Skip to main content
SpringerLink
Log in
Book cover

CNS Infections pp 233–249Cite as

The Human Borreliosis: Lyme Neuroborreliosis and Relapsing Fever

  • Chapter
  • First Online:

  • 1250 Accesses

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.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Steere AC, Malawista SE, Hardin JA, Ruddy S, Askenase W, Andiman WA. Erythema chronicum migrans and Lyme arthritis. The enlarging clinical spectrum. Ann Intern Med. 1977;86:685–98.

    Article  CAS  PubMed  Google Scholar 

  2. Reik L, Steere AC, Bartenhagen NH, Shope RE, Malawista SE. Neurologic abnormalities of Lyme disease. Medicine. 1979;58:281–94.

    Article  CAS  PubMed  Google Scholar 

  3. Benach JL, Bosler EM, Hanrahan JP, Coleman JL, Habicht GS, Bast TF, et al. Spirochetes isolated from the blood of two patients with Lyme disease. N Engl J Med. 1983;308:740–2.

    Article  CAS  PubMed  Google Scholar 

  4. Burgdorfer W, Barbour AG, Hayes SF, Benach JL, Grunwaldt E, Davis JP. Lyme disease-a tick-borne spirochetosis? Science. 1982;216:1317–9.

    Article  CAS  PubMed  Google Scholar 

  5. Steere AC, Grodzicki RL, Kornblatt AN, Craft JE, Barbour AG, Burgdorfer W, et al. The spirochetal etiology of Lyme disease. N Engl J Med. 1983;308:733–40.

    Article  CAS  PubMed  Google Scholar 

  6. Scrimenti RJ. Erythema chronicum migrans. Arch Dermatol. 1970;102:104–5.

    Article  CAS  PubMed  Google Scholar 

  7. Hollstrom E. Successful treatment of erythema migrans Afzelius. Acta Derm Venereol. 1951;31:235–43.

    CAS  PubMed  Google Scholar 

  8. Azfellius A. Erythema chronicum migrans. Arch Dermatol Venereol (Stockh). 1921;2:120–5.

    Google Scholar 

  9. Garin C, Bujadoux A. Paralysie par les tiques. J Med Lyon. 1922;71:765–7.

    Google Scholar 

  10. Asbrink E, Hovmark A, Hederstedt B. The spirochetal etiology of acrodermatitis chronica atrophicans Herxheimer. Acta Derm Venereol. 1984;64:506–12.

    CAS  PubMed  Google Scholar 

  11. Nowakowski J, Schwartz I, Liveris D, Wang G, Aguero-Rosenfeld ME, Girao G, et al. Laboratory diagnostic techniques for patients with early Lyme disease associated with erythema migrans: a comparison of different techniques. Clin Infect Dis. 2001;33:2023–7.

    Article  CAS  PubMed  Google Scholar 

  12. Dattwyler RJ, Volkman DJ, Luft BJ, Halperin JJ, Thomas J, Golightly MG. Seronegative Lyme disease. Dissociation of specific T- and B-lymphocyte responses to Borrelia burgdorferi. N Engl J Med. 1988;319:1441–6.

    Article  CAS  PubMed  Google Scholar 

  13. Anonymous. Recommendations for test performance and interpretation from the Second National Conference on serologic diagnosis of Lyme disease. MMWR. 1995;44:590–1.

    Google Scholar 

  14. Wormser GP, Schriefer M, Aguero-Rosenfeld ME, Levin A, Steere AC, Nadelman RB, et al. Single-tier testing with the C6 peptide ELISA kit compared with two-tier testing for Lyme disease. Diagn Microbiol Infect Dis. 2013;75:9–15.

    Article  CAS  PubMed  Google Scholar 

  15. Branda JA, Strle F, Strle K, Sikand N, Ferraro MJ, Steere AC. Performance of United States serologic assays in the diagnosis of lyme borreliosis acquired in Europe. Clin Infect Dis. 2013;57:333–40.

