Evaluation of an Algorithm for the Diagnosis and Therapy of Lyme Neuroborreliosis: A Follow-up Study

2021 ◽  
Vol 8 (2) ◽  
Author(s):  
Linauer L ◽  
◽  
Brunner J ◽  
Keyword(s):  
Antibiotic Treatment ◽  
Facial Palsy ◽  
German Society ◽  
Lyme Neuroborreliosis ◽  
Diagnosis And Therapy ◽  
Peripheral Facial Palsy ◽  
Paediatric Department ◽  
Paediatric Practice ◽  
Csf Pleocytosis

Background: Although Lyme Neuroborreliosis (LNB) is often seen in paediatric practice, diagnostic criteria for LNB in children are not clearly defined. The guidelines for LNB in adults are based on a combination of clinical picture, CSF pleocytosis and the detection of specific antibodies against Borrelia burgdorferi in CSF and serum. Diagnostic procedure takes several days, thus it isn´t useful in deciding for the need of prompt antibiotic treatment. Aim of study was a retrospective evaluation of an algorithm for the diagnosis and therapy of lyme’s disease, which is used since 2005 at the paediatric department of Innsbruck. Patients and Methods: All patients presenting with acute peripheral facial palsy from January 2006 to December 2014 were reviewed. The patients were diagnosed according to the algorithm, based on the criteria of the German Society of Neurology. The focus lay on evaluation of diagnosis and therapy according to the algorithm and whether overtreatment and underdiagnosis could therefore be avoided. Results: 120 patients were enrolled with peripheral facial palsy. 65 (54%) were handled as bell´s palsy and 55 (46 %) as B. burgdorferi s.l. infection. 19 cases were classified as confirmed LNB, 10 as probable and 26 as possible LNB. A total of 69 patients (58 %) were treated correctly according to the algorithm, 16 (13%) were over treated and 14 (11%) under treated with antibiotics. 21 (18%) could not be classified, according to the algorithm, due to the lack of CSF results. Although receiving proper treatment, 3 cases had a persistent defect after recovery. Conclusions: The algorithm is an appropriate diagnostic tool for the diagnosis and therapy of LNB, particularly with regard to the necessity of a prompt antibiotic treatment, and therefore helpful to avoid underdiagnosis and overtreatment.

Adjunctive Corticosteroids for Lyme Neuroborreliosis Peripheral Facial Palsy – a prospective study with historical controls

2021 ◽  
Author(s):  
Sanna Avellan ◽  
Daniel Bremell
Keyword(s):  
Facial Palsy ◽  
Bell’S Palsy ◽  
Lyme Neuroborreliosis ◽  
Control Group ◽  
Study Group ◽  
Bell's Palsy ◽  
Oral Doxycycline ◽  
Peripheral Facial Palsy ◽  
Historical Controls

Abstract Background Lyme neuroborreliosis peripheral facial palsy (LNB PFP) and idiopathic peripheral facial palsy, Bell’s palsy (BP), are the most common causes of facial palsy in borrelia-endemic areas and are clinically similar. Early treatment with corticosteroids has been shown to be effective in Bell’s palsy and antibiotics improve outcome in LNB, but there is a lack of knowledge on how the addition of corticosteroids to standard antibiotic treatment affects outcome in LNB PFP. Methods This prospective open trial with historical controls was conducted at two large hospitals in western Sweden between 2011 and 2018. Adults presenting with LNB PFP were included in the study group and were treated with oral doxycycline 200 mg b.i.d. for 10 days and prednisolone 60 mg o.d. for 5 days, then tapered over 5 days. The historical controls were adult patients with LNB PFP included in previous studies and treated with oral doxycycline. Both groups underwent a follow-up lumbar puncture and were followed until complete recovery or for 12 months. Results Fifty-seven patients were included, 27 in the study group and 30 in the control group. Two patients (6%) in the study group and 6 patients (20%) in the control group suffered from sequelae at end follow up. There was no statistically significant difference between the groups, neither in the proportion of patients with sequelae, nor in the decline in CSF mononuclear cell count. Conclusions Adjunctive corticosteroids neither improve nor impair the outcome for patients with Lyme neuroborreliosis peripheral facial palsy treated with doxycycline.

