Incidence and characteristics of Lyme neuroborreliosis in adult patients with facial palsy in an endemic area in the Netherlands
Incidence and characteristics of Lyme neuroborreliosis in adult patients with facial palsy in an endemic area in the Netherlands
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DOI：
10.1017/s0950268819000438
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发表时间：
2019-01-01
影响因子：
4.2
通讯作者：
Zomer, T. P.
中科院分区：
文献类型：
--
作者：
Bierman, S. M.;van Kooten, B.;Zomer, T. P.
区分莱姆神经疏螺旋体病（LNB）和特发性面瘫（IFP）对确保及时和充分的治疗至关重要。本研究的目的是评估LNB所致面神经麻痹的发病率和患者特征。回顾了2007年6月至2017年12月期间前往Gelre医院神经科和/或耳鼻喉科就诊的成年面瘫患者的医院记录。Gelre医院位于莱姆病流行地区。LNB患者有白细胞增多和鞘内抗体产生或IgG血清学阳性的白细胞增多。IFP患者血清学阴性。比较LNB和IFP患者的临床特征。559例患者表现为面神经麻痹，4.7%（26例）为LNB，39.4%（220例）为IFP。面神经麻痹的发病率为0.9/10万居民/年。超过70%的LNB所致面神经麻痹患者未报告近期蜱虫叮咬和/或游走性红斑（EM）。LNB所致面瘫患者7 ~ 9月发病率较高（69.2% vs.21.9%，P < 0.001），头痛发病率较高（42.3% vs.15.5%，P < 0.01）。为了降低LNB在流行地区诊断不足的风险，我们建议在夏季对面瘫患者进行LNB检测，特别是当出现头痛时，无论最近是否有蜱虫叮咬和/或EM。
Making a distinction between facial palsy due to Lyme neuroborreliosis (LNB) and idiopathic facial palsy (IFP) is of importance to ensure timely and adequate treatment. The study objective was to assess incidence and patient characteristics of facial palsy due to LNB. Hospital records were reviewed of adult patients with facial palsy visiting the departments of neurology and/or otorhinolaryngology of Gelre hospitals between June 2007 and December 2017. Gelre hospitals are located in an area endemic for Lyme borreliosis. Patients with LNB had pleocytosis and intrathecal antibody production or pleocytosis with positive IgG serology. Patients with IFP had negative serology. Clinical characteristics were compared between patients with LNB and patients with IFP. Five hundred and fifty-nine patients presented with facial palsy, 4.7% (26) had LNB and 39.4% (220) IFP. The incidence of facial palsy due to LNB was 0.9/100 000 inhabitants/year. Over 70% of patients with facial palsy due to LNB did not report a recent tick bite and/or erythema migrans (EM). Patients with facial palsy due to LNB presented more often in July to September (69.2% vs. 21.9%, P < 0.001), and had more often headache (42.3% vs. 15.5%, P < 0.01). To reduce the risk of underdiagnosing LNB in an endemic area, we recommend testing for LNB in patients with facial palsy in summer months especially when presenting with headache, irrespective of a recent tick bite and/or EM.