Abstract
Lyme borreliosis, which is one of the most common anthropozoonoses in the temperate zone, manifests itself in susceptible individuals by first affecting the skin and then other organs. Borreliosis, a spirochete infection, is most commonly caused by Borrelia afzelii or Borrelia garinii in Europe, which are mostly transmitted by ticks.
The most common local manifestation of overt infection is approximately 50% of infected individuals with erythema migrans, which develop after a tick bite, often accompanied by mild symptoms of general infection. Cutaneous manifestations of Lyme borreliosis, which is subject to mandatory reporting, are recorded in more than 70% of all patients; arthralgia and borreliosis arthritis in 16% of patients; Nervous system involvement is reported in 10% of individuals, myocardial involvement is diagnosed in 0.3% of reported cases.
The incidence of borreliosis in the Czech Republic ranges from 2,000 to 6,000 reported cases / year. Among them are several hundred people with neuroborreliosis, manifested as cerebral nerve involvement, meningitis, meningoencephalitis, meningomyeloradiculitis and radiculoneuropathy.
In the disseminated late stage of the disease, chronic encephalomeningitis develops, which may progress to vencephalopathy or myelopathy. They may resemble demyelinating or degenerative diseases of the nervous system, sometimes requiring the care of a psychiatrist.
Diagnosis and treatment of uncomplicated borreliosis are based on early detection of erythema migrans, without waiting for verification of infection by serological tests. In cases of organ involvement that develops without a clear link to cutaneous manifestations, the diagnosis of borreliosis continues to be based on indirect or direct detection of an infectious agent and other laboratory tests.
For the diagnosis of neuroborreliosis, examination of the fluid by direct and indirect detection of borrelia is crucial. Magnetic resonance imaging of the brain and spinal cord, uneuropathy, EMG and examination of evoked potentials are of great importance.
The early stages of neuroborreliosis at the borderline in urinary tract can be treated orally with broad-spectrum antibiotics such as doxycycline and β-lactam antibiotics. With developed neuroborreliosis, parenteral treatment with benzylpenicillin or cephalosporins is necessary for two to three weeks.
Symptomatic treatment is based on current problems and also uses physiotherapeutic and psychotherapeutic methods. The prognosis of an organ form of borreliosis depends on the individual's susceptibility, immune profile and psychosocial factors.
As a rule, it is significantly affected by early diagnosis and immediate use of broad-spectrum antibiotics.