    Article  CAS  PubMed  Google Scholar 

  16. Halperin JJ, Luft BJ, Anand AK, Roque CT, Alvarez O, Volkman DJ, et al. Lyme neuroborreliosis: central nervous system manifestations. Neurology. 1989;39:753–9.

    Article  CAS  PubMed  Google Scholar 

  17. Hansen K, Cruz M, Link H. Oligoclonal Borrelia burgdorferi-specific IgG antibodies in cerebrospinal fluid in Lyme neuroborreliosis. J Infect Dis. 1990;161:1194–202.

    Article  CAS  PubMed  Google Scholar 

  18. Stiernstedt GT, Granstrom M, Hederstedt B, Skoldenberg B. Diagnosis of spirochetal meningitis by enzyme-linked immunosorbent assay and indirect immunofluorescence assay in serum and cerebrospinal fluid. J Clin Microbiol. 1985;21:819–25.

    CAS  PubMed  PubMed Central  Google Scholar 

  19. Hammers-Berggren S, Hansen K, Lebech AM, Karlsson M. Borrelia burgdorferi-specific intrathecal antibody production in neuroborreliosis: a follow-up study. Neurology. 1993;43:169–75.

    Article  CAS  PubMed  Google Scholar 

  20. Ogrinc K, Lusa L, Lotrič-Furlan S, Bogovič P, Stupica D, Cerar T, et al. Course and outcome of early European lyme neuroborreliosis (Bannwarth Syndrome): clinical and laboratory findings. Clin Infect Dis. 2016;63(3):346–53.

    Article  PubMed  Google Scholar 

  21. Halperin JJ, Volkman DJ, Wu P. Central nervous system abnormalities in Lyme neuroborreliosis. Neurology. 1991;41:1571–82.

    Article  CAS  PubMed  Google Scholar 

  22. Steere AC, Berardi VP, Weeks KE, Logigian EL, Ackermann R. Evaluation of the intrathecal antibody response to Borrelia burgdorferi as a diagnostic test for Lyme neuroborreliosis. J Infect Dis. 1990;161:1203–9.

    Article  CAS  PubMed  Google Scholar 

  23. Gerber MA, Shapiro ED, Burke GS, Parcells VJ, Bell GL. Lyme disease in children in southeastern Connecticut. Pediatric Lyme Disease Study Group. N Engl J Med. 1996;335:1270–4.

    Article  CAS  PubMed  Google Scholar 

  24. Bannwarth A. Chronische lymphocytare meningitis, entzundliche polyneuritis und “rheumatismus”. Arch Psychiatr Nervenkr. 1941;113:284–376.

    Article  Google Scholar 

  25. Bacon RM, Kugeler KJ, Mead PS, Centers for Disease Control, and Prevention. Surveillance for Lyme disease—United States, 1992–2006. MMWR Surveill Summ. 2008;57:1–9.

    PubMed  Google Scholar 

  26. Garcia-Monco JC, Benach JL. Lyme neuroborreliosis. Ann Neurol. 1995;37:691–702.

    Article  CAS  PubMed  Google Scholar 

  27. Cohn KA, Thompson AD, Shah SS, Hines EM, Lyons TW, Welsh EJ, et al. Validation of a clinical prediction rule to distinguish Lyme meningitis from aseptic meningitis. Pediatrics. 2012;129:e46–53.

    Article  PubMed  Google Scholar 

  28. Garro AC, Rutman M, Simonsen K, Jaeger JL, Chapin K, Lockhart G. Prospective validation of a clinical prediction model for Lyme meningitis in children. Pediatrics. 2009;123:e829–34.

    Article  PubMed  Google Scholar 

  29. Tuerlinckx D, Bodart E, Jamart J, Glupczynski Y. Prediction of Lyme meningitis based on a logistic regression model using clinical and cerebrospinal fluid analysis: a European study. Pediatr Infect Dis J. 2009;28:394–7.

    Article  PubMed  Google Scholar 

  30. Halperin JJ, Golightly M. Lyme borreliosis in Bell’s palsy. Long Island Neuroborreliosis Collaborative Study Group. Neurology. 1992;42:1268–70.

