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Lyme Meningoencephalitis


Presentation

  • Photo taken by Carol Sotsky, MD Photo taken by John Aucott, MD Presentations of Lyme Disease Lyme disease is known to have both typical and atypical presentations. Below we present the primary clinical manifestations of Lyme disease.[columbia-lyme.org]
  • In addition, physicians should be aware that the disease may present without the rash and as neurologic complications, as demonstrated in the present case.[jaoa.org]
  • HGA and HME have similar clinical presentations.[ahcmedia.com]
  • We present a case of an HIV positive patient that presented with a severe LNB, without any previous sign of Lyme disease.[bmcneurol.biomedcentral.com]
Fever
  • He had been well until eight hours prior to admission when fever and headache developed. Received December 17, 1987. Accepted February 17, 1988.[pediatrics.aappublications.org]
  • […] ehrlichiosis A778Other spotted fevers A779Spotted fever, unspecified A78Q fever A790Trench fever A791Rickettsialpox due to Rickettsia akari A7981Rickettsiosis due to Ehrlichia sennetsu A7989Other specified rickettsioses A799Rickettsiosis, unspecified[cms.gov]
  • A68.0 Louse-borne relapsing fever A68.1 Tick-borne relapsing fever A68.9 Relapsing fever, unspecified A69 Other spirochetal infections A69.0 Necrotizing ulcerative stomatitis A69.1 Other Vincent's infections A69.21 Meningitis due to Lyme disease A69.22[icd10data.com]
  • Biphasic course: initial flu-like symptoms and fever ;, followed (after 8 days ) by a fever -free interval and subsequent increase in temperature, which is associated with the onset of meningoencephalitis Treatment: symptomatic Prognosis: Full recovery[amboss.com]
  • This may or may not be associated with flu-like symptoms within days to a month after the tick bite such as achiness, chills, fever, sweats, fatigue, malaise, headache, stiff neck, muscle soreness, joint pain, swollen lymph nodes, and sore throat.[hopkinslyme.org]
Vomiting
  • The first symptoms can come on quickly or start several days after someone has had a cold, diarrhea, vomiting, or other signs of an infection.[kidshealth.org]
  • The virus, which causes symptoms that include fever, headache, vomiting and lethargy, can potentially infect the central nervous system, causing meningitis, encephalitis and long-term neurological problems, according to Theodore Andreadis, director of[courant.com]
  • Infants: a rapid increase in head circumference and may include vomiting, sleepiness, irritability, downward deviation of the eyes (also called "sunsetting"), and seizures.[lyme-symptoms.com]
  • Vomiting may also be seen. Infants' symptoms are not as specific as those in older children and adults but usually include irritability, lethargy, poor feeding, crying when moved, and vomiting.[humanillnesses.com]
  • Children and adults Classic triad of meningitis: fever, headache, and neck stiffness ( nuchal rigidity ) Altered mental status Photophobia Nausea, vomiting Malaise Seizures If due to N. meningitidis : myalgia and possibly petechial or purpuric rash (especially[amboss.com]
Nausea
  • Older children/adults may experience include headache followed by vomiting, nausea, papilledema (swelling of the optic disk which is part of the optic nerve), blurred or double vision.[lyme-symptoms.com]
  • Children and adults Classic triad of meningitis: fever, headache, and neck stiffness ( nuchal rigidity ) Altered mental status Photophobia Nausea, vomiting Malaise Seizures If due to N. meningitidis : myalgia and possibly petechial or purpuric rash (especially[amboss.com]
  • The symptoms may include: high fever flu-like symptoms ( fever, headache ) severe headache photosensitivity nausea and vomiting obtundation / coma (muscle ) weakness eye muscle paralysis problems with vision / double vision epilepsy / seizures Some variations[braininjury-explanation.com]
  • Primary Outcome Measures : Changes in selected clinical parameters in patients with acute aseptic meningitis/meningoencephalitis [ Time Frame: at enrollment and during 12 months follow-up ] Selected clinical parameters (presence or absence of headache, nausea[clinicaltrials.gov]
  • The damage can be very serious and the symptoms at this stage include severe headache, nausea, vomiting, light sensitivity and various neurological symptoms ranging from stiffness of neck to nerve paralysis.[cmcpraha.cz]
Joint Stiffness
  • Muscle or joint stiffness. Limited mobility. Weakness. Clumsiness. Lack of coordination.[lyme-symptoms.com]
Diplopia
  • The symptoms may include facial paralysis, abducens palsy, anorexia, tiredness, headache, diplopia, paraesthesias, erythema migrans, and other disorders.[lyme-symptoms.com]
