Jacobson D M, Marx J J, Dlesk A
Department of Neurology and Ophthalmology, Marshfield Clinic, WI 54449.
Neurology. 1991 May;41(5):706-11. doi: 10.1212/wnl.41.5.706.
We evaluated antibody reactivity against Borrelia burgdorferi in 20 consecutive patients with newly diagnosed isolated optic neuritis who resided in a region endemic for Lyme disease. Four (20%) patients had positive serology. All three patients who had follow-up serologies showed rising convalescent levels of Borrelia-specific IgM. One patient refused lumbar puncture, one had normal CSF constituents except for an elevated Lyme antibody index, and two had CSF lymphocytic pleocytosis that remained unexplained after extensive evaluations for causes other than Lyme disease. We treated both patients who had CSF pleocytosis with intravenous ceftriaxone; the pleocytosis and optic nerve function improved. The other two patients received oral antibiotics and showed excellent recovery of visual acuity. We believe that serologic testing for Lyme disease is warranted for individuals with optic neuritis who reside in an endemic region, and patients with rising convalescent antibody levels or unexplained CSF pleocytosis should receive antibiotic treatment for Lyme disease.
我们评估了20例新诊断为孤立性视神经炎的连续患者针对伯氏疏螺旋体的抗体反应性，这些患者居住在莱姆病流行地区。4例（20%）患者血清学呈阳性。所有3例接受随访血清学检查的患者，其恢复期伯氏疏螺旋体特异性IgM水平均升高。1例患者拒绝腰椎穿刺，1例患者除莱姆抗体指数升高外，脑脊液成分正常，2例患者出现脑脊液淋巴细胞增多症，在对除莱姆病以外的病因进行广泛评估后，病因仍无法解释。我们对2例出现脑脊液淋巴细胞增多症的患者采用静脉注射头孢曲松进行治疗；脑脊液淋巴细胞增多症和视神经功能均有改善。另外2例患者接受口服抗生素治疗，视力恢复良好。我们认为，对于居住在流行地区的视神经炎患者，进行莱姆病血清学检测是必要的，恢复期抗体水平升高或脑脊液淋巴细胞增多症原因不明的患者应接受莱姆病抗生素治疗。