    Article  CAS  PubMed  Google Scholar 

  31. Bremell D, Hagberg L. Clinical characteristics and cerebrospinal fluid parameters in patients with peripheral facial palsy caused by Lyme neuroborreliosis compared with facial palsy of unknown origin (Bell’s palsy). BMC Infect Dis. 2011;11:215.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Sibony P, Halperin J, Coyle PK, Patel K. Reactive Lyme serology in optic neuritis. J Neuroophthalmol. 2005;25:71–82.

    Article  PubMed  Google Scholar 

  33. Halperin J, Luft BJ, Volkman DJ, Dattwyler RJ. Lyme neuroborreliosis. Peripheral nervous system manifestations. Brain. 1990;113(Pt 4):1207–21.

    Article  PubMed  Google Scholar 

  34. Logigian EL, Steere AC. Clinical and electrophysiologic findings in chronic neuropathy of Lyme disease. Neurology. 1992;42:303–11.

    Article  CAS  PubMed  Google Scholar 

  35. Camponovo F, Meier C. Neuropathy of vasculitic origin in a case of Garin-Bujadoux-Bannwarth syndrome with positive borrelia antibody response. J Neurol. 1986;233:69–72.

    Article  CAS  PubMed  Google Scholar 

  36. Elamin M, Alderazi Y, Mullins G, Farrell MA, O’Connell S, Counihan TJ. Perineuritis in acute lyme neuroborreliosis. Muscle Nerve. 2009;39:851–4.

    Article  PubMed  Google Scholar 

  37. England JD, Bohm RP Jr, Roberts ED, Philipp MT. Mononeuropathy multiplex in rhesus monkeys with chronic Lyme disease. Ann Neurol. 1997;41:375–84.

    Article  CAS  PubMed  Google Scholar 

  38. Halperin JJ, Little BW, Coyle PK, Dattwyler RJ. Lyme disease: cause of a treatable peripheral neuropathy. Neurology. 1987;37:1700–6.

    Article  CAS  PubMed  Google Scholar 

  39. Vallat JM, Hugon J, Lubeau M, Leboutet MJ, Dumas M, Desproges-Gotteron R. Tick-bite meningoradiculoneuritis: clinical, electrophysiologic, and histologic findings in 10 cases. Neurology. 1987;37:749–53.

    Article  CAS  PubMed  Google Scholar 

  40. Ackermann R, Rehse-Kupper B, Gollmer E, Schmidt R. Chronic neurologic manifestations of erythema migrans borreliosis. Ann N Y Acad Sci. 1988;539:16–23.

    Article  CAS  PubMed  Google Scholar 

  41. Kalina P, Decker A, Kornel E, Halperin JJ. Lyme disease of the brainstem. Neuroradiology. 2005;47:903–7.

    Article  PubMed  Google Scholar 

  42. Wroblewski D, Gebhardt L, Prusinski MA, Meehan LJ, Halse TA, Musser KA. Detection of Borrelia miyamotoi and other Tick-borne pathogens in human clinical specimens and Ixodes scapularis ticks in New York State, 2012-2015. Ticks Tick Borne Dis. 2017;8(3):407–11.

    Article  PubMed  Google Scholar 

  43. Boden K, Lobenstein S, Hermann B, Margos G, Fingerle V. Borrelia miyamotoi-associated neuroborreliosis in immunocompromised person. Emerg Infect Dis. 2016;22(9):1617–20.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Pritt BS, Mead PS, DKH J, Neitzel DF, Respicio-Kingry LB, Davis JP, et al. Identification of a novel pathogenic Borrelia species causing Lyme borreliosis with unusually high spirochaetaemia: a descriptive study. Lancet Infect Dis. 2016;16(5):556–64.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Halperin JJ, Krupp LB, Golightly MG, Volkman DJ. Lyme borreliosis-associated encephalopathy. Neurology. 1990;40:1340–3.