  • She denied any vertigo, nausea, diplopia, or blurred vision and was able to chew without much difficulty despite some numbness to her tongue. The patient's hearing was normal, and she did not describe arthralgia, rashes, or joint swelling.[jaoa.org]
  • […] improvement 2 months, complete recovery 2 Zidovudine none reported Erythema Headache, painful limbs, weight loss, pneumonia Primairily: PO Azithromycin Progression to neuroborreliosis Saquinavir 1 day 500 mg, 4 days 250 mg Zalcitabine 2 weeks later: fever, diplopia[bmcneurol.biomedcentral.com]
  • A 71-year-old woman with headache, malaise, fever, and diplopia. Initial coronal postcontrast T1 MR imaging ( A and B ) with enhancing bilateral third and fifth cranial nerves.[ajnr.org]
  • Besides that the signs of the violations by innervation of the eyes (diplopia, ptosis, squint) and damages of the nucleuses of the cranial nerves may observed depending on localization of viral damages of the brain.[intranet.tdmu.edu.ua]
Headache
  • He had been well until eight hours prior to admission when fever and headache developed. Received December 17, 1987. Accepted February 17, 1988.[pediatrics.aappublications.org]
  • —A 13-year-old boy had temperatures to 38.3 C and headaches when he returned from summer camp on Cape Cod. During the second week after his return from camp, the headaches became[jamanetwork.com]
  • More recognizable Lyme disease nervous system manifestations include facial paralysis (Bell palsy), or meningitis with severe headache and stiff neck.[hopkinslyme.org]
  • Some cranial neuropathies mimic sinus disease or other chronic headache syndromes.[lyme-symptoms.com]
Confusion
  • Severe Neurological Symptoms In the later stages of Lyme disease you may become disoriented, confused and experience dizziness. You may develop short-term memory loss and an inability to participate in a conversation.[livestrong.com]
  • Symptoms are usually similar to those of acute bacterial meningitis (headache, fever, and stiff neck) but may also include confusion, hearing loss, and double vision.[merckmanuals.com]
  • When To Call a Professional Contact a doctor if someone in your family suddenly becomes confused, is very hard to arouse, seems to have lost consciousness or has severe headaches.[drugs.com]
  • Unfortunately, by the time your dog starts showing obvious symptoms, such as fever, confusion, and convulsions, it may have already done irreparable damage.[wagwalking.com]
  • In more severe cases, confusion and disorientation, tremors, convulsions (especially in the very young), and coma may occur.[my.clevelandclinic.org]
Peripheral Neuropathy
  • Peripheral neuropathy – particularly small fibre damage. Lyme associated neurological symptoms may include: Facial palsy/weakness (Facial nerve palsy VII cranial nerve palsy). Headache/neckache.[lymediseaseaction.org.uk]
  • neuropathy, migratory musculoskeletal pains or cardiac abnormalities.[medical-dictionary.thefreedictionary.com]
  • Leprosy produces a peripheral neuropathy, which is characterized by the involvement of nerves only in the cooler parts of the body.[dartmouth.edu]
  • A more severe peripheral neuropathy with unique skin changes, known as acrodermatitis chronica atrophicans, is common in Europe. This is manifested as bluish-red oedematous cutaneous lesions on the feet at onset.[pmj.bmj.com]
  • Furthermore, radiculopathy and peripheral neuropathy are features of Lyme disease that syphilis does not share.[angelfire.com]
Altered Mental Status
  • Patients may also present with neurological deficits, altered mental status, and seizures, indicating increased intracranial pressure (ICP). The course of viral meningitis is generally much milder.[amboss.com]
  • Meningitis is distinct from encephalitis, which is inflammation of the brain parenchyma and is strongly associated with altered mental status.[infectiousdiseaseadvisor.com]
  • However, 95% had at least two of the four symptoms of headache, fever, neck stiffness and altered mental status. [ 12 ] Most patients with viral meningitis present with subacute neurological symptoms developing over 1-7 days.[patient.info]
  • The first is characterized by an acute onset of high fever, photophobia, headache, and altered mental status, similar to bacterial meningitis, occurring within 1 week after exposure.[emedicine.medscape.com]
Nystagmus
  • Coarse nystagmus was present on horizontal gaze, left greater than right, and vertical nystagmus on upward gaze.[canlyme.com]
  • Both diseases can, in rare cases, lead to the Tullio phenomenon (40), characterized by nausea and nystagmus in response to sound stimulation. (This syndrome was previously considered pathognomonic for syphilis.)[angelfire.com]