Peripheral facial palsy as an initial symptom of Lyme neuroborreliosis in an Austrian endemic area

2015 ◽  
Vol 128 (21-22) ◽  
pp. 837-840 ◽  
Author(s):  
Wolfgang Kindler ◽  
Hubert Wolf ◽  
Katrin Thier ◽  
Stefan Oberndorfer
Keyword(s):  
Facial Palsy ◽  
Endemic Area ◽  
Lyme Neuroborreliosis ◽  
Initial Symptom ◽  
Peripheral Facial Palsy

scholarly journals Peripheral Facial Palsy in the Setting of Melkersson-Rosenthal Syndrome

2001 ◽  
Vol 20 (2) ◽  
pp. 233-235
Author(s):  
Sabrina Pimentel ◽  
Amélia Mendes ◽  
Maria José Rosas
Keyword(s):  
Case Report ◽  
Facial Palsy ◽  
Clinical Suspicion ◽  
Peripheral Facial Palsy ◽  
High Clinical Suspicion ◽  
Clinical Triad ◽  
Suspicion Index ◽  
Fissured Tongue

Melkersson-Rosenthal syndrome is characterized by recurrent periph­eral facial palsy, recurrent or persistent orofacial edema and a fissured tongue. However, this clinical triad occurs only in a minority of cases; mono or oligosymptomatic forms are much more common. The au­thors describe a case report of a 39-year-old woman with Melkersson- Rosenthal syndrome, discuss the evolution of the disease and treat­ment, highlighting the need of a high clinical suspicion index and a regular follow-up to reduce progression of deficits

Lyme neuroborreliosis: aetiology and diagnosis of facial palsy in children from Tyrol

2013 ◽  
Vol 44 (02) ◽  
Author(s):  
J Brunner ◽  
RW Reinhard ◽  
LB Zimmerhackl
Keyword(s):  
Facial Palsy ◽  
Lyme Neuroborreliosis

Follow-up of Osteomyelitis of Infants with Systemic Serum Parameters and Bone Scintigraphy

1996 ◽  
Vol 35 (04) ◽  
pp. 116-121 ◽  
Author(s):  
G. E Fueger ◽  
M. Vejda ◽  
R. M. Aigner
Keyword(s):  
Bone Scintigraphy ◽  
Antibiotic Treatment ◽  
Diagnostic Value ◽  
Clinical Findings ◽  
Laboratory Findings ◽  
Radiographic Findings ◽  
Serum Parameters ◽  
Wbc Count ◽  
Differential White Blood Cell

Summary Aim: To prevent orthopedic sequelae in acute hematogenous pyogenic osteomyelitis (AHPO) of infants early diagnosis, recognition of recurrence and effective therapy is needed. This retrospective study of 47 infants with bacteriologically confirmed AHPO concerned with an analysis of the diagnostic value of systemic serum parameters compared to bone scintigraphy (BSC). Methods: AHPO was characterized initially and during the course of disease by clinical findings, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), total and differential white blood cell (WBC) count, BSC, and plain radiography. Results: CRP was the most effective serum parameter for follow- up of disease. The first sign of BSC to signal adequate response to antibiotic treatment was the decrease or normalization of hyperperfusion. Escape from therapy or poor prognosis, even when the serum parameters were normalized, was signaled by the recurrence of focal hyperperfusion and the persistent or increasing local uptake ratios on the 3-h-image over 6 weeks during a course of antibiotic treatment. Conclusion: Antibiotic treatment masks the clinical presentation, and the radiographic findings, causes non-characteristic laboratory findings, but do not prevent the scintigraphic visualization; BSC and serum parameters used in the right completion are the most successful and efficient modalities for follow-up of AHPO. Maintenance of antibiotic therapy should be done until BSC findings have reverted to normal.

