LYME DISEASE

AGENDA

What is Lyme Lyme LNB Symptoms Case 1 Case 2

Disease? Neuroborreliosis

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 WHAT IS LYME
DISEASE?
 Most common vector-borne disease in the US.
 Caused by bacterium Borrelia burgdorferi.
 Transmitted to humans through the bite of infected
blacklegged ticks.
 Incubation time: 3-30 days
 Treatment: Oral Penicillin, Erythromycin, Tetracycline

Authorize Monetize
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Unique
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• Neurological complications most often occur in early
disseminated Lyme disease
• Numbness
• Pain
• Weakness Tested
• Facial palsy/droop
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• Visual disturbances
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• Meningitis symptoms such as fever, stiff neck, and severe
headache.
LYME
NEUROBORELLIOSIS
First to Market • Lyme Disease when left untreated can be complicated
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adipiscing elit. • 15-40% late stage lyme patients are affected.
• Early detection in the key to successful treatment.
• Persistent Lyme infection can cause blood flow to the
brain resulting in Dysautonomia.
• Diagnostic tools includes peripheral blood and CSF
serodiagnostics.
• Neuroimaging can also be done to confirm diagnosis.
Authentic
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 LYME NEUROBORRELIOSIS SYMPTOMS
Business Model
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CNS PNS • ANS which controls bodily functions such as BP

and HR may be affected when lower brain and
spinal cord gets inflamed.

Encephalitis Radiculitis • This can lead to difficulty when standing.

• Symptoms affecting Peripheral Nerves causes 3

Research
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Neuritis
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symptoms forming
Invest the Bannwarth’s Syndrome.
• Mostly affects lower limb
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Vasculitis Meningitis
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Infection of the peripheral nerves is more common and the following symptoms can occur
relatively early in disease:

•Inflammation of motor or sensory spinal nerve roots – radiculitis. This may cause weakness eg foot-
drop or paralysis.
•Common sensory symptoms include sharp pain which may be severe and often worse at night, or
feelings such as tingling, itching or numbness.

•inflammation of the nerves in the head which emerge directly from the brain – cranial neuritis. Most
commonly the facial nerve causing facial palsy with weakness or paralysis on one or both sides of the
face. Involvement of other cranial nerves may cause double vision, drooping eyelid, numbness, pain
and tingling of the face, hearing loss, dizziness and tinnitus.

•inflammation of the membranes which surround the brain and spinal cord – meningitis. Symptoms
may include headache, neck stiffness and sensitivity to light. This is less severe than the bacterial
meningitis caused by other organisms.

Central nervous system complications are said to be rare and include:

•brain inflammation (encephalitis);

•spinal cord inflammation (myelitis);
•cerebral blood vessel inflammation (vasculitis). 6
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A) Inflammatory lesion in pons, medulla & cerebellum in MRI
B) Corresponding restricted diffusion

C) Hyper-metabolic areas in PET scan suggesting inflammation/vasculitis of affected areas. 8

CASE - 1

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• An 80-year-old Caucasian female, resident of the state of
Pennsylvania, USA.
• Hx: Hypertension, right-sided thyroidectomy, and stroke
without residual deficits
• CC: fever, confusion, headaches, bilateral lower extremity
weakness, and an episode of stool incontinence.
• Total WBC = normal
On presentation to the hospital,
c/o: severe headaches
• mild unilateral right-sided facial droop and a diffuse
macular rash throughout the body was noted.
• She denied any outdoor activities, recent tick bites, or
noticing any previous rashes.

• CT head = Normal • NO neck stiffness or photophobia.

• MRI (T&L) for spinal compression = normal
• CXR, urine and blood cultures = negative.
• Lumbar puncture = NO lymphocytic pleocytosis or
findings suggestive of an infectious process.
Due to the complexity of her presentation, she was
transferred to tertiary care hospital after spending 3 days at
the outlying facility.

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 TREATMENT PROVIDED

• She was started on IV ceftriaxone for suspected

LD as she comes from an endemic region and
has an uncharacteristic rash with neurological DX: LYME DISEASE
manifestations.

• Unfortunately, CSF testing for LD was not

performed at the outside facility. The patient’s
headache, fever, lethargy, and her neurological
manifestations including facial droop resolved
within 24 hours of antibiotic therapy.

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CASE - 2

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• 21YR, M
• H/O: 2-week facial swelling and now decreased facial movement for the last several days.
• Dental visit was made. Clindamycin was placed for a presumed dental infection several days prior to presentation but notes
worsened symptoms.
• Currently, has difficulty opening and closing his mouth. NO difficulty with mastication.
• PMH = negative
• Social history = Returned from a camping trip in western Pennsylvania.

• On physical exam
• Vital signs = normal
• Able to open and close his mouth but not to full extent.
• NO drooling. NO changes in phonation.

• TEETH EXAM:
• Had dental fillings
• NO dental abscess, dental discomfort, or gingival abscess.

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NEUROLOGICAL EXAM:
• Normal gait and strength.
• Had a difficult time raising his eyebrows
• Was only able to make a very small smile.
• Had subjective sensory loss to light touch over the cheeks bilaterally but this
could not be reproduced on examination.
• Besides the bilateral peripheral nerve palsy, remaining neurological exam was
normal.

• LAB RESULTS:
• CBC = normal
• Basic metabolic panel = normal
• ESR = normal. TREATMENT
Doxycycline = 21 days
• RAPID LYME TITERS
• Lyme IgM = +ve
• Lyme IGG = +ve

• WESTERN BLOT RESULTS:

• Lyme IgM = +ve (early B.burgdorferi infection)
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THANK YOU
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