Page 29 - Human Lyme Neuroborreliosis

Historical Overview 13

and less than two weeks of active disease and 16 control sera, 4 of 6 study
cases with EM and 4 of 6 with cranial neuritis without EM, demonstrated
evidence of CSF B. burgdorferi-specific DNA, compared to none of 16 control
samples. Only 4 of 8 study cases found to have spirochetal DNA in their CSF
had complaints referable to the CNS, whereas no other abnormalities were
noted in 3 of the 8 PCR-positive CSF samples. The authors concluded that B.
burgdorferi invaded the CNS early in the course of infection and therefore
careful consideration of antibiotics should be undertaken to achieve adequate
levels in the CSF to treat those with disseminated infection.

Conclusion

Since its recognition at the turn of the twentieth century in Europe and its
identification several decades ago in the U.S., investigators and clinicians have
come to appreciate the depth and complexity of the clinical infectious and
associated immunological response elicited by B. burgdorferi, the causative
organism of Lyme disease. The recognition and successful treatment
strategies of nervous system Lyme disease occurred through systematic public
health-like analysis of waves of affected patients initiated by Allan Steere and
his colleagues at Yale University beginning in 1977. Since its definition as a
unique human model for an infectious cause of arthritis, Lyme disease has
moved into the spotlight because of the annual toll of neurological disease
most prominently, early childhood facial palsy, subacute adult meningitis,
cranial neuritis, and radiculoneuritis, and late-stage peripheral neuropathy and
encephalopathy, some of which have the potential for improvement with
appropriate antimicrobial therapy. Further understanding of LNB will be
obtained as investigations continue into the spirochete microbiome, and human
host genome and immune defense mechanisms with the development for latent
autoimmunity.

References

[1] Halperin JJ. Nervous system Lyme disease. Handb Clin Neurol 2014;
121:1473-1483.

[2] Garin CH, Bujadoux A. Un cas de tick paralysis. J Méd Lyon 1922;
3:765-767.

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