CNS presentation of Lyme disease
CNS presentation of Lyme disease CNS presentation of Lyme disease
Antibiotic choice for neuroborreliosis• Ceftriaxone was effective in cases ofneuroborreliosis where penicillin had failed, and canalso be used in children with neurological involvement– Dattwyler RJ, et al. Ceftriaxone as effective therapy in refractory Lymedisease J Infect Dis 1987; 155: 1322–1324• Among patients with Lyme encephalopathy,characterized by loss of memory, ceftriaxone is ableto improve the clinical signs in some, but not all, cases– Logigian EL, : Successful treatment of Lyme encephalopathy withintravenous ceftriaxone. J Infect Dis 1999; 180: 377–383.
Doxyxyclin and neuroborreliosis• Several studies show equivalent efficacy (200mg/day, 3 weeks) compared to ceftriaxone and highdosageintravenous penicillin• Karlsson M, et al.: Comparison of intravenous penicillin G and oral doxycycline for treatment of Lymeneuroborreliosis. Neurology 1994; 44: 1203–1207.• Dattwyler RJ, et al:Ceftriaxone compared with doxycycline for the treatment of acute disseminated Lymeborreliosis. N Engl J Med 1997; 337: 289–294.• Dotevall L, et al. Successful oral doxycycline treatment of Lyme disease-associated facial palsy and meningitis. ClinInfect Dis 1999; 28: 569–574.• In other studies, neurological complications occurredafter doxycycline treatment,– poorly diffusion into the CSF ?– When dosage increased to 400 mg/day : equivalence to ceftriaxone• Borg R, et al.: Intravenous ceftriaxone compared with oral doxycycline for the treatment ofLyme neuroborreliosis. Scand J Infect Dis 2005; 37: 449–454.• Oral doxycycline as efficient as intravenousceftriaxone– inclusion criteria including patients with Bb antibodies in serum,without any other biological criteria• Ljostad Lancet Neurology, 2008 ; 7 : 6988-690.
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- Page 27 and 28: Serology two-step approachScreening
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Antibiotic choice for neuroborreliosis• Ceftriaxone was effective in cases <strong>of</strong>neuroborreliosis where penicillin had failed, and canalso be used in children with neurological involvement– Dattwyler RJ, et al. Ceftriaxone as effective therapy in refractory <strong>Lyme</strong><strong>disease</strong> J Infect Dis 1987; 155: 1322–1324• Among patients with <strong>Lyme</strong> encephalopathy,characterized by loss <strong>of</strong> memory, ceftriaxone is ableto improve the clinical signs in some, but not all, cases– Logigian EL, : Successful treatment <strong>of</strong> <strong>Lyme</strong> encephalopathy withintravenous ceftriaxone. J Infect Dis 1999; 180: 377–383.
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