Borrelia burgdorferi in the nervous system: the new “great imitator”

Pachner AR. Borrelia burgdorferi in the nervous system: the new “great imitator”. Ann N Y Acad Sci. 1988;539:56-64. doi: 10.1111/j.1749-6632.1988.tb31838.x. PMID: 3190104.

Patient Vignette – Bicycle Boy
The patient was bitten by a tic. Weeks later he presented with neuropsychiatric symptoms. Was given IV antibiotics and all symptoms resolved.

  • Lyme disease shares key similarities with syphilis: spirochetal etiology, extended tissue survival, staged clinical manifestations, and antibiotic susceptibility. Lessons from syphilis, particularly regarding spirochetal brain disease mimicking other neurological conditions, apply to Lyme disease.
  • Clinicians should consider Lyme disease early due to its effective response to antibiotics.
  • Lyme meningitis in the second stage is recognizable, but milder cases often go undiagnosed.
  • Progression to third-stage disease, as in Lyme arthritis, may occur, highlighting the importance of serologic tests.
  • Serology is crucial for diagnosing later stages of Lyme disease, paralleling the situation in neurosyphilis where cultures and antigen tests are less useful.
  • Antibody titers vary in different manifestations, with Lyme arthritis and acrodermatitis atrophicans showing high titers.
  • Recognition challenges exist for CNS Lyme disease without prior stages, emphasizing the significance of serological diagnosis in later stages.

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