Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark.
Ticks Tick Borne Dis. 2020 Jul;11(4):101411. doi: 10.1016/j.ttbdis.2020.101411. Epub 2020 Feb 24.
The goal of this paper is to characterize the clinical presentation, serological results, current antibiotic treatment practice, including compliance with current European guidelines, and outcome in adults with Lyme neuroborreliosis (LNB) diagnosed at departments of infectious diseases in Denmark. Using a nationwide prospective cohort of patients with central nervous system infections, we identified all adults (≥ 18 years of age) treated for LNB at departments of infectious diseases in Denmark from 2015 through 2017. The database contains information on baseline demographics, history of tick bite, erythema migrans, clinical presentation, laboratory results of blood samples, and cerebrospinal (CSF) biochemistry (e.g. specific Borrelia burgdorferi sensu lato (s.l.) antibodies in serum, B. burgdorferi s.l. intrathecal antibody index) as well as antibiotic therapy. Outcome was assessed by the Glasgow Outcome Scale (GOS) and the presence of residual symptoms at follow-up one month after discharge. We included 194 LNB patients with a median age of 59 years (range 18-85 years, interquartile range [IQR] 47-69 years). The female-to-male ratio was 0.8. A total of 177 of 191 (93 %) of patients had early (second stage) LNB. A history of tick bite or erythema migrans was registered in 75 (39 %) and 49 (25 %) patients, respectively. The median duration of neurological symptoms before first hospital contact was 21 days (range 0-600 days, IQR 10-42 days). Predominant symptoms consisted of radicular pain in 135 of 194 (70 %), cranial nerve paresis in 88 of 194 (45 %), headache in 71 of 185 (38 %), and extremity paresis in 33 of 194 (17 %) patients. Serum-B. burgdorferi s.l. IgM and/or IgG antibodies were detectable in 166 of 181 (92 %) patients at the time of first CSF investigation. Median duration of antibiotic treatment was 14 days (range 10-35 days, IQR 14-21 days) and 59 (39 %) of the patients received intravenous ceftriaxone and/or benzylpenicillin G throughout treatment. At the 1-month follow-up, GOS was unfavorable (< 5) in 54 of 193 (28 %) patients. An unfavorable GOS score was more often registered in patients with ≥ 45 days of symptom duration (20 of 45 (44 %) vs. 34 of 145 (23 %); P = 0.006). In conclusion, a European cohort of adult patients with LNB diagnosed between 2015-2017 presented with classic symptoms and CSF findings. However, a substantial diagnostic delay was still observed. In disagreement with current guidelines, a substantial part of LNB patients were treated with antibiotics longer than 14 days and/or intravenously as route of administration.
本文的目的是描述在丹麦传染病科诊断为莱姆神经Borreliosis（LNB）的成年人的临床表现、血清学结果、当前抗生素治疗实践，包括符合当前欧洲指南的情况，以及预后。通过一项针对中枢神经系统感染的全国前瞻性队列研究，我们确定了 2015 年至 2017 年期间在丹麦传染病科接受 LNB 治疗的所有成年人（≥18 岁）。该数据库包含基线人口统计学、蜱虫叮咬史、游走性红斑、临床表现、血液样本实验室结果和脑脊液（CSF）生物化学信息（例如血清中的特定伯氏疏螺旋体（s.l.）抗体、伯氏疏螺旋体 s.l.鞘内抗体指数）以及抗生素治疗。预后通过格拉斯哥预后量表（GOS）和出院后一个月随访时的残留症状进行评估。我们纳入了 194 例 LNB 患者，中位年龄为 59 岁（范围 18-85 岁，四分位距 [IQR] 47-69 岁）。女性与男性的比例为 0.8。191 例患者中共有 177 例（93%）为早期（二期）LNB。分别有 75 例（39%）和 49 例（25%）患者有蜱虫叮咬或游走性红斑史。首次住院前神经系统症状的中位持续时间为 21 天（范围 0-600 天，IQR 10-42 天）。主要症状包括 194 例患者中的 135 例（70%）神经根痛、88 例（45%）颅神经麻痹、71 例（38%）头痛和 33 例（17%）肢体无力。181 例患者中有 166 例（92%）在首次脑脊液检查时可检测到血清伯氏疏螺旋体（s.l.）IgM 和/或 IgG 抗体。抗生素治疗的中位持续时间为 14 天（范围 10-35 天，IQR 14-21 天），59 例（39%）患者接受了整个治疗过程中的头孢曲松和/或苄青霉素 G 静脉注射。在 1 个月的随访中，193 例患者中有 54 例（28%）的 GOS 评分不理想（<5）。症状持续时间≥45 天的患者更常出现 GOS 评分不佳（45 例中有 20 例 [44%] vs. 145 例中有 34 例 [23%]；P=0.006）。总之，2015-2017 年间在欧洲诊断为 LNB 的成年患者队列表现出典型的症状和 CSF 发现。然而，仍观察到明显的诊断延迟。与当前指南不一致的是，相当一部分 LNB 患者接受了超过 14 天的抗生素治疗，并且/或者静脉途径作为给药途径。
