Corral I, Quereda C, Guerrero A, Escudero R, Martí-Belda P
Unidad de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid.
Neurologia. 1997 Jan;12(1):2-8.
Eight years of case histories of patients with positive serum tests for Borrelia burgdorferi (Bb) are reviewed with the aims of analyzing the neurological manifestations involved and of assessing the value of serology in the diagnosis of neuroborreliosis (NB) in our clinical setting. Of the 105 cases with neurological manifestations that could be examined, 25 patients (24%) with other infections, neoplasms or other diseases had false positive serologies. Forty-one patients (39%) met the criteria for NB diagnosis: 26 had lymphocytic meningitis, 13 had polyradiculitis and 20 had cranial neuropathy. Spinal fluid cultures were positive in 43% of the patients on whom the test was performed, and all patients in this group who were treated with antibiotics improved. The other 39 patients (37%) had only neurological manifestations, which were not typical of NB (peripheral neuropathy, stroke, demyelinating disease, dementia or myelopathy), but for which no other etiology could be demonstrated. Spinal fluid serology was positive in 16% of those cases studied and none of those treated only with antibiotics improved. Among patients with both neurological manifestations and Bb positive serology, there were many false positives and cases with signs that were of dubious relation to infection by Bb; therefore, the prevalence of cases consistent with NB is low [corrected].
回顾了血清学检测伯氏疏螺旋体（Bb）呈阳性患者的八年病历，目的是分析其中涉及的神经学表现，并评估血清学在我们临床环境中对神经型莱姆病（NB）诊断的价值。在105例可检查出神经学表现的病例中，25例（24%）患有其他感染、肿瘤或其他疾病的患者血清学呈假阳性。41例（39%）患者符合NB诊断标准：26例患有淋巴细胞性脑膜炎，13例患有多发性神经根炎，20例患有颅神经病变。进行检测的患者中43%的脑脊液培养呈阳性，该组中所有接受抗生素治疗的患者病情均有改善。其他39例（37%）患者仅有神经学表现，并非NB的典型表现（周围神经病变、中风、脱髓鞘疾病、痴呆或脊髓病），但未发现其他病因。在这些病例中，16%的脑脊液血清学呈阳性，且仅接受抗生素治疗的患者无一病情改善。在有神经学表现且Bb血清学呈阳性的患者中，存在许多假阳性病例以及症状与Bb感染关系存疑的病例；因此，符合NB的病例患病率较低[校正后]。
