Objawy Boreliozy dotyczące oczu:
http://lymepoland.com/pliki/Zalecenia_DBG.pdf.
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Borelioza z Lyme może powodować wiele objawów ocznych, przybierając różne postacie. Częstotliwość zajęcia narządu wzroku w boreliozie wynosi 2-4%(wg Bodagni), możliwe w każdym stadium choroby, najczęściej jednak w późnych fazach.
Pacjent z zajęciem narządu wzroku w przebiegu choroby z Lyme powinien być traktowany jak z infekcją OUN
U 20 pacjentow . z objawami ocznymi w przebiegu boreliozy stwierdzono u10 :zapalenie błony naczyniowej, 5-zapalenie przydatków oka, 4-objawy neurookulistyczne , 1-centralne zamknięcie żyły siatkówki; kontakt z kleszczem zgłaszało 13 pacjentów
(The expanding clinical spectrum of ocular lyme borreliosis. Mikkilä HO, Seppälä IJ, Viljanen MK, Peltomaa MP, Karma A. Department of Ophthalmology, Helsinki University Central Hospital, Finland. Ophtalmology 2010, PubMed
Wg Golubić i wsp. (Chorwacja) –wśród 11 pacjentów z postacią oczną boreliozy : chorioretinitis- 6; zapalenie grudkowe spojówek 2; zapalenie błony naczyniowej-2; zamknięcie ż.sr.siatkówki-1;pozagałkowe zapalenie n II-1; neuroretinitis -1
[Ocular manifestations of Lyme borreliosis in northwest Croatia]. Golubić D, Vinković T, Turk D, Hranilović J, Slugan I. Zupanijska bolnica Cakovec, Djelatnost za infektologiju.2004;5-6 PubMed
Wg Huppertz (Niemcy) i wsp. w gr. 84 dzieci z zapaleniem stawów na tle boreliozy : narząd wzroku zajęty u 3 pacjentów w postaci zapalenia rogówki i zapalenia błony naczyniowej (anterior uveitis, pars planitis)
Ocular manifestations in children and adolescents with Lyme arthritis. Huppertz HI, Münchmeier D, Lieb W. Children's Hospital, University of Würzburg, Würzburg, Germany. Br.J Ophtalmol. 1999.PubMed.
Borelioza- stadium I
Objawy układowe,Rumień wędrujący,Bóle głowy, złe samopoczucie, zmęczenie,Bóle mięśni i stawów,Powiększone węzły chłonne
Objawy oczne , Zapalenie spojówek, Zapalenie nadtwardówki, Obrzęk okołooczodołowy
Zapalenie spojówek ,Obustronne zaczerwienienie i przekrwienie, Reakcja grudkowa, wydzielina ropna w worku spojówkowym , obrzęk, czasami wylewy podspojówkowe, Zapalenia nadtwardówki i twardówki Występuje b. rzadko- dotyczy I i III stadium choroby,Zapalenia nadtwardówki: proste i guzkowe,Zapalenie ziarninujące twardówki , Zapalenie tkanek oczodołu
Borelioza-stadium II (disseminated)
Objawy układowe Schorzenia układu mięśniowoszkieletowego, Zapalenie opon mózgowych i mózgu, neuropatie obwodowe Zapalenie mięśnia sercowego-bloki przewodnictwa
Objawy oczne Zapalenie błony naczyniowej (zapalenie ziarninujące tęczówki i ciała rzęskowego) Zapalenie części pośredniej błony naczyniowej. Panuveitis Zapalenie naczyń siatkówki Zapalenie nerwu wzrokowego Torbielowaty obrzęk plamki Porażenie nerwów okoruchowych
Zapalenie błony naczyniowej (ZBN) Lokalizacja: odcinek przedni, pośredni, tylny Przebieg: ostry, przewlekły, nawracający Ciężkość: łagodne, ciężkie Charakter: ziarninujące czy nieziarninujące
Zapalenie błony naczyniowejobjawy kliniczne: Triada: ból, zaczerwienienie, światłowstręt ,Spadek ostrości wzroku, męty, łzawienie ,Wysięk w komorze przedniej, osady na śródbłonku rogówki, zrosty przednie , Vitritis, wysięki w okolicy pars plana („kule śnieżne”), pływające męty, może przebiegać z wtórnym zajęciem siatkówki-zapalenie naczyń, obrzęk torbielowaty plamki
Borelioza a zapalenie błony naczyniowej ,Wg. Jumper z.b.n. na tle boreliozy stanowi reakcję immunologiczną na bezpośrednie zakażenie tkanek oka.