    Article  CAS  PubMed  Google Scholar 

  46. Krupp LB, Masur D, Schwartz J, Coyle PK, Langenbach LJ, Fernquist SK, et al. Cognitive functioning in late Lyme borreliosis. Arch Neurol. 1991;48:1125–9.

    Article  CAS  PubMed  Google Scholar 

  47. Logigian EL, Kaplan RF, Steere AC. Chronic neurologic manifestations of Lyme disease. N Engl J Med. 1990;323:1438–44.

    Article  CAS  PubMed  Google Scholar 

  48. Dersch R, Sommer H, Rauer S, Meerpohl JJ. Prevalence and spectrum of residual symptoms in Lyme neuroborreliosis after pharmacological treatment: a systematic review. J Neurol. 2016;263(1):17–24.

    Article  CAS  PubMed  Google Scholar 

  49. Eikeland R, Mygland A, Herlofson K, Ljostad U. Risk factors for a non-favorable outcome after treated European neuroborreliosis. Acta Neurol Scand. 2013;127:154–60.

    Article  CAS  PubMed  Google Scholar 

  50. Ljostad U, Mygland A. Remaining complaints 1 year after treatment for acute Lyme neuroborreliosis; frequency, pattern and risk factors. Eur J Neurol. 2010;17:118–23.

    Article  CAS  PubMed  Google Scholar 

  51. Skogman BH, Glimaker K, Nordwall M, Vrethem M, Odkvist L, Forsberg P. Long-term clinical outcome after Lyme neuroborreliosis in childhood. Pediatrics. 2012;130:262–9.

    Article  PubMed  Google Scholar 

  52. Seltzer EG, Gerber MA, Cartter ML, Freudigman K, Shapiro ED. Long-term outcomes of persons with Lyme disease. JAMA. 2000;283:609–16.

    Article  CAS  PubMed  Google Scholar 

  53. Shadick NA, Phillips CB, Sangha O, Logigian EL, Kaplan RF, Wright EA, et al. Musculoskeletal and neurologic outcomes in patients with previously treated Lyme disease. Ann Intern Med. 1999;131:919–26.

    Article  CAS  PubMed  Google Scholar 

  54. Cerar D, Cerar T, Ruzic-Sabljic E, Wormser GP, Strle F. Subjective symptoms after treatment of early Lyme disease. Am J Med. 2010;123:79–86.

    Article  PubMed  Google Scholar 

  55. Luo N, Johnson JA, Shaw JW, Feeny D, Coons SJ. Self-reported health status of the general adult U.S. population as assessed by the EQ-5D and Health Utilities Index. Med Care. 2005;43:1078–86.

    Article  PubMed  Google Scholar 

  56. Keller TL, Halperin JJ, Whitman M. PCR detection of Borrelia burgdorferi DNA in cerebrospinal fluid of Lyme neuroborreliosis patients. Neurology. 1992;42:32–42.

    Article  CAS  PubMed  Google Scholar 

  57. Luft BJ, Steinman CR, Neimark HC, Muralidhar B, Rush T, Finkel MF, et al. Invasion of the central nervous system by Borrelia burgdorferi in acute disseminated infection. JAMA. 1992;267:1364–7.

    Article  CAS  PubMed  Google Scholar 

  58. Garcia-Monco JC, Villar BF, Alen JC, Benach JL. Borrelia burgdorferi in the central nervous system: experimental and clinical evidence for early invasion. J Infect Dis. 1990;161:1187–93.

    Article  CAS  PubMed  Google Scholar 

  59. Grab DJ, Perides G, Dumler JS, Kim KJ, Park J, Kim YV, et al. Borrelia burgdorferi, host-derived proteases, and the blood–brain barrier. Infect Immun. 2005;73:1014–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Grab DJ, Nyarko E, Nikolskaia OV, Kim YV, Dumler JS. Human brain microvascular endothelial cell traversal by Borrelia burgdorferi requires calcium signaling. Clin Microbiol Infect. 2009;15:422–6.