Workup

  • It is noteworthy that partially treated bacterial meningitis accounts for a large number of meningitis cases with a negative microbiologic workup. Table 1.[emedicine.medscape.com]
  • HIV serology was found positive during workup for the cause of his bilateral facial palsy, CD4 count was decreased at that time. Case 2 had a low CD4 count with progression to neuroborreliosis, despite treatment for his recent early LB.[bmcneurol.biomedcentral.com]
  • An extensive medical workup revealed no abnormalities except for a positive Lyme ELISA titer. A Western blot for B. burgdorferi also came back positive. Ms. A insisted on getting a spinal tap.[angelfire.com]
Cerebrospinal Fluid Abnormality
  • Moderate pleocytosis and increased albumin can be found in the cerebrospinal fluid; abnormalities in the thalamus, cerebellum, and brainstem in MRI may be shown as well.[columbia-lyme.org]
  • Lymphocytic meningoradiculitis: Intense pain, mostly in the lumbar and cervical regions, and radiating to the extremities;migrating sensory and motor disorders of the peripheral nerves, peripheral radiculopathies, and cerebrospinal fluid abnormalities[lyme-symptoms.com]

Treatment

  • Although Lyme disease frequently attacks the central nervous system, this involvement is rarely severe, and high-dose intravenous penicillin usually is adequate treatment.[ncbi.nlm.nih.gov]
  • She underwent eight months of oral antibiotics and seven weeks of intravenous treatment — far more than the treatment guidelines allow — and achieved 90 percent improvement, she said.[poughkeepsiejournal.com]
  • Treatment Treatment regimens listed in the following table are for localized (early) Lyme disease. See references for treatment of patients with disseminated (late) Lyme disease.[cdc.gov]
  • Treatment-related complications in children hospitalized with disseminated Lyme disease. J Pediatr Infect Dis Soc. 2017;6:e152-154.[mdedge.com]

Prognosis

  • Prognosis Bacterial meningitis Fatal if left untreated Prognosis in treated patients depends on age, overall condition, immune status and the pathogen(s) involved Viral meningitis Resolves spontaneously in the majority of cases Residual symptoms such[amboss.com]
  • Meningitis Symptoms Meningitis Causes Meningitis Mechanism Meningitis Diagnosis Meningitis Treatment Meningitis Prognosis History of Meningitis[news-medical.net]
  • Prognosis Meningitis kills more UK children under the age of 5 than any other infectious disease. [ 2 ] Prognosis depends on the pathogen, the patient's age and condition and the severity of acute illness.[patient.info]
  • […] syndrome is a group of heterogeneous degenerative neurological disorders, which differ from the classical idiopathic Parkinson’s disease in certain associated clinical features, poor response to levodopa, distinctive pathological characteristics and poor prognosis[danielcameronmd.com]
  • Meningoencephalitis of unknown origin can be difficult to treat and generally carries and unfavourable prognosis; if not performed already, an examination of cerebrospinal fluid would be a good diagnostic test to perform next.[wagwalking.com]

