Inflamação)/patologia , Radiculopatia/patologia , Adolescente , Adulto , Western Blotting , Criança , Pré-Escolar , Encefalomielite/microbiologia , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Neuroborreliose de Lyme/microbiologia , Masculino , Meningite/microbiologia , México/epidemiologia , Pessoa de Meia-Idade , Neurite (Inflamação)/microbiologia , Radiculopatia/microbiologia , Picadas de Carrapatos/microbiologia , Adulto JovemRESUMO
BACKGROUND: Facial palsy is the most frequent manifestation of neuroborreliosis in the United States, Europe, and Asia, whereas in Mexico, its frequency is unknown. OBJECTIVE: We aimed to determine the frequency of Borrelia spp. infection in patients with acute facial palsy in Mexico. MATERIALS AND METHODS: In this cross-sectional, referral hospital-based survey, 191 patients with facial palsy were selected and clinical and epidemiologic data recorded. IgM and IgG serum antibodies to Borrelia burgdorferi were tested by enzyme-linked immunosorbent assay (ELISA) and confirmed by Western-Blot (WB). IgM and IgG antibodies against the herpes viruses HSV-1, HSV-2, cytomegalovirus, and Epstein-Barr virus were tested by ELISA. RESULTS: 71 patients (37%) tested positive by ELISA to either Borrelia spp. or the herpes viruses. Of 25 patients (13%) who tested positive for B. burgdorferi by ELISA, 23 (12%) were confirmed by WB; 14 had IgM and 9 had IgG antibodies. Among the 14 IgM-WB positive patients, two cases recognized antigens of B. burgdorferi sensu stricto (s.s.), 10 of Borrelia garinii and 2 of B. afzelii, whereas all 9 IgG-WB positive were reactive against B. burgdorferi s.s. 14 patients had facial palsy in addition to other clinical data compatible with Lyme borreliosis. Patients infected with B. burgdorferi s.s. had a longer recovery time and a significantly higher risk (odds ratio 4.4, 95% confidence interval 1.5-12.9) of recurrent facial palsy than patients infected with other Borrelia genospecies. CONCLUSIONS: Borrelia infection is frequent in facial palsy patients in Mexico, with B. burgdorferi s.s. and B. garinii being the most frequent causative species.