DNA bakterii (met. PCR) znaleziono w próbce ciała szklistego pobranego w biopsji diagnostycznej, bad. histologiczne również potwierdziło obecność krętka w próbce.
Wg. innych autorów objawy oczne mogą stanowić reakcję autoimmunologiczną. Wg. Bodaghi: patogeneza kontrowersyjna- bezpośrednie zakażenie oka i opóźniony mechanizm nadwrażliwości zaangażowane są w rożnych okresach choroby.
Krętek może wnikać do oczu i pozostawać w formie utajonej, wywołując zarówno wczesne i późne objawy.
Zapalenie n II i siatkówki- neuroretinitis
Spadek ostrości wzroku, zaburzenie widzenia barwnego, mroczek centralny w polu widzenia Przekrwienie i obrzęk tarczy n II , Płomykowate krwotoczki okołotarczowe ,Obrzęk plamki w postaci gwiazdy
Zapalenie n II i siatkówkineuroretinitis
Porażenie nerwów czaszkowych w neuroboreliozie .Inwazja krętka do układu nerwowego- zapalenie opon m-rdz. z zajęciem nerwów czaszkowych (VII, VIII, IX, X, XII)
Może być izolowane porażenie jako mono- lub poli- neuritis (wg.A. Sauer).
Zajęcie nerwów gałkoruchowych najczęściej dotyczy n VI-odwodzącego, rzadziej n III i IV
Neuroborelioza- porażenie n VI
Dwojenie, zez zbieżny, ograniczenie odwodzenia
WUG w celu zmniejszenia dwojenia (twarz w kierunku działania porażonego mięśnia)
Leczenie: systemowe ,Miejscowe: zasłonki, pryzmaty, toksyna botulinowa.
Neuroborelioza- porażenie n VI
Borelioza-Stadium III - trwałe Objawy układowe ,Encefalopatia ,Przewlekłe zap. stawów Zapalenie rdzenia kręgowego ,Zaburzenia psychiczne, Limfoadenopatia ,
Objawy oczne ,Przewlekłe zapalenie wewnątrzgałkowe ,Czasami zapalenie nadtwardówki ,Śródmiąższowe zapalenie rogówki
Zapalenie rogówki - objawy kliniczne:
Światłowstręt, czerwone oko, pogorszenie ostrości wzroku.
W lampie szczelinowej stwierdza się: śródmiąższowe przymglenie rogówki, łagodny obrzęk zrębu, odczyn zapalny w komorze przedniej oka, nawracające zapalenie prowadzi do neowaskularyzacji rogówki.
Wywiad -bardzo istotny, pomaga nam w poszukiwaniu czynnika etiologicznego zapalenia.
Zapalenie rogówki
Leczenie zapalenia rogówki
W leczeniu stosujemy antybiotyki miejscowo, początkowo co godzinę przez 24-48 godzin, następnie co 2 godziny przez kolejne 48 godzin, a następnie 4 razy na dobę przez tydzień.Podawane są również cykloplegiki w celu zniesienia bólu wywołanego skurczem mięśnia rzęskowego oraz zapobiegania zrostom tylnym, czasami wymagane podanie leków przeciwbólowych.
Podsumowanie
Borelioza- jako jednostka chorobowa wymaga współpracy lekarzy wielu specjalności, w tym również okulisty.
Pacjent z boreliozą, zgłaszający problemy z widzeniem powinien być zawsze konsultowany i objęty opieką Poradni Okulistycznej
http://www.slideshare.net/ArturGrabos/objawy-oczne-boreliozy
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Porażenie nerwów zewnątrzgałkowych w neuroboreliozie
http://www.slideshare.net/ArturGrabos/poraenie-nerww-zewntrzgakowych-w-neuroboreliozie
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Objawy oczne Boreliozy
https://www.podyplomie.pl/okpd_online/articles/17600
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Borelioza oczna - ocularborreliosis
Tlumaczenie : geodeta.
