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Colocalization of Radicular Pain and Erythema Migrans in Patients With Bannwarth Syndrome Suggests a Direct Spread of Borrelia Into the Central Nervous System.
Ogrinc, Katarina; Kastrin, Andrej; Lotric-Furlan, Stanka; Bogovic, Petra; Rojko, Tereza; Maraspin, Vera; Ruzic-Sabljic, Eva; Strle, Klemen; Strle, Franc.
Afiliación
  • Ogrinc K; Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia.
  • Kastrin A; Faculty of Medicine, Institute for Biostatistics and Medical Informatics, University of Ljubljana, Ljubljana, Slovenia.
  • Lotric-Furlan S; Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia.
  • Bogovic P; Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia.
  • Rojko T; Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia.
  • Maraspin V; Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia.
  • Ruzic-Sabljic E; Faculty of Medicine, Institute for Microbiology and Immunology, University of Ljubljana, Ljubljana, Slovenia.
  • Strle K; Laboratory of Microbial Pathogenesis and Immunology, Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, New York, USA.
  • Strle F; Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia.
Clin Infect Dis ; 75(1): 81-87, 2022 08 24.
Article en En | MEDLINE | ID: mdl-34606609
BACKGROUND: There is a general assumption that after deposition into skin, Lyme borreliae disseminate hematogenously to other organs, resulting in extracutaneous manifestations of Lyme borreliosis, including Lyme neuroborreliosis. However, our experience over the past 40 years, along with several published case reports that observed colocalization of radicular pain and erythema migrans (EM) in patients with borrelial meningoradiculoneuritis (Bannwarth syndrome), argues against hematogenous dissemination in Lyme neuroborreliosis. METHODS: We compared the location of EM in 112 patients with Bannwarth syndrome to 12315 EM patients without neurological involvement. Moreover, we assessed the colocalization of EM and radicular pain in patients with Bannwarth syndrome. RESULTS: Compared to >12000 EM patients without neurological involvement, patients with Bannwarth syndrome had a significantly higher frequency of EM on head/neck (6% vs 1%; P=.0005) and trunk (47% vs 24%; P<.0001), similar frequency on arms (16% vs 16%; P=.91), but lower frequency on legs (30% vs 59%; P<.0001). Moreover, in 79% (89/112) of patients the site of EM matched the dermatomes of radicular pain. The odds for a congruent location of EM and radicular pain were highly significant with the highest odds ratios (OR) observed for head (OR=221), followed by neck (OR=159), legs (OR=69), arms (OR=48), and trunk (OR=33). CONCLUSIONS: The greater frequency of EM on head/neck and trunk and the colocalization of EM with radicular pain in patients with Bannwarth syndrome suggest that central nervous system involvement in Lyme neuroborreliosis is due to a retrograde spread of borrelia from skin to the spinal cord via peripheral nerves.
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Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Enfermedades Óseas / Borrelia / Enfermedad de Lyme / Eritema Crónico Migrans / Neuroborreliosis de Lyme / Glositis Migratoria Benigna Límite: Humans Idioma: En Revista: Clin Infect Dis Asunto de la revista: DOENCAS TRANSMISSIVEIS Año: 2022 Tipo del documento: Article País de afiliación: Eslovenia

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Enfermedades Óseas / Borrelia / Enfermedad de Lyme / Eritema Crónico Migrans / Neuroborreliosis de Lyme / Glositis Migratoria Benigna Límite: Humans Idioma: En Revista: Clin Infect Dis Asunto de la revista: DOENCAS TRANSMISSIVEIS Año: 2022 Tipo del documento: Article País de afiliación: Eslovenia