Lyme Disease

Authors

Affiliations

Nate Yomogida, B.S., SPT

Doctor of Physical Therapy

B.S. in Kinesiology

Chloë Kerstein, B.S., SPT

Doctor of Physical Therapy

B.A. in Neuroscience

Lyme disease is a bacterial infection (spirochetes of genus Borrelia) generally transmitted via Ixodes tick bite¹

Bacteria

The type of bacteri a

North America, only one spirochete in the genus Borrelia causes Lyme disease, Borrelia burgdorferi.1 In addition to B. burgdorferi, other Borrelia species causing Lyme Disease in Europe include Borrelia afzelii and Borrelia garinii (and the much rarer Borrelia spielmanii and Borrelia bavariensis)

Transmission

The Ixodes tick typically must remain attached for 24 to 48 hours to transmit Borrelia¹ Most humans are infected through the bites of nymphs, which are smaller than 2 mm in length¹

Pathophysiology

Chemokines and Cytokines

In Lyme meningitis, infection of the CNS with B. burgdorferi is followed by an increase in CSF CXCL₁₃

Complications

Cutaneous

Arthritis

• Monarthritis or oligoarthritis may occur¹
• The knee is the most frequently involved joint¹.

Cardiac complications

Cardiac complications may also be present, of which atrioventricular conduction defects are most commonly reported

Neurologic complications

Lyme disease neurologic complicatios are referred to as “neuroborreliosis”¹

Most common neurologic complications of Lyme disease

• Cranial neuritis (most often cranial nerve VII)¹
• Meningitis¹
• Radiculoneuritis¹

Cranial Neuritis

Cranial neuritis generally occurs in CNVII Facial Nerve¹

Lyme disease cranial neuritis can also occur in CNIII, CNIV, VI, and CNVIII, but at lower rates¹

Mechanism:

• Cranial neuritis due to lyme disease is believed to be caused by a mild meningitis¹

Lyme Meningitis

The most common symptom in Lyme meningitis is headache

The most common symptom in Lyme meningitis is headache (CASE 10-1). Patients may have photo- and phonosensitivity,4 but fever and meningismus may be mild or absent.8 Analysis of the CSF demonstrates a lymphocytic pleocytosis, a mildly increased protein concentration, and a normal glucose concentration. Papilledema due to intracranial hypertension has been reported in children with Lyme meningitis and may rarely occur in adults.

Presentation

Treatment

Neuroborreliosis Treatment

Lyme meningitis, cranial neuropathy, or radiculoneuropathy be treated with IV ceftriaxone, IV cefotaxime, IV penicillin G, or oral doxycycline¹

References

1.

Roos KL. Neurologic Complications of Lyme Disease. CONTINUUM: Lifelong Learning in Neurology. 2021;27(4):1040-1050. doi:10.1212/CON.0000000000001015