Gatunki Stephanii, najbardziej S. tetrandra, są bardzo dobre na zapalenia oczu wywołane przez boreliozę. W rzeczywistości, cały szeroki zakres ocznych objawów boreliozy może być leczony z sukcesem tymi właśnie ziołami. Zioła nie dopuszczają również do zbijania się komórek i chemotaksji oraz zabezpieczają komórki śródbłonkowe. Istnieje możliwość, iż zioła te zakłócają dynamikę
przylegania do siebie komórek borelii. Przede wszystkim odkryto jednak, że te rośliny zwiększają efektywność antybiotyków i innych farmaceutyków w leczeniu nowotworów czy wielorakich wirusów takich jak malaria. Lekarstwa zdezaktywowane przez nowotwory i mikroby dzięki rozmaitym mechanizmom odporności stają się bardzo efektywne kiedy podamy je w połączeniu z ziołami Stephania. Niedawne odkrycia dowodzą również, że Stephania wzmaga działanie
innych ziół.
Szeroki zakres działania tych ziół, odpowiedni dla wielu symptomów boreliozy oraz niezwykła natura ich działania sugerują, iż są one potencjalnie wspaniałymi ziołami dla leczenia choroby z Lyme. Niestety są one trudno dostępne. Szczególnie S. cepharantha. Spore ilości S. tetrandra można zamówić u importerów chińskiej medycyny i generealnie musi ona być przetworzona do
postaci kapsułek, nalewek, wywarów i naparów (patrz źródła). Problemy w zakupie solidnych zapasów tych ziół sa powodem nie uwzględnienia korzenia Stephanii wśród leków opisanych na czele protokołu.
PROBLEMY Z OCZAMI
Krętki borelii atakują wodnisty płyn (ciało szkliste) oka prawie natychmiast po dostaniu się do ciała człowieka. Jest to jeden z powodów dlaczego tak wiele osób z boreliozą mówi o "mętach w ciele szklistym" w ich polu widzenia. To że krętki dostają się do tej części ciała ludzkiego, sprawia
leczenie o wiele trudniejszym gdyż antybiotyki działają bardzo wolno lub wcale w tym środowisku (miejscu).
Główny protokół powinien znacznie pomóc w dolegliwościach ocznych. Jednakże, wiele symptomów infekcji borelią - mętny, rozmazany obraz, ciśnienie w gałce ocznej i inne - mogą zostać usunięte poprzez zioła i suplementy wymienione tutaj. W wielu przypadkach, infekcja
borelią ciała szklistego oka powoduje rodzaj delikatnej jaskry. Rozbicie kolagenu i zapalenie od infekcji bakteryjnej są bardzo podobne do procesów zachodzących w tej chorobie (jaskrze). Jaskra jest chorobą spowodowaną wzrostem ilości płynu wewnątrzgałkowego co powoduje z kolei ciśnienie
wewnątrz oka. Rozmyty obraz jest jednym z objawów. Degeneruje się kolagen. W istocie kolagen w oku psuje się (degraduje) i nie zostaje przetworzony właściwie więc narasta w szkliste oka. To blokuje drenaż płynu z oka i wzrost ciśnienia wewnętrznego. Kiedy ciśnienie wzrasta, nerw wzrokowy może zostać uszkodzony. To powoduje rozmazany, zamglony obraz, utratę pobocznego
widzenia, efekt aureoli wokół świateł, "ślepe" plamki, bóle oczu i zaczerwienienia ( i wiele innych dręczących dolegliwości w boreliozie).
Prawdopodobnie najlepszym ziołem na problemy z oczami jest Stephania root . Vincamina może również okazać się wyjątkowo pomocna. Witamina C wspomaga struktury kolagenu w oczach, jak również Cynk.
PROTOKÓŁ DLA PROBLEMÓW Z OCZAMI:
Stephania root - połowa łyżeczki do herbaty nalewki 3x dziennie
przemywać oczy wywarem
Vincamine - 20mg 3x dziennie
Witamina C - 1000mg 3x dziennie (musujące sole???)
Cynk - 40mg dziennie
KORZEŃ STEPHANII ( STEPHANIA TETRANDRA, STEPHANIA CEPHARANTHA )
RODZINA: Menispermiaceae
UŻYWANA CZĘŚĆ ROŚLINY: korzenie i korzonki, czasami pnącza
DZIAŁANIE: Przeciwobrzękowe, przeciwzapalne, bloker kanału wapniowego,
czynnik rozszerzający naczynia, przeciwzwłóknieniowe, przeciwbólowe,
relaksator mięśni gładkich, przeciwpasożytnicze, przeciwgorączkowe,
przeciwnowotworowe, antybakteryjne, moczopędne, przeciw artretyczny, środek
uspokajający, przeciwastmatyczny.