Respiratory Complications in Outpatient Endoscopy with Endoscopist-Directed Sedation

2014 ◽  
Vol 23 (3) ◽  
pp. 255-259 ◽  
Author(s):  
Kilian Friedrich ◽  
Sabine G. Scholl ◽  
Sebastian Beck ◽  
Daniel Gotthardt ◽  
Wolfgang Stremmel ◽  
...  
Keyword(s):  
Antibiotic Treatment ◽  
Respiratory Infection ◽  
Endoscopic Procedure ◽  
Shortness Of Breath ◽  
Respiratory Complications ◽  
Endoscopic Procedures ◽  
Increased Risk ◽  
High Incidence ◽  
Respiratory Complaints

Background & Aims: Respiratory complications represent an important adverse event of endoscopic procedures. We screened for respiratory complications after endoscopic procedures using a questionnaire and followed-up patients suggestive of respiratory infection.Method: In this prospective observational, multicenter study performed in Outpatient practices of gastroenterology we investigated 15,690 patients by questionnaires administered 24 hours after the endoscopic procedure.Results: 832 of the 15,690 patients stated at least one respiratory symptom after the endoscopic procedure: 829 patients reported coughing (5.28%), 23 fever (0.15%) and 116 shortness of breath (SOB, 0.74%); 130 of the 832 patients showed at least two concomitant respiratory symptoms (107 coughing + SOB, 17 coughing + fever, 6 coughing + coexisting fever + SOB) and 126 patients were followed-up to assess their respiratory complaints. Twenty-nine patients (follow-up: 22.31%, whole sample: 0.18%) reported signs of clinically evident respiratory infection and 15 patients (follow-up: 11.54%; whole sample: 0.1%) received therefore antibiotic treatment. Coughing or vomiting during the endoscopic procedure resulted in a 156.12-fold increased risk of respiratory complications (95% CI: 67.44 - 361.40) and 520.87-fold increased risk of requiring antibiotic treatment (95% CI: 178.01 - 1524.05). All patients of the follow-up sample who coughed or vomited during endoscopy developed clinically evident signs of respiratory infection and required antibiotic treatment while this occurred in a significantly lower proportion of patients without these symptoms (17.1% and 5.1%, respectively).Conclusions: We demonstrated that respiratory complications following endoscopic sedation are of comparably high incidence and we identified major predictors of aspiration pneumonia which could influence future surveillance strategies after endoscopic procedures.

Neurological manifestation in severe hypothyroidism in pregnancy

2020 ◽  
Vol 13 (12) ◽  
pp. e238069
Author(s):  
Aparna Sharma ◽  
Nilofar Noor ◽  
Vatsla Dadhwal
Keyword(s):  
Peripheral Neuropathy ◽  
Facial Palsy ◽  
Caesarean Delivery ◽  
Thyroid Stimulating Hormone ◽  
Neurological Manifestations ◽  
Second Trimester ◽  
Pituitary Hyperplasia ◽  
Very High ◽  
In Pregnancy

Neurological manifestations of hypothyroidism include peripheral neuropathy and pituitary hyperplasia. However, these associations are rarely encountered during pregnancy. We report a case of a known hypothyroid with very high thyroid stimulating hormone (TSH) values (512 μIU/mL) in the second trimester. At 24 weeks she developed facial palsy and pituitary hyperplasia which responded to a combination of steroids and thyroxine. She had caesarean delivery at 35 weeks and 3 days gestation in view of pre-eclampsia with severe features and was discharged on oral antihypertensives and thyroxine. On follow-up at 5 months, TSH normalised and pituitary hyperplasia showed a greater than 50% reduction in size. To our knowledge, this is the first reported case of facial palsy and pituitary hyperplasia associated with hypothyroidism during pregnancy.

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