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CNS Infections pp 211-226 | Cite as

The Human Borreliosis: Lyme Neuroborreliosis and Relapsing Fever

  • John J. Halperin
  • Juan Carlos García-MoncóEmail author
Chapter

Abstract

Lyme disease, caused by the tick-borne spirochete Borrelia burgdorferi, infects the nervous system in up to 15 % of patients. Involvement can include the peripheral nervous system, with a mononeuropathy multiplex manifest as a radiculopathy, cranial neuropathy, plexopathy, or confluent mononeuropathy multiplex. In most instances, central nervous system involvement is limited to meningitis; rarely the spinal cord or brain parenchyma can be involved. Recent work has shed light on the pathophysiologic sequence that results in neuroborreliosis, including early CNS invasion, CXCL13-stimulated B cell entry into and proliferation within the CNS, and then a prominent immune response that requires ongoing presence of organisms. Pathophysiology of peripheral nerve involvement is not well established although it similarly requires the presence of viable organisms. Future work should focus on the mechanisms of tissue injury. Regardless of the presentation, infection is highly responsive to antimicrobial therapy.

Relapsing fever is another human borreliosis caused by a variety of Borrelia species and transmitted by lice (epidemic form) or ticks (endemic form). Both are characterized by recurrent spirochetemia and can cause neurological complications similar to Lyme neuroborreliosis. Diagnosis is made by the direct observation of the spirochetes in peripheral blood during febrile episodes and by PCR. Tetracycline therapy is used.

Keywords

Lyme disease Neuroborreliosis Diagnosis Treatment Pathophysiology Garin-Bujadoux-Bannwarth syndrome Erythema migrans Relapsing fever Louse-borne relapsing fever Tick-borne relapsing fever Borrelia recurrentis 

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Copyright information

© Springer-Verlag London 2014

Authors and Affiliations

  • John J. Halperin
    • 1
  • Juan Carlos García-Moncó
    • 2
    Email author
  1. 1.Department of NeurosciencesOverlook Medical CenterSummitUSA
  2. 2.Department of NeurologyHospital de Galdakao-UsansoloGaldakao, VizcayaSpain

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