气候变化领域集成服务门户(CCPortal): Diagnostic Challenges of Lyme Neuroborreliosis in Inpatient Neurology: A Case Series

CCPortal

DOI	10.1177/19418744241246308
	Diagnostic Challenges of Lyme Neuroborreliosis in Inpatient Neurology: A Case Series
	Palmer, Kaitlyn N.; Sokola, Maria; Uysal, Sanem P.; Cooperrider, Jessica; Leung, Anthony K.; Torres-Trejo, Alejandro; Li, Yuebing; Abbatemarco, Justin R.
发表日期	2024
ISSN	1941-8744
EISSN	1941-8752
英文摘要	Lyme disease is a multisystem disorder transmitted through the Ixodes tick and is most commonly diagnosed in northeastern and mid-Atlantic states, Wisconsin, and Minnesota, though its disease borders are expanding in the setting of climate change. Approximately 10%-15% of untreated Lyme disease cases will develop neurologic manifestations of Lyme neuroborreliosis (LNB). Due to varying presentations, LNB presents diagnostic challenges and is associated with a delay to treatment. We discuss three cases of LNB admitted to our referral center in a traditionally low-incidence state to highlight clinical pearls in LNB diagnosis. Three patients from low-incidence areas with prior diagnostic evaluations presented in August with neurologic manifestations of radiculoneuritis, cranial neuropathies, and/or lymphocytic meningitis. MRI findings included cranial nerve, nerve root, and leptomeningeal enhancement leading to broad differential diagnoses. Lumbar puncture demonstrated lymphocytic pleocytosis (range 85-753 cells/uL) and elevated protein (87-318 mg/dL). Each patient tested positive for Lyme on two-tiered serum testing and was diagnosed with LNB. All three cases were associated with a delay to health care presentation (mean 20 days) and a delay to diagnosis and treatment (mean 54 days) due to under-recognition and ongoing evaluation. With the geographic expansion of Lyme disease, increasing awareness of LNB manifestations and acquiring detailed travel histories in low-incidence areas is crucial to prompt delivery of care. Clinicians should be aware of two-tiered serum diagnostic requirements and use adjunctive studies such as lumbar puncture and MRI to eliminate other diagnoses. Treatment with an appropriate course of antibiotics leads to robust improvement in neurological symptoms.
英文关键词	central nervous system bacterial infections; central nervous system infections; infectious disease medicine; neurohospitalist
语种	英语
WOS研究方向	Neurosciences & Neurology
WOS类目	Clinical Neurology
WOS记录号	WOS:001204128600001
来源期刊	NEUROHOSPITALIST
文献类型	期刊论文
条目标识符	http://gcip.llas.ac.cn/handle/2XKMVOVA/299369
作者单位	Cleveland Clinic Foundation; Cleveland Clinic Foundation; Cleveland Clinic Foundation; Cleveland Clinic Foundation; Cleveland Clinic Foundation; Cleveland Clinic Foundation
推荐引用方式 GB/T 7714	Palmer, Kaitlyn N.,Sokola, Maria,Uysal, Sanem P.,et al. Diagnostic Challenges of Lyme Neuroborreliosis in Inpatient Neurology: A Case Series[J],2024.
APA	Palmer, Kaitlyn N..,Sokola, Maria.,Uysal, Sanem P..,Cooperrider, Jessica.,Leung, Anthony K..,...&Abbatemarco, Justin R..(2024).Diagnostic Challenges of Lyme Neuroborreliosis in Inpatient Neurology: A Case Series.NEUROHOSPITALIST.
MLA	Palmer, Kaitlyn N.,et al."Diagnostic Challenges of Lyme Neuroborreliosis in Inpatient Neurology: A Case Series".NEUROHOSPITALIST (2024).