FUNKCJA W BORELIOZIE: dla zapalenia nerwów, stawów, odmiana oczna boreliozy,
obrzęki, mialgie, immunomodulator
SPECYFICZNE WSKAZANIA: paraliż Bell'a, oczne objawy boreliozy (uveitis,
conjunctivis etc.), artretyzm, neuroborelioza, artretyzm oporny na leczenia
antybiotykami, późne stadia boreliozy układu nerwowego, stawy, skóra.
UWAGA!
Należy uważać z zastosowaniem tych ziół przy boreliozie „sercowej”."
http://forum.gazeta.pl/forum/w,26140,58403509,58403509,Borelioza_oczna_ocularborreliosis.html
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okulistyka :
11.4. Borelioza (choroba z Lyme)
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Co to jest i jakie są przyczyny?
Zaburzenia ruchów oczu (zwrotów) mogą być spowodowane uszkodzeniem ośrodków i szlaków zarządzających obuocznymi ruchami oczu na skutek chorób neurologicznych. Powstaje wówczas porażenie spojrzenia. Natomiast w zezie porażennym porażenie lub niedowład, czyli częściowe porażenie, dotyczy jednego mięśnia lub kilku mięśni gałki ocznej. Zez ten występuje wskutek uszkodzenia samego mięśnia lub, co zdarza się znacznie częściej, wskutek urazu lub choroby nerwu zaopatrującego dany mięsień.
Przyczyną porażenia mogą być choroby lub urazy ośrodkowego układu nerwowego (guzy, tętniaki, stwardnienie rozsiane, miastenia, choroby zakaźne, gościec, zakażenia wirusowe, borelioza, zatrucia).
http://okulistyka.mp.pl/objawychoroboczu/show.html?id=86449
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Zaćma / katarakta - Borelioza i Bartonella
Bacterial tick-borne diseases caused by Bartonella spp., Borrelia burgdorferi sensu lato, Coxiella burnetii, and Rickettsia spp. among patients with cataract surgery.
CONCLUSIONS:
RECENT FINDINGS:
Vision-threatening ophthalmic manifestations are relatively common in Lyme disease and Rocky Mountain spotted fever. Ocular involvement is rare in babesiosis, tick-borne relapsing fever, Powassan encephalitis, ehrlichiosis, anaplasmosis, and Colorado tick fever.There are clear guidelines for diagnosis and treatment of Lyme disease; however, confusion and misinformation among the general public as well as controversy about chronic or late-stage Lyme disease can impact the evaluation of ophthalmic disease. Furthermore, there are many gaps in our knowledge regarding the pathophysiology of ocular borreliosis although it seems likely that Lyme uveitis is rare in the United States.
http://www.ncbi.nlm.nih.gov/pubmed/27585218
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Abstract
Lyme disease is a multisystemic disorder caused by Borrelia burgdorferi spirochete, transmitted by ticks. Mainly described in the northern hemisphere and rarely in Brazil. The purpose of this report is to describe a patient with Lyme disease who developed bilateral tonic pupil as the only remaining sign. A 13-year-old female with Lyme disease, presented with bilateral peripheral facial and oculomotor paralysis. After recovery from neurological abnormalities the patient sustained anisocoria, reduced fotomotor reflex, less than normal amplitude of accommodation, tonic pupil constriction for near objects and slow redialation in both eyes. Dilute 0.1% pilocarpine test was positive in both eyes, confirming the suspicion of bilateral tonic pupil. This is the first case report of bilateral tonic pupil caused by Lyme disease.
https://www.ncbi.nlm.nih.gov/pubmed/16059573
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How does lyme disease affect the eye?
Fortunately, involvement of the eye is uncommon in lyme disease. But when the eyes can be affected in many different ways by the disease.
In the early stage of the disease, many persons have conjunctivitis. In this condition, commonly called pink eye, the eyes are red and uncomfortable, and there is a discharge of pus. Unlike many forms of conjunctivitis, the type that occurs in lyme disease is not contagious.
In later stages of the disease, inflammation of the eye may develop. Parts of the eye that may be affected include the uvea, the middle layer inside the eye, the cornea, part of the outer coat of the eye; the iris, the colored circle around the pupil, and the choroid, a layer of blood vessels in the eye. Ocular symptoms can include sensitivity to light and floaters (spots in front of the eyes).
