Assessment of anti-HSV antibodies in patients with facial palsy in the course of neuroborreliosis
Assessment of anti-HSV antibodies in patients with facial palsy in the course of neuroborreliosis
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DOI：
10.1111/ijcp.13749
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发表时间：
2020-11-09
影响因子：
2.6
通讯作者：
Zajkowska, Joanna
中科院分区：
文献类型：
--
作者：
Moniuszko-Malinowska, Anna;Guziejko, Katarzyna;Zajkowska, Joanna
目的面神经麻痹的原因有很多。最常见的原因是神经疏螺旋体病（NB），特发性瘫痪或单纯疱疹病毒（HSV）再激活。本研究的目的是面神经麻痹患者在NB的过程中，并确定是否HSV-1再激活发生在NB的急性期。方法对66例面神经麻痹患者进行了回顾性分析。在38例患者中，面瘫由伯氏疏螺旋体sl感染引起。结果55.2%的NB患者有右侧神经麻痹，21%的患者有双侧神经麻痹，15.8%的患者有游走性红斑（EM）。92%的患者被诊断为淋巴细胞性脑膜炎，47%的患者被诊断为Bannwarth综合征。在4例NB患者和2例其他来源的面神经麻痹患者中检测到IgM抗HSV-1抗体。3例（7.9%）NB患者CSF中检测到IgM抗HSV-1抗体，其中1例同时伴有双侧VII轻瘫和EM。结论神经疏螺旋体病是引起周围性面神经麻痹的重要原因之一。周围性面神经麻痹是NB病程中的一个重要症状，尤其是伴有脑膜炎的患者。面神经麻痹的病理机制至今尚未得到很好的解释，可能取决于两个独立的机制，包括HSV-1的再激活。
Aim There are many causes of facial nerve palsy. The most common causes are neuroborreliosis (NB), idiopathic paralysis or Herpes simplex virus (HSV) reactivation. The aim of this study was to characterize patients with facial palsy in the course of NB and to determine whether HSV-1 reactivation takes place during the acute phase of NB.Methods A retrospective analysis of 66 patients with facial nerve palsy was performed. In 38 patients, facial palsy was caused by Borrelia burgdorferi sl infection. Immunological tests for HSV-1, tick-borne encephalitis virus and B burgdorferi sl in serum and cerebrospinal fluid (CSF) were performed.Results In this analysis, 55.2% of NB patients had right nerve palsy and 21% bilateral palsy; 15.8% of patients had erythema migrans (EM). Lymphocytic meningitis was diagnosed in 92% of patients and Bannwarth's syndrome was diagnosed in 47% of patients. IgM anti-HSV-1 antibodies were detected in four patients with NB and two patients with facial nerve palsy of other origin. IgM anti-HSV-1 antibodies were detected in the CSF of three patients (7.9%) with NB, and one of them had bilateral VII paresis and EM simultaneously. Treatment with ceftriaxone or doxycycline led to complete recovery.Conclusions Neuroborreliosis should always be considered as a cause of peripheral facial nerve palsy. Peripheral facial nerve palsy is a significant symptom in the course of NB, especially in patients accompanied by meningitis. Pathomechanism of facial nerve paresis has not been well explained so far and may depend on two independent mechanisms in NB, including HSV-1 reactivation.