PDF(Pubmed)
Abstract：
Lyme disease is a multisystem disorder transmitted through the Ixodes tick and is most commonly diagnosed in northeastern and mid-Atlantic states, Wisconsin, and Minnesota, though its disease borders are expanding in the setting of climate change. Approximately 10%-15% of untreated Lyme disease cases will develop neurologic manifestations of Lyme neuroborreliosis (LNB). Due to varying presentations, LNB presents diagnostic challenges and is associated with a delay to treatment. We discuss three cases of LNB admitted to our referral center in a traditionally low-incidence state to highlight clinical pearls in LNB diagnosis. Three patients from low-incidence areas with prior diagnostic evaluations presented in August with neurologic manifestations of radiculoneuritis, cranial neuropathies, and/or lymphocytic meningitis. MRI findings included cranial nerve, nerve root, and leptomeningeal enhancement leading to broad differential diagnoses. Lumbar puncture demonstrated lymphocytic pleocytosis (range 85-753 cells/uL) and elevated protein (87-318 mg/dL). Each patient tested positive for Lyme on two-tiered serum testing and was diagnosed with LNB. All three cases were associated with a delay to health care presentation (mean 20 days) and a delay to diagnosis and treatment (mean 54 days) due to under-recognition and ongoing evaluation. With the geographic expansion of Lyme disease, increasing awareness of LNB manifestations and acquiring detailed travel histories in low-incidence areas is crucial to prompt delivery of care. Clinicians should be aware of two-tiered serum diagnostic requirements and use adjunctive studies such as lumbar puncture and MRI to eliminate other diagnoses. Treatment with an appropriate course of antibiotics leads to robust improvement in neurological symptoms.
摘要：
莱姆病是一种通过Ixodes蜱传播的多系统疾病，最常见于东北和大西洋中部各州，威斯康星州,明尼苏达州,尽管在气候变化的背景下，其疾病边界正在扩大。大约10％-15％的未经治疗的莱姆病病例将发展为莱姆病神经症（LNB）的神经系统表现。由于不同的介绍，LNB呈现诊断挑战并且与治疗延迟相关联。我们讨论了以传统的低发病率状态进入我们转诊中心的三例LNB病例，以突出LNB诊断中的临床珍珠。来自低发病率地区的3例患者，在8月份进行了先前的诊断评估，表现为神经根神经炎，颅神经病,和/或淋巴细胞性脑膜炎。MRI检查结果包括颅神经，神经根,和软脑膜增强导致广泛的鉴别诊断。腰椎穿刺显示淋巴细胞增多（范围85-753细胞/uL）和蛋白质升高（87-318mg/dL）。每位患者在两级血清检测中莱姆病呈阳性，并被诊断为LNB。由于认识不足和正在进行的评估，所有三例病例均与医疗保健报告延迟（平均20天）和诊断和治疗延迟（平均54天）相关。随着莱姆病的地理扩展,在低发病率地区提高对LNB表现的认识并获得详细的旅行史对于及时提供护理至关重要.临床医生应了解两级血清诊断要求，并使用辅助研究，例如腰椎穿刺和MRI，以消除其他诊断。用适当疗程的抗生素治疗导致神经症状的有力改善。