Inflammation of the optic nerve (optic neuritis) also can occur, which results in visual loss. Loss of vision can result from inflammation in the brain as well.
Persons who develop Bell’s palsy may be unable to blink or close their eyes. This dries the cornea and can result in an infection or even a hole in the cornea, which can endanger vision if not treated promptly.
http://chicago.medicine.uic.edu/departments___programs/departments/eye
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Pradella SP, Krause A, Müller A.
Klinik und Poliklinik für Augenheilkunde, Martin-Luther-Universität, Halle-Wittenberg.
BACKGROUND: Borrelia burgdorferi is the cause of erythema chronicum migrans and Lyme disease. Ticks like Ixodes ricinus are responsible for transmission. Frequently, the tick bite is not noticed by the patient. Eye manifestations, such as keratoconjunctivitis, scleritis, chronic uveitis, vitritis, chorioretinitis, optic nerve disease, orbital myositis and paresis of the eye muscles, often occur after a long period of time and vary greatly. PATIENTS AND METHODS: We present below the case reports of a man 38 years old and a woman of 31, each with manifestation of an ocular Borrelia infection (papillitis and panuveitis, respectively). RESULTS: By antibody-screening with the ELISA technique and Western Blot analysis we were able to prove the serological infection. After specific antibiotic therapy, ocular inflammation improved rapidly, as did visual acuity. The papillitis only healed partially. CONCLUSIONS: In case of therapy-resistant inflammation of the eye we have to exclude general infections because cortisone therapy alone may result in worsening the condition. VECP can be used effectively in the differential diagnosis of papilloedemas. Early diagnosis and therapy of an acute Borrelia infection restrict the extent of the lesions and prevent ocular and general late manifestations. Seronegative values in subjects strongly suspected of having Lyme disease do not necessarily exclude the diagnosis of Lyme disease.
https://www.ncbi.nlm.nih.gov/pubmed/9376700
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Karma A, Stenborg T, Summanen P, Immonen I, Mikkilä H, Seppälä I.
Department of Ophthalmology, University of Helsinki, Finland.
PURPOSE:
The authors report sequential fluorescein angiographic and color photographic findings of the fundi and response to treatment in a patient with chronic Lyme neuroretinitis. METHODS: A Lyme enzyme-linked immunosorbent assay with purified 41-kd flagellin as antigen was used to detect immunoglobulin G and immunoglobulin M antibodies to Borrelia burgdorferi in serum, cerebrospinal fluid, and vitreous. The changes were documented by fluorescein angiography and color photography tests performed during a 5 1/2 year follow-up. RESULTS: The diagnosis of Lyme neuroretinitis was based on the history of erythema migrans and positive Lyme enzyme-linked immunosorbent assay tests from cerebrospinal fluid and vitreous and by the exclusion of other infectious and systemic diseases and uveitis entities. Fluorescein angiography results disclosed bilateral chronic neuroretinal edema with areas of cystoid, patchy, and diffuse hyperfluorescence peripapillary and in the macular areas. The hyperfluorescent lesions enlarged despite a 9-month period of antibiotic therapy. CONCLUSION: Lyme borreliosis may cause neuroretinitis with unusual angiographic findings. Chronic Lyme neuroretinitis may be unresponsive to antibiotic therapy.
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+9002133
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PURPOSE:
To assess the distribution of different uveitis entities and to evaluate their associations with infections, especially Lyme borreliosis. METHODS: During a one-year period 160 consecutive uveitis patients were evaluated in a university clinic. Selected tests were performed depending on the medical history of the patient and the clinical picture of the ocular inflammation. RESULTS: Uveitis was classified into selected entities for 74.4% of the patients. A direct infection was suggested to be linked with uveitis in 23 patients (14.4%). Lyme borreliosis, toxoplasmosis, and herpetic infections were the most frequently seen, in seven patients (4.3%) each. All patients with Lyme uveitis had manifestations of the posterior segment of the eye, such as vitritis, retinal vasculitis, neuroretinitis, chorioretinitis, or optic neuropathy. CONCLUSION: Infections are an important cause of uveitis in a university clinic. Lyme borreliosis is a newly recognised uveitis entity which should be kept in mind in the differential diagnosis of intermediate or posterior uveitis in areas endemic for Lyme borreliosis.
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+9527338
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Rícarová R, Struncová V, Plísková S, Jurcuková M.
