背景:出现脑炎的莱姆病(LNB)很少见,几乎没有描述。
目的:描述有关LNB脑炎的现有文献,并通过斯堪的纳维亚回顾性队列研究来描述该患者组的特征。
方法:Medline,Embase,Scopus,Cochrane图书馆.
方法:研究类型没有区别,出版时间或语言。
方法:综述:所有有明确LNB和确诊/可能脑炎的文章。队列:来自丹麦的LNB队列,瑞典和挪威1990-2019年进行脑炎患者筛查。
方法:综述:遵守PRISMA指南;两位作者提取综述并评估研究质量。队列:人口统计数据,症状,脑脊液发现,鉴别诊断检查,治疗,残留症状,登记了1年死亡率。
结果:评论:在标题/摘要上筛选了2330篇文章,281篇全文,产生42篇文章(病例报告/系列或队列研究),包括来自18个国家35岁的45名患者。改变的精神状态从人格变化和混乱到无意识。常见的局灶性症状是偏瘫,共济失调和构音障碍;7名患者癫痫发作。从症状发作到住院的中位时间为2周(IQR2-90天)。在中位12个月(IQR5-13)后获得随访的38例患者中,32人已经完全或部分康复,两个人死了。队列:35名患者(中位年龄67岁,包括IQR48-76)。在1019例筛查的LNB患者中,脑炎患病率为3.3%(95%CI2.2-4.4%)。常见的脑炎症状是混乱,人格改变,失语症,共济失调.脑电图和神经影像学显示脑炎分别占93.8%和20.6%,分别。从症状发作到住院的中位延迟为14天(IQR7-34),再延迟7天(IQR3-34),直至靶向治疗。随访时(治疗后中位数298天;IQR113-389),65.6%有残留症状。没有人死亡。
结论:这项研究表明,脑炎是一种罕见的,但可能忽略了LNB的临床表现。由于高频率的残留症状可能与长时间的治疗延迟有关,应考虑对伯氏疏螺旋体病流行区的脑炎患者进行快速LNB检测.
BACKGROUND: Lyme neuroborreliosis (LNB) presenting with encephalitis is rare and scarcely described.
OBJECTIVE: To describe the available literature on LNB encephalitis and to characterize this patient group through a Scandinavian retrospective cohort study.
METHODS: Medline, Embase, Scopus, Cochrane library.
METHODS: There was no discrimination on study type, time of publication or language.
METHODS: Review: All articles with definite LNB and confirmed/possible encephalitis. Cohort: LNB cohorts from Denmark, Sweden and Norway 1990-2019 were screened for patients with encephalitis.
METHODS: Review: Adhering to PRISMA guidelines; two authors extracted reviews and assessed quality of studies. Cohort: Data on demography, symptoms, cerebrospinal fluid findings, differential diagnostic examinations, treatment, residual symptoms, 1-year mortality were registered.
RESULTS: Review: 2330 articles screened on title/abstract, 281 full texts, yielding 42 articles (case reports/series or cohort studies), including 45 patients from 18 countries spanning 35 years. Altered mental status ranged from personality changes and confusion to unconsciousness. Common focal symptoms were hemiparesis, ataxia and dysarthria; seven patients had seizures. Median time from symptom onset to hospital was 2 weeks (IQR 2-90 days). Of 38 patients with available follow-up after median 12 months (IQR 5-13), 32 had fully or partially recovered, two had died. Cohort: Thirty-five patients (median age 67 years, IQR 48-76) were included. The encephalitis prevalence was 3.3% (95% CI 2.2-4.4%) among 1019 screened LNB patients. Frequent encephalitis symptoms were confusion, personality changes, aphasia, ataxia. EEGs and neuroimaging showed encephalitis in 93.8% and 20.6%, respectively. Median delay from symptom onset to hospital was 14 days (IQR 7-34), with further 7 days (IQR 3-34) delay until targeted therapy. At follow-up (median 298 days post-treatment; IQR 113-389), 65.6% had residual symptoms. None had died.
CONCLUSIONS: This study shows that encephalitis is an uncommon, but likely overlooked clinical manifestation of LNB. As the high frequency of residual symptoms may be related to prolonged treatment delay, prompt LNB testing of patients with encephalitis in Borrelia burgdorferi-endemic areas should be considered.