Q 2.12. Neurologic Complications in Lyme disease and AIDS

Neurologic Complications in Lyme Disease:

1. Definition: Neurologic Lyme disease, also known as neuroborreliosis, occurs when Lyme disease bacteria invade and affect the nervous system.
2. Symptoms:
   • Early onset: Neurological symptoms often appear 3-5 weeks after the initial tick bite and the flu-like symptoms associated with Lyme disease.
   • Common manifestations:
     • Radiculoneuritis: Inflammation of motor and sensory spinal nerve roots, leading to muscle weakness, paralysis, tingling, numbness, and sharp pain.
     • Cranial neuritis: Inflammation of cranial nerves (essential for eye movements, vision, hearing, taste, balance, and facial expression).
     • Lymphocytic/monocytic meningitis: Characterized by headache, stiff neck, and extreme light sensitivity.
     • Facial nerve palsy: Common and may affect one or both sides of the face.
   • Rare CNS involvement: Meningitis, encephalitis, myelitis, and vasculitis.
   • Long-term effects: Some patients may experience difficulty concentrating, memory disorders, sleep disturbances, irritability, and nerve damage in the arms and legs.
   • Pediatric presentation: Young children may exhibit nonspecific symptoms like headaches, loss of appetite, behavior problems, and fatigue.
3. Cause: Lyme disease is transmitted through the bite of blood-feeding hard-shelled Ixodes ticks .

4. Diagnosis: The diagnosis of neuroborreliosis is typically made through a combination of a physical exam, blood tests that detect Borrelia antibodies, and importantly, CSF testing. CSF analysis is crucial and typically reveals elevated CSF cell count, blood-CSF barrier dysfunction, CSF oligoclonal bands, and quantitative intrathecal synthesis of immunoglobulins. These findings suggest the presence of intrathecal antibody synthesis to Lyme disease-associated Borrelia species, indicating neuroinvasive Lyme disease.

5. Treatment: The treatment for neuroborreliosis involves intravenous antibiotics for 14–28 days. Antibiotics that can cross the blood-brain barrier, such as penicillins, ceftriaxone, or cefotaxime, are used. Ceftriaxone may be more effective than penicillin in some cases.

6. Prognosis: Most patients with neuroborreliosis have a favorable outcome after antibiotic treatment. However, some may experience residual symptoms that persist for weeks or even months. Early treatment during the stages of Lyme disease can prevent the development of neuroborreliosis and its inflammatory effects on the nervous system. It’s important for medical students to understand that while the majority of patients respond well to treatment, a small number may have varying degrees of permanent nervous system damage, especially if treatment is delayed or if the patient develops late-stage Lyme disease.

Neurologic Complications in AIDS:

1. Definition: AIDS (Acquired Immunodeficiency Syndrome) is caused by the HIV virus, which weakens the immune system and leads to various complications.
2. Neurological Manifestations:
   • HIV encephalopathy: Cognitive decline, memory impairment, and behavioral changes due to direct HIV effects on the brain.
   • Opportunistic infections: AIDS patients are susceptible to infections like toxoplasmosis, cryptococcal meningitis, and progressive multifocal leukoencephalopathy (PML).
   • Peripheral neuropathy: Sensory symptoms (stocking-glove fashion) due to nerve damage.
   • HIV-associated neurocognitive disorders (HAND): Includes asymptomatic neurocognitive impairment, mild neurocognitive disorder, and HIV-associated dementia.
3. Diagnosis: Testing for AIDS involves HIV antibody testing and monitoring CD4 cell counts.
4. Treatment: Antiretroviral therapy (ART) is crucial to manage HIV and prevent neurological complications.

Remember, early recognition and appropriate management are essential for improving outcomes in both Lyme disease and AIDS patients.

References:

1 medicalnewstoday.com

2 journals.lww.com

3 europepmc.org

4 uptodate.com

5 med.brown.edu