    Article  CAS  PubMed  Google Scholar 

  61. Rupprecht TA, Plate A, Adam M, Wick M, Kastenbauer S, Schmidt C, et al. The chemokine CXCL13 is a key regulator of B cell recruitment to the cerebrospinal fluid in acute Lyme neuroborreliosis. J Neuroinflammation. 2009;6:42.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Lebech AM, Hansen K, Brandrup F, Clemmensen O, Halkier-Sorensen L. Diagnostic value of PCR for detection of Borrelia burgdorferi DNA in clinical specimens from patients with erythema migrans and Lyme neuroborreliosis. Mol Diagn. 2000;5:139–50.

    Article  CAS  PubMed  Google Scholar 

  63. Sigal LH. Molecular mimicry and Lyme borreliosis. Ann Neurol. 1990;28:195–6.

    Article  CAS  PubMed  Google Scholar 

  64. Sigal LH, Tatum AH. Lyme disease patients’ serum contains IgM antibodies to Borrelia burgdorferi that cross-react with neuronal antigens. Neurology. 1988;38:1439–42.

    Article  CAS  PubMed  Google Scholar 

  65. Pachner AR, Zhang WF, Schaefer H, Schaefer S, O’Neill T. Detection of active infection in nonhuman primates with Lyme neuroborreliosis: comparison of PCR, culture, and a bioassay. J Clin Microbiol. 1998;36:3243–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  66. Ramesh G, Borda JT, Gill A, Ribka EP, Morici LA, Mottram P, et al. Possible role of glial cells in the onset and progression of Lyme neuroborreliosis. J Neuroinflammation. 2009;6:23.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Ramesh G, Benge S, Pahar B, Philipp MT. A possible role for inflammation in mediating apoptosis of oligodendrocytes as induced by the Lyme disease spirochete Borrelia burgdorferi. J Neuroinflammation. 2012;9:72.

    CAS  PubMed  PubMed Central  Google Scholar 

  68. Halperin JJ, Shapiro ED, Logigian E, Belman AL, Dotevall L, Wormser GP, et al. Practice parameter: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2007;69:91–102.

    Article  CAS  PubMed  Google Scholar 

  69. Fallon BA, Keilp JG, Corbera KM, Petkova E, Britton CB, Dwyer E, et al. A randomized, placebo-controlled trial of repeated IV antibiotic therapy for Lyme encephalopathy. Neurology. 2008;70:992–1003.

    Article  CAS  PubMed  Google Scholar 

  70. Klempner MS, LT H, Evans J, Schmid CH, Johnson GM, Trevino RP, et al. Two controlled trials of antibiotic treatment in patients with persistent symptoms and a history of Lyme disease. N Engl J Med. 2001;345:85–92.

    Article  CAS  PubMed  Google Scholar 

  71. Krupp LB, Hyman LG, Grimson R, Coyle PK, Melville P, Ahnn S, et al. Study and treatment of post Lyme disease (STOP-LD): a randomized double masked clinical trial. Neurology. 2003;60:1923–30.

    Article  CAS  PubMed  Google Scholar 

  72. Seilmaier M, Guggemos W, Wieser A, Fingerle V, Balzer L, Fenzl T, et al. Louse-borne-relapsing-fever in refugees from the Horn of Africa; a case series of 25 patients. Dtsch Med Wochenschr. 2016;141(14):e133–42.

    Article  CAS  PubMed  Google Scholar 

  73. Hoch M, Wieser A, Loscher T, Margos G, Purner F, Zuhl J, et al. Louse-borne relapsing fever (Borrelia recurrentis) diagnosed in 15 refugees from northeast Africa: epidemiology and preventive control measures, Bavaria, Germany, July to October 2015. Euro Surveill. 2015;20(42).

    Google Scholar 

  74. Barbour AG. Antigenic variation of a relapsing fever Borrelia species. Annu Rev Microbiol. 1990;44:155–71.

    Article  CAS  PubMed  Google Scholar 

  75. Cadavid D, Barbour AG. Neuroborreliosis during relapsing fever: review of the clinical manifestations, pathology, and treatment of infections in humans and experimental animals. Clin Infect Dis. 1998;26:151–64.

