Oral doxycycline for Lyme neuroborreliosis with symptoms of encephalitis, myelitis, vasculitis or intracranial hypertension
Oral doxycycline for Lyme neuroborreliosis with symptoms of encephalitis, myelitis, vasculitis or intracranial hypertension
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DOI：
10.1111/ene.12420
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发表时间：
2014-09-01
影响因子：
5.1
通讯作者：
Dotevall, L.
中科院分区：
文献类型：
--
作者：
Bremell, D.;Dotevall, L.
背景和目的：根据美国和欧洲现行指南，治疗伴有中枢神经系统（CNS）症状的莱姆神经疏螺旋体病的推荐治疗方法是静脉注射头孢曲松。对于伴有周围神经系统（PNS）症状的莱姆神经疏螺旋体病，静脉注射头孢曲松和口服强力霉素治疗被认为同样有效。本研究的目的是评估口服多西环素治疗伴有 CNS 症状的莱姆神经疏螺旋体病的疗效。方法：纳入 1990 年至 2012 年期间在萨尔格伦斯卡大学医院感染科治疗前后接受脑脊液 (CSF) 采样的莱姆神经疏螺旋体病患者。 这项回顾性研究。脑脊液单核细胞计数用作治疗结果的替代标志物。比较口服多西环素治疗前后有CNS症状的患者和有PNS症状的患者的脑脊液单核细胞计数。结果：包括26例有CNS症状的患者和115例有PNS症状的患者。两组患者脑脊液单核细胞计数的下降没有显着差异。所有中枢神经系统疾病患者在治疗后均表现出显着的临床改善，尽管 62% 的患者在随访结束时仍有剩余症状。结论：与有中枢神经系统症状的莱姆神经疏螺旋体病患者相比，口服多西环素治疗导致有中枢神经系统症状的莱姆神经疏螺旋体病患者的脑脊液单核细胞计数有类似的减少。结果表明，无论症状严重程度如何，口服多西环素都是治疗莱姆神经疏螺旋体病的有效方法。
Background and purpose: The treatment recommendation for Lyme neuroborreliosis with central nervous system (CNS) symptoms is intravenous ceftriaxone, according to current American and European guidelines. For Lyme 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 Lyme neuroborreliosis with CNS symptoms.Methods: Patients with Lyme neuroborreliosis who had undergone cerebrospinal fluid (CSF) sampling before and after treatment at the Department of Infectious Diseases, Sahlgrenska University Hospital, 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 Lyme neuroborreliosis with CNS symptoms compared with patients with Lyme neuroborreliosis with PNS symptoms. The results indicate that oral doxycycline is an effective treatment for Lyme neuroborreliosis irrespective of the severity of symptoms.