Lyme disease meningitis

What is Lyme borreliosis?

Lyme borreliosis is caused by Borrelia bugdorferi sensu lato, transmitted by the ticks of the Ixodes ricinus complex. The incubation period lasts from 3 to 32 days. Lyme disease manifests with erythema migrans, which usually resolves spontaneously after several weeks. B. burgdorferi disseminates throughout the body within days or weeks after the onset of the disease and damages various organ systems. Late manifestations of Lyme disease typically occur months to years after the initial infection.

What causes the disease?

Lyme disease is caused by a spirochete from the so-called Borrelia burgdorferi sensu lato complex, which includes 13 borrelia species, 3 of which are known to cause Lyme disease – B. burgdorferi sensu stricto, B.garinii, and B.afzelii.

How is Lyme disease acquired?

Borrelia burgdorferi is transmitted by the ticks from the Ixodes ricinus complex (Ixodes persulcatus complex).

• The deer tick, Ixodes scapularis, plays the role of the vector in the north-eastern and midwestern part of the USA;
• The deer tick, Ixodes pacificus, is the vector in the west of the USA;
• The sheep tick, Iхodes ricinus, is involved in the transmission of the bacteria in Europe;
• The taiga tick, Ixodes persulcatus, is responsible for the spirochete transmission in Asia.

Humans become infected by the young tiny Ixodes nymph. They attach to a human who walks through tall grass or brush. The tick starts to feed and the bacteria escape into the human skin from the tick’s salivary glands.

Meningitis

Meningitis is the inflammation of the brain and spinal cord covering known as the meninges.

As the spirochetes disseminate throughout the body they affect the nervous system causing severe headaches. Symptoms that are suggestive of meningeal involvement develop early in Lyme disease, but the cerebrospinal fluid may remain normal. When the disease is not treated after several weeks to months occurs meningitis.

• Headache (typically described as waxing and waning) and photophobia (sensitivity to light) indicate possible meningitis.
• Neck stiffness is also observed, although usually, it is minimal, whereas Kernig’s and Brudzinski’s signs are not present.
• The triad which consists of meningitis, radiculoneuritis, and cranial neuritis is known as Bannworth’s syndrome – the disorder more commonly seen in Europe.
• Facial nerve palsy (when the cranial nerve VI is affected) may occur; the optic nerve is typically affected in children.

Neurologic disorders typically last for several weeks or months, although they may recur or even become chronic.

Cerebrospinal fluid examination

In meningitis, cerebrospinal fluid (CSF) has:

• A lymphocytic pleocytosis (prevalence of lymphocytes in the sample) of about 100 cells/mm³;
• Protein concentration often increases;
• A glucose level is of normal value;

IgM and IgG antibodies to B.burgdorferi may be found in the CSF.

Treatment

Early Lyme disease symptoms may resolve spontaneously. However, oral antibiotic therapy is strongly recommended to decrease the duration of the symptoms and prevent serious outcomes.

Neurologic disorders require intravenous administration of antibiotic therapy. The medicines should be given for 2 to 4 weeks, such treatment will fasten the recovery.

Nonsteroidal anti-inflammatory drugs may also be prescribed.

Administered medicines

• Ceftriaxone 2 g daily for 14–30 days;
• Penicillin G 20 million units daily for 14–28 days;
• Cefotaxime sodium 2 g every 8 hours;
• Doxycycline 100 mg twice daily for 14–28 days;