Oral doxycycline for Lyme neuroborreliosis with symptoms of encephalitis, myelitis, vasculitis or intracranial hypertension
2014; Wiley; Volume: 21; Issue: 9 Linguagem: Inglês
10.1111/ene.12420
ISSN1468-1331
AutoresDaniel Bremell, Leif Dotevall,
Tópico(s)Mosquito-borne diseases and control
ResumoBackground and purpose The treatment recommendation for L yme neuroborreliosis with central nervous system ( CNS ) symptoms is intravenous ceftriaxone, according to current A merican and E uropean guidelines. For L yme neuroborreliosis with peripheral nervous system ( PNS ) symptoms, treatment with intravenous ceftriaxone and oral doxycycline is considered equally effective. The purpose of this study was to evaluate the efficacy of oral doxycycline in the treatment of L yme neuroborreliosis with CNS symptoms. Methods Patients with L yme neuroborreliosis who had undergone cerebrospinal fluid ( CSF ) sampling before and after treatment at the D epartment of I nfectious D iseases, S ahlgrenska U niversity H ospital, during the period 1990–2012, were included in this retrospective study. The CSF mononuclear cell count was used as a surrogate marker of treatment outcome. Comparisons of CSF mononuclear cell counts were made between patients with CNS symptoms and patients with PNS symptoms before and after treatment with oral doxycycline. Results Twenty‐six patients classified as having CNS symptoms and 115 patients classified as having PNS symptoms were included. The decline in CSF mononuclear cell counts did not differ significantly between the two groups of patients. All patients with CNS disease showed a marked clinical improvement after treatment, even though 62% had remaining symptoms at the end of follow‐up. Conclusion Treatment with oral doxycycline resulted in a similar decrease in CSF mononuclear cell counts in patients with L yme neuroborreliosis with CNS symptoms compared with patients with L yme neuroborreliosis with PNS symptoms. The results indicate that oral doxycycline is an effective treatment for L yme neuroborreliosis irrespective of the severity of symptoms.
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