Ocní klinika LF UK, Plzen.
The authors present an account of two patients with anterior uveitis in the second stage of Lyme borreliosis. The draw attention to diagnostic problems of the disease from the ophthalmological aspect
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+7736621
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Wilk CM, Bialasiewicz AA, Ruprecht KW, Naumann GO.
Augenklinik mit Poliklinik, Universität Erlangen-Nürnberg.
Two patients with bilateral extensive confluent choroidal lesions, exudative retinal detachments, positive lyme serology and a typical history are documented: A 32-year-old woman presented 14 days after a "flu-like" illness with bilateral acute extensive choroidal lesions and exudative retinal detachments (OD from 5 to 8:30 o'clock, OS from 5 to 8 o'clock, both including the macula) accompanied by a mild lymphocytic meningitis. The laboratory work-up revealed increased serum and CSF titers of antibodies against Borrelia burgdorferi (Lyme immunofluorescent test (IFT) and Lyme-IgM IFT) which declined after a 14-day treatment with doxycycline (200 mg/d), CSF titers non-detectable (serum IgG: from 1:640 to 1:320, serum IgM: from 1:40 to 1:20). A distinct improvement with visual acuity increasing from OD 0.2/OS 0.3 p to OD/OS 0.8 p was observed after seven days of treatment. A 40-year-old man with a 14-day history of tick-bite developed the same, though more severe ocular findings and a lymphocytic meningitis. The serological work-up revealed increased antibody titers against Borrelia burgdorferi (ELISA); the IgM titer was normal. After a 10-day treatment with penicillin, antibody titers against the spirochete decreased slightly and the patient's neurologic and ophthalmologic status improved dramatically. Five weeks after admission visual acuity was OD/OS 0.5 (compared to OD/OS 0.1) and has remained at 0.8 p (OD/OS) since the ninth week after onset. The clinical course of the disease and the decreasing lyme serology strongly suggest an infection with Borrelia burgdorferi. The authors propose thorough laboratory work-ups including tests for Lyme disease in selected patients with diffuse choroidal lesions.
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+2716229
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Macarez R, Bazin S, Lagauche D, Soullié B, Giordano P, May F, Guigon B.
Service d'Ophtalmologie, HIA Clermont Tonnerre, BP 41, 29240 Brest-Armées.
INTRODUCTION: The diagnosis of Lyme disease in the presence of an acute optical neuritis always raises a difficult diagnostic problem. We present a case of Lyme-associated Leber's hereditary optic neuropathy (LHON). OBSERVATION: A 17-year-old Eurasian young man presented with left-eye visual impairment for 1 month. This loss of vision acuity in the left eye is related to an optic neuropathy. Mitochondrial DNA testing showed a G to A substitution at position 11778 confirming a diagnosis of LHON. The family history disclosed a case of LHON in a maternal cousin. The mother's family is Asian. Besides, serum examination of anti-Borrelia antibodies was performed and was positive against Borrelia burgdorferi garinii. The patient history indicated that he had been possessing a dog and was living in an endemic area of Lyme disease. But he did not recall receiving a tick bite nor having any erythema chronicum migrans. Initial examination showed bilateral green-red axis colour vision defects which made us fear bilateralisation of the optic neuropathy, which occurred 2 months later (that is 3 months after the onset of symptoms on the left eye). An antibiotic treatment by ceftriaxone was administered for 4 weeks all in all; and a long term ubidecarenone therapy was established. At present, after a 1-year follow up, the eyes' conditions remains unchanged. CONCLUSION: To our knowledge, this would be the first case reporting such an association, in which we can discuss the fortuitous character or the role of the infectious factor in the developing of the mitochondrial pathology. This observation also raises the problem of the positive diagnosis of Lyme disease when tick bite and erythema are absent or underestimated.
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+16395203
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Lyme disease associated with unilateral interstitial keratitis.
Miyashiro MJ, Yee RW, Patel G, Ruiz RS.
Department of Ophthalmology and Visual Science, The University of Texas Medical School at Houston, 77030, USA.
