Lyme neuroborreliosis: A diagnostic challenge

Lyme borreliosis (LB), also known as Lyme disease (LD) is the most prevalent tick-borne infectious disease in Bulgaria. In Europe, the most common causes of LB are the spirochetal bacteria of the Borrelia burgdorferi sensu lato genospecies complex (B. burgdorferi senso stricto, B. garinii and B. afzelii), which have different organotropism. B. garinii is especially neurotropic. Neuroborreliosis (LNB) is a disseminated form of LB and can present with neurological symptoms in both early and late disease with central and/or peripheral nervous systems involvement. Clinical manifestations of LNB are diverse and nonspecific, and may be mimic other neurological diseases, which often makes the diagnostic process challenging. In most patients, examination of the cerebrospinal fluid (CSF) establishes lymphocytic pleocytosis, damage to the blood-CSF barrier and an intrathecal synthesis immunoglobulines. The antibiotic treatment is efficient in the majority of cases.