Halperin J J, Krupp L B, Golightly M G, Volkman D J
Department of Neurology, State University of New York, Stony Brook 11794.
Neurology. 1990 Sep;40(9):1340-3. doi: 10.1212/wnl.40.9.1340.
Borrelia burgdorferi infection (Lyme disease) is frequently accompanied by CNS dysfunction. Particularly common is a mild confusional state, the mechanism of which is unknown. Since CNS infection with B burgdorferi is usually accompanied by intrathecal synthesis of specific antibody, we studied CSF in 73 patients referred for presumed CNS Lyme, manifested primarily as this confusional state. Of 30 seropositive patients evaluated, only 5 had intrathecal antibody production. Seven seronegative patients had positive cell-mediated immune responses to B burgdorferi in the peripheral blood; none had antibody production in the CSF. Of the remaining 36 patients referred with this diagnosis despite negative serologic studies, none had compelling evidence of CNS infection by this criterion. We conclude that CNS infection with B burgdorferi does occur in a small proportion of seropositive patients with this confusional state but is extremely uncommon among seronegative individuals with this clinical presentation.
伯氏疏螺旋体感染（莱姆病）常伴有中枢神经系统功能障碍。特别常见的是一种轻度意识模糊状态，其机制尚不清楚。由于伯氏疏螺旋体中枢神经系统感染通常伴有鞘内特异性抗体的合成，我们对73例因疑似中枢神经系统莱姆病（主要表现为这种意识模糊状态）而转诊的患者的脑脊液进行了研究。在评估的30例血清学阳性患者中，只有5例有鞘内抗体产生。7例血清学阴性患者外周血对伯氏疏螺旋体有阳性细胞介导免疫反应；脑脊液中均无抗体产生。其余36例尽管血清学检查阴性但以此诊断转诊的患者，按此标准均无中枢神经系统感染的确凿证据。我们得出结论，伯氏疏螺旋体中枢神经系统感染在一小部分有这种意识模糊状态的血清学阳性患者中确实存在，但在有此临床表现的血清学阴性个体中极为罕见。