Etiology

  • Brief Summary: The main objective of this study is: to establish etiology of acute aseptic meningitis/meningoencephalitis in Slovenia to assess the clinical course and outcome of tick-borne encephalitis and Lyme neuroborreliosis to characterize the inflammatory[clinicaltrials.gov]
  • Lyme disease is a recently described inflammatory disorder characterized by the appearance of a unique skin lesion, erythema chronicum migrans, recurrent attacks of arthritis, and occasional involvement of the heart and nervous system. 1 Although the etiologic[jamanetwork.com]
  • […] corticobasal degeneration (CBD), and vascular Parkinsonism (VaP), according to Litvan from the University of California. [3] The authors conclude, “Lyme meningitis merits consideration in endemic areas in cases of subacute onset of Parkinsonism of unknown etiology[danielcameronmd.com]
  • A necrotizing meningoencephalitis of unknown etiology has been reported in young, adult Pug dogs, as well as in Yorkshire Terriers and Maltese dogs.[merckvetmanual.com]
  • Four patients classified as having AM had papilledema (enterovirus: n 1; viral meningitis without a known etiology: n 2; and acute disseminated encephalomyelitis: n 1).[pediatrics.aappublications.org]

Epidemiology

  • The tick specimens collecting was performed by flagging at the selected localities by workers of the Department of Epidemiology of the Public Heath Authority of the City of Prague in the co-operation with personnel of the Municipal Public Health Authority[portalzp.praha.eu]
  • Main outcome measures Epidemiological, clinical and laboratory characteristics of different types of childhood meningitis. Results Infectious meningitis was diagnosed in 211 children (annual incidence 38/100 000).[adc.bmj.com]
  • Auwaerter has assembled a group of expert authors to review the following topics: Epidemiology of Lyme Disease; Early Lyme disease: Erythema Migrans; Neuroborreliosis; Lyme Carditis; Lyme Arthritis; Pediatric Lyme Disease; Diagnostics of Lyme Disease;[books.google.es]
  • […] inflammatory disorder characterized by the appearance of a unique skin lesion, erythema chronicum migrans, recurrent attacks of arthritis, and occasional involvement of the heart and nervous system. 1 Although the etiologic agent has not been determined, epidemiologic[jamanetwork.com]
  • Attention to pertinent epidemiological and historical data, along with physical and CSF findings, allows timely differentiation of LM from VM.[nature.com]
Sex distribution
Age distribution

Pathophysiology

  • ., NSAIDs ) References: [1] [2] [3] [4] [5] [6] Pathophysiology Most pathogens that cause meningitis colonize the nasopharynx or the upper airways entry into the CNS via: Incubation times Bacterial meningitis : usually 3–7 days Viral meningitis: depends[amboss.com]
  • Pathophysiology: Clinical Concepts of Disease Processes. 6th ed. St Louis, MO: Mosby;2003 : 1106. 7 Tibbles CD, Edlow JA. Does this patient have erythema migrans? JAMA. 2007 : 297 (23);2617-2627. 8 Steere AC. Lyme borreliosis.[jaoa.org]
  • The exact pathophysiology of Lyme neuroborreliosis is unknown and may be multifactorial. In some specimens, the spirochete can be identified (6).[canlyme.com]
  • The pathophysiology of early versus late manifestations of the disease is similar to that seen with syphilis.[emedicine.medscape.com]
  • Pathophysiology Borrelia burgdorferi can spread throughout the body during the course of the disease and has been found in the skin, heart, joint, peripheral nervous system, and central nervous system.[intranet.tdmu.edu.ua]

Prevention

  • Centers for Disease Control and Prevention. Frequently Asked Questions – Lyme Disease. Available online at . Accessed July 2012. Centers for Disease Control and Prevention. Transmission – Lyme Disease. Available online at . Accessed July 2012.[labtestsonline.it]
  • Meningitis, especially caused by certain bacteria and viruses, is preventable with vaccinations and prophylactic or preventable antibiotics and medications among those who have been exposed to the infection.[news-medical.net]
  • Can Meningitis Be Prevented? Vaccinations Routine immunization can go a long way toward preventing meningitis. The Hib, measles, mumps, polio, and pneumococcal vaccines can protect against meningitis caused by those germs.[kidshealth.org]
  • So, quickly removing the tick will not always prevent infection. Tick bites can be prevented by wearing protective clothing and by using repellents that contain DEET on exposed skin.[rivm.nl]
  • Centers for Disease Control and Prevention and the American Academy of Pediatrics.[humanillnesses.com]

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