PURPOSE: To report a case of Lyme disease that presented with a single nummular unilateral interstitial keratitis. METHODS: Case report and review of the literature. RESULTS: A 57-year-old black man who had contact with freshly killed deer had a chief complaint of foreign-body sensation in his right eye (OD) that had been diagnosed and treated for herpes simplex stromal keratitis. The patient underwent a systemic workup for interstitial keratitis. All results including RPR and MHA-TP were negative except for Lyme antibody titer (enzyme-linked immunosorbent assay [ELISA]) 178 U/ml (normal, <159 U/ml). CONCLUSION: Interstitial keratitis from Lyme disease has been regarded as a bilateral disease in the literature. We present this infrequent ocular manifestation of Lyme disease as a rare single nummular unilateral presentation
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+9894947
-------------------------------
Fugimoto F, Ghanem RC, Monteiro ML.
Clínica Oftalmológica, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
Lyme disease is a multisystemic disorder caused by Borrelia burgdorferi spirochete, transmitted by ticks. Mainly described in the northern hemisphere and rarely in Brazil. The purpose of this report is to describe a patient with Lyme disease who developed bilateral tonic pupil as the only remaining sign. A 13-year-old female with Lyme disease, presented with bilateral peripheral facial and oculomotor paralysis. After recovery from neurological abnormalities the patient sustained anisocoria, reduced fotomotor reflex, less than normal amplitude of accommodation, tonic pupil constriction for near objects and slow redialation in both eyes. Dilute 0.1% pilocarpine test was positive in both eyes, confirming the suspicion of bilateral tonic pupil. This is the first case report of bilateral tonic pupil caused by Lyme disease.
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+16059573
--------------------------------------
Ocular findings in infection with Borrelia burgdorferi
Reim H, Reim M.
Augenklinik, Medizinischen Fakultät, Rheinisch-Westfälischen Technischen Hochschule Aachen.
During the years 1988 to 1990 ten patients were observed in the eye clinic of RWTH Aachen with ocular findings of infection with Borrelia burgdorferi. 6 of them showed neuro-ophthalmological signs, 4 had uveitis. In both groups recent infections were documented in fresh and chronic stages of the disease, lasting longer than one year. The various clinical pictures of the disease following infection with Borrelia burgdorferi are described. As a vaccination against Borreliosis is not yet available, it is important to detect the antibodies against Borrelia burgdorferi early enough, to initiate an effective treatment.
https://www.ncbi.nlm.nih.gov/pubmed/1434386
----------------------------------------
Schönherr U, Lang GE, Meythaler FH.
Augenklinik mit Poliklinik der Universität Erlangen-Nürnberg.
We report on a 22-year-old white female with bilateral Leber's stellate neuroretinitis occurring 5 weeks after a viral-like illness. Serological tests revealed a seroconversion for Borrelia burgdorferi indicating an etiological connection. During therapy with 200 mg doxycycline daily for 2 weeks on systemically steroids the optic disc swelling and macular star figure resolved. Visual acuity improved from 0.4 to 1.0 in this time period. It is important that the ophthalmologist should consider Lyme-Borreliosis in isolated neuroretinitis, because the prognosis depends on the time when treatment is initiated.
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+2023374
----------------------------------------
BACKGROUND:
To describe the outcome in a patient with macular edema caused by Lyme disease treated with injection of 4 mg intravitreal triamcinolone. METHODS: The patient, 2 years after systemic Lyme disease treated with doxycycline for 4 weeks, developed macular edema with serous retinal detachment in one eye (visual acuity: 0.6). After unsuccessful therapy with intravenous ceftriaxone, indomethacin and acetazolamide, 4 mg intravitreal triamcinolone (IVTA) was injected via the pars plana. RESULTS: Visual acuity improved to 1.0 and macular thickness recovered over 1 month. No changes were found in intraocular pressure. No recurrence of macular edema was seen after 2 years. CONCLUSIONS: IVTA can restore visual acuity and reduce macular thickness in macular edema caused by Lyme disease. However, since borreliosis is a systemic disease, previous systemic antibiotic treatment is recommended.
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+18193264
---------------------------------
Bialasiewicz AA, Schönherr U.
Univ.-Augenklinik mit Poliklinik der Friedrich-Alexander-Universität Erlangen-Nürnberg.
A significant B. burgdorferi seroconversion with an IgM of 1:80 was observed in a patient complaining of loss of vision in his right eye. The finding correlated morphologically with hyperpigmentation and depigmentation in the macular region, similar to pigment epitheliitis or choriocapillaritis. In the course of the following four weeks the IgM decreased by four titer steps. The visual acuity of the patient's right eye recovered from 0.4 on admission to 1.0 on discharge. The angiogram did not reveal any pathology. Since choroidal manifestations have often been documented in patients with B. burgdorferi infections, it is recommended that serological workups be performed in such patients. Studies in larger groups of patients are necessary to establish the relevance of this case report and its significance concerning infection as a cause of choriocapillaritis.