    Article  CAS  PubMed  Google Scholar 

  76. Bergeret C, Raoult A. Notes sur les formes nerveuses de la fievre recurrente & tiques en Afrique Occidentale Franchise. Bulletin Medicale de l’Afrique Occidentale Francaise. 1948;5:271–9.

    Google Scholar 

  77. Salih SY, Mustafa D, Abdel Wahab SM, Ahmed MA, Omer A. Louse-borne relapsing fever: I. A clinical and laboratory study of 363 cases in the Sudan. Trans R Soc Trop Med Hyg. 1977;71:43–8.

    Article  CAS  PubMed  Google Scholar 

  78. Hamilton J. Ocular complications in relapsing fever. Br J Ophthalmol. 1943;27:68–80.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  79. Southern P, Sanford JP. Relapsing fever: a clinical and microbiological review. Medicine. 1969;48:129–50.

    Article  Google Scholar 

  80. Brahim H, Perrier-Gros-Claude JD, Postic D, Baranton G, Jambou R. Identifying relapsing fever Borrelia, Senegal. Emerg Infect Dis. 2005;11:474–5.

    Article  PubMed  PubMed Central  Google Scholar 

  81. Garcia-Monco JC, Miller NS, Backenson PB, Anda P, Benach JL. A mouse model of Borrelia meningitis after intradermal injection. J Infect Dis. 1997;175(5):1243.

    Article  CAS  PubMed  Google Scholar 

  82. Cadavid D, Sondey M, Garcia E, Lawson CL. Residual brain infection in relapsing-fever borreliosis. J Infect Dis. 2006;193:1451–8.

    Article  CAS  PubMed  Google Scholar 

  83. Gugliotta JL, Goethert HK, Berardi VP, Telford SR III. Meningoencephalitis from Borrelia miyamotoi in an immunocompromised patient. N Engl J Med. 2013;368:240–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  84. Hovius JW, de Wever B, Sohne M, Brouwer MC, Coumou J, Wagemakers A, et al. A case of meningoencephalitis by the relapsing fever spirochaete Borrelia miyamotoi in Europe. Lancet. 2013;382(9892):658.

    Article  PubMed  PubMed Central  Google Scholar 

  85. Telford SR III, Molloy PJ, Berardi VP. Borrelia miyamotoi. Ann Intern Med. 2015;163(12):963–4.

    Article  PubMed  Google Scholar 

  86. Molloy PJ, Telford SR III, Chowdri HR, Lepore TJ, Gugliotta JL, Weeks KE, et al. Borrelia miyamotoi disease in the Northeastern United States: a case series. Ann Intern Med. 2015;163(2):91–8.

    Article  PubMed  Google Scholar 

  87. Arteaga F, Golightly MG, Garcia Perez A, Barral M, Anda P, Garcia-Monco JC. Disparity between serological reactivity to Borrelia burgdorferi and evidence of past disease in a high-risk group. Clin Infect Dis. 1998;27:1210–3.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosciences, Overlook Medical Center, Summit, NJ, USA

    John J. Halperin M.D.

  2. Department of Neurology, Hospital de Galdakao-Usansolo, Galdakao, Vizcaya, Spain

    Juan Carlos García-Moncó M.D.

Authors
  1. John J. Halperin M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Juan Carlos García-Moncó M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Juan Carlos García-Moncó M.D. .

Editor information

Editors and Affiliations

  1. Department of Neurology, Hospital de Galdakao-Usansolo, Galdacano, Vizcaya, Spain

    Juan Carlos García-Moncó

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing Switzerland

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Halperin, J.J., García-Moncó, J.C. (2018). The Human Borreliosis: Lyme Neuroborreliosis and Relapsing Fever. In: García-Moncó, J. (eds) CNS Infections. Springer, Cham. https://doi.org/10.1007/978-3-319-70296-4_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-70296-4_11

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-70295-7

  • Online ISBN: 978-3-319-70296-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation