Amanda Rădulescu 1, Doina Ţăţulescu 2 , Lăcrimioara Perju-Dumbravă 3, Mirela Flonta 4,
Augusta Aştilean 5, Melinda Horvat 2
1 The “Iuliu Haţieganu” University of Medicine and Pharmacy,” Cluj-Napoca, Department of
Epidemiology,
2 The “Iuliu Haţieganu” University of Medicine and Pharmacy,” Cluj-Napoca, Department of
Infectious Diseases
3 The “Iuliu Haţieganu” University of Medicine and Pharmacy,” Cluj-Napoca, Department of Neurology
4 The Laboratory – the University Hospital of Infectious Diseases Cluj-Napoca
5 Resident in the specialty of Infectious Diseases
Abstract
Introduction. Th e etiology of MS remains uncertain, bacterial infection with B. burgdorferi is most frequently incriminated. Neuroimaging criteria considered in the diagnosis of MS can also be fulfilled in NB, the joint feature being demyelinating lesions. We present the diagnosis and treatment difficulties in NB versus MS and other clinical considerations.Methods We retrospectively studied all consecutive cases of neuroborreliosis hospitalized in the University Hospital of Infectious Diseases during 2006-2008. Th e diagnosis was established through clinical criteria (using a probability score for Lyme disease), serological criteria (enzyme immunoassay for IgM and IgG antibodies followed by confi rmatory Western blot) and MS diagnosis was stratifi ed as confi rmed or possible according to MacDonald’s criteria. Results Th ere were 36 cases of probable or highly probable neuroborreliosis (score ≥6), out of which ten cases were also diagnosed as possible (5) or confi rmed MS (5). Th e age range was 19 to 43 years, with female predominance (7/10). Th e clinical picture was marked by poor stamina and fatigue, paresthesia mainly in the lower extremities, palsies (facial or in the limbs), diffi cult walking and vertigo. In all cases the screening enzyme immunoassay was positive for IgM antibodies, confi rmatory Western blots were positive in four out of seven tests performed. Tick exposure was identifi ed in 5 cases without erythema migrans. In all patients cerebral imaging examination revealed demyelinating lesions that were interpreted as late NB and/or MS (possible or confi rmed). Treatment with neurotropic drugs and antibiotics was done and the fi ve patients with confi rmed MS received beta interferon or corticosteroids. All cases demonstrated improvement after 6 weeks of sequential treatment (ceftriaxone and doxycycline). In one case, the diagnosis of cerebral lymphoma was considered suggesting the association between NB and MS or neuroborreliosis mimicking primary eff usion lymphoma. Conclusions. Th e diagnosis of MS and NB are diffi cult showing remarkable clinical and neuroimaging similarities. Th e infectious etiology of MS remains probable and in patients with possible MS it is reasonable to evaluate B. burgdorferi infection in order to ensure etiologic treatment.