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+2376946
------------------------------
Karma A, Seppälä I, Mikkilä H, Kaakkola S, Viljanen M, Tarkkanen A.
Department of Ophthalmology, University of Helsinki, Finland.
PURPOSE:
To establish a diagnosis, in a group of patients we studied the characteristics of ocular Lyme borreliosis. METHODS: During a two-year period, 236 patients with prolonged external ocular inflammation, uveitis, retinitis, optic neuritis, or unexplained neuro-ophthalmic symptoms were examined for Lyme borreliosis. Antibodies to Borrelia burgdorferi were measured by indirect ELISA and western blot. Cerebrospinal fluid was also analyzed by polymerase chain reaction. RESULTS: Ocular Lyme borreliosis was diagnosed in ten patients on the basis of medical history, clinical findings, and serologic test results. Results of ELISA disclosed that five patients were seropositive, two patients showed borderline reactivity, and three patients were seronegative. Four of the five patients with borderline or negative results by ELISA had a positive result by western blot analysis. In one seropositive patient, polymerase chain reaction verified a gene of B. burgdorferi endoflagellin from the vitreous and cerebrospinal fluid specimen. In five of the six patients with known onset of the Borrelia infection, the ocular disorder appeared as a late manifestation. Abnormalities of the posterior segment of the eye, such as vitreitis, retinal vasculitis, neuroretinitis, choroiditis, and optic neuropathy were seen in six patients. Bilateral paralytic mydriasis, interstitial keratitis, episcleritis, and anterior uveitis were seen in one patient each. CONCLUSIONS: Late-phase ocular Lyme borreliosis is probably underdiagnosed because of weak seropositivity or seronegativity in ELISA assays. Ocular borrelial manifestations show characteristics resembling those seen in syphilis.
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+7832219
----------------------------------
PURPOSE:
To describe a case of uveitis that is associated with Borrelia hermsii relapsing fever. DESIGN: Interventional case report.
METHODS: A 12-year-old boy with two weeks of relapsing fevers 10 days after camping in remote eastern Oregon was examined. Borrelia hermsii immunoglobulin M and G levels were markedly elevated. Intravenous ceftriaxone, followed by four weeks of oral cephuroxime was administered, but the patient developed unilateral floaters and blurred vision in association with anterior and intermediate uveitis.
RESULTS: Doxycycline was administered for presumed residual infection. Four weeks later, the visual acuity had improved. The anterior chamber was quiet, and topical corticosteroid was tapered successfully.
CONCLUSION: Although rare, Borrelia hermsii should be included in the list of spirochetal diseases that are associated with uveitis.
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+16876531
-----------------------------------------
Meier P, Blatz R, Gau M, Spencker FB, Wiedemann P.
Klinik und Poliklinik für Augenheilkunde der Universität Leipzig.
BACKGROUND: Ocular manifestations of Lyme borreliose present with unusual forms of conjunctivitis, keratitis, optic nerve disease, uveitis, vitritis and rarely endophthalmitis. CASE REPORT: A 57-year-old man working as logger in Sax-ony-Anhalt suffering from an endophthalmitis on his left eye was referred to us. The vision of his left eye was intact light perception and hand motions. The slit-lamp examination revealed severe inflammation of the anterior chamber with hypopyon, posterior synechiae, and opacity of the posterior lens capsule. Funduscopy showed no red reflex, no retinal details. In the local hospital serum analysis was performed and showed in Western-Blot IgM- and IgG-antibodies against Borrelia burgdorferi. Despite of intravenous application of ceftriaxon for 14 days panuveitis persisted, and endophthalmitis developed when antibiotic therapy was finished. RESULTS: During pars plana vitrectomy a sharply delineated cystic lesion containing yellowish fluid was revealed, and creamy yellow fluid was aspirated. Microscopically in hematoxylineosin stained slides of the aspirate structures consistent with Borrelia burgdorferi were found. Postoperatively vision increased to 1/15. Despite of a second intravenous ceftriaxon treatment for 14 days we observed a retinal vasculitis in the follow up of 6 months. CONCLUSIONS: Despite intravenous ceftriaxