Neurológia pre prax 6/2010

Neskorá neuroborelióza či postboreliový syndróm?

MUDr. Ladislav Gurčík, PhD.

V článku predkladám kazuistiku pacienta s anamnézou prekonanej a preliečenej boreliózy, u ktorého sa po rokoch objavili príznaky neskorej (chronickej) neuroboreliózy (NB) a táto bola potvrdená a adekvátne preliečená. Podľa najnovších EFNS guidelines on the diagnosis and management of European Lyme neuroborreliosis sa neskorá NB v periférnom nervovom systéme prejavuje chronickou mononeuropatiou, radikulopatiou alebo polyneuropatiou a v CNS cerebrálnou vaskulitídou, chronickou progresívnou encefalitídou alebo encefalomyelitídou s kvadruspasticitou, spasticko – ataktickou chôdzou a poruchami močenia. Diagnóza neskorej NB je založená na anamnéze prisatia kliešťa, výskyte erythema migrans (EM), klinickom obraze a analýze likvoru, ale výnimočne sa môže zistiť aj u pacientov, ktorí nemajú v anamnéze kontakt s kliešťom alebo neprekonali EM. Stav, kedy symptómy perzistujú dlhšie ako 6 mesiacov po štandardnej liečbe a nález v likvore nesvedčí pre boréliovú infekciu, sa označuje termínom post-Lyme disease syndróm (PLDS). Článok v krátkosti vymenúva aj rozdiely medzi neskorou NB a PLDS.

Kľúčové slová: chronická mononeuropatia, radikulopatia, polyneuropatia, chronická encefalomyelitída, postboreliový syndróm.

Late Lyme neuroborreliosis or post-Lyme borreliosis syndrome? A case report

The paper presents a case report of a patient with a history of healed Lyme borreliosis who, years later, developed symptoms of late (chronic) Lyme neuroborreliosis (LNB) which was confirmed and treated appropriately. According to the most recent EFNS guidelines on the diagnosis and management of European Lyme neuroborreliosis, late LNB is manifested by chronic mononeuropathy, radiculopathy or polyneuropathy in the peripheral nervous system and by cerebral vasculitis, chronic progressive encephalitis or encephalomyelitis with tetraspastic syndrome, spastic-ataxic gait disorder and disturbed micturition in the CNS. The diagnosis of late LNB is based on the history of tick attachment, the presence of erythema migrans (EM), the clinical presentation and cerebrospinal fluid (CSF) analysis; exceptionally, however, it may be established even in patients with no history of tick exposure or those who have not experienced EM. When the symptoms persist for more than six months following standard treatment and the CSF finding fails to show evidence of Borrelia infection, the condition is referred to as post-Lyme disease syndrome (PLDS). The paper also briefly mentions the differences between late LNB and PLDS.

Keywords: chronic mononeuropathy, radiculopathy, polyneuropathy, chronic encephalomyelitis, post-Lyme disease syndrome.