Update Neuroborreliose – Neues und Bewährtes

Zusammenfassung

Die Neuroborreliose ist die Beteiligung des Nervensystems bei einer Infektion mit Borrelia burgdorferi sensu lato. Als häufigste zeckenübertragene Infektionskrankheit in Europa kann die Borreliose Haut, Gelenke, Herz, Nervensystem und selten die Augen betreffen. Seit der Entdeckung des Erregers vor 30 Jahren haben fortschreitende wissenschaftliche Erkenntnisse zur Entwicklung gut evaluierter klinischer und mikrobiologischer Diagnosekriterien geführt. So ist die Neuroborreliose eine in der Regel gut zu diagnostizierende und zu behandelnde Erkrankung. Fortschritte auf dem Gebiet der mikrobiologischen Diagnostik haben zu einer verbesserten Sensitivität der verwendeten Testsysteme geführt und neue Ansätze der Frühdiagnostik eröffnet. Häufigste Manifestation einer Borreliose ist das Erythema migrans, welches klinisch diagnostiziert wird. Eine systemische Borrelieninfektion wird bei Vorliegen typischer klinischer Symptome durch den Nachweis erregerspezifischer Antikörper im Serum gesichert. Die Diagnosesicherung einer Neuroborreliose schließt den Nachweis entzündlicher Liquorveränderungen und einer intrathekalen Synthese borrelienspezifischer Antikörpern ein. Das Erythema migrans wird oral bei Erwachsenen mit Doxycyclin, bei Kindern mit Amoxicillin behandelt. Standardtherapie der Neuroborreliose ist die intravenöse Gabe von Ceftriaxon oder Cefotaxim. Aktuelle Arbeiten sprechen auch für die Wirksamkeit einer oralen Doxycyclintherapie bei der meningoradikulitischen Form der frühen Neuroborreliose. Die adäquate Antibiotikatherapie führt zu einer effektiven Erregerelimination. Das Wiederauftreten von auf eine akute Borrelieninfektion hinweisenden Symptomen nach einer vorangegangenen adäquat antibiotisch behandelten Episode ist in der Regel durch eine Reinfektion bedingt. Nur ein geringer Anteil antibiotisch behandelter Patienten weist persistierende Residuen auf. Neben neurologischen Restsymptomen wurden in aktuellen Arbeiten persistierende neuropsychologische Folgen beschrieben. Hingegen ist bei den Patienten, die aufgrund unspezifischer Beschwerden befürchten an einer Borreliose erkrankt zu sein, eine ausführliche Differenzialdiagnostik von vorrangiger Bedeutung.

Abstract

Neuroborreliosis is a nervous system infection caused by Borrelia burgdorferi sensu lato. Lyme disease is the most frequent tick-borne infectious disease in Europe affecting the skin, joints, heart, nervous system and rarely the eyes. Since the discovery of the causative pathogen Borrelia burgdorferi 30 years ago, the rapid accumulation of knowledge about this disease has resulted in well-evaluated clinical and microbiological diagnostic guidelines. Today, neuroborreliosis can generally be diagnosed and treated successfully. Progress in microbiological research has led to improved serological tests with higher sensitivity and new approaches for early diagnosis of Lyme disease. Erythema migrans is the most frequent manifestation of Borrelia infection. It is diagnosed clinically. Neuroborreliosis is diagnosed by the combination of typical neurological symptoms, cerebrospinal fluid pleocytosis and Borrelia-specific antibodies produced intrathecally. In adults, erythema migrans is treated with doxycycline, in children with amoxicillin. Standard treatment of neuroborreliosis is ceftriaxone or cefotaxime i. v. Recent studies show similar efficacy of oral doxycycline in early neuroborreliosis. An appropriate antibiotic treatment eliminates the pathogen effectively. Repeated episodes of acute manifestations of Lyme disease in treated patients are probably due to reinfection and not to relapse. Only in a small proportion of treated patients is recovery from neuroborrelioses incomplete. In addition to neurological residual sequelae recent studies have detected persistent neuropsychological deficits in a small subgroup of patients. Conversely, when borreliosis is suspected by patients suffering from non-specific symptoms, a thorough clinical and laboratory assessment is required to identify other underlying diseases.

Schlüsselwörter

Neuroborreliose - Borrelia burgdorferi - Liquoranalytik - Lyme-Borreliose

Keywords

neuroborreliosis - Borrelia burgdorferi - CSF analysis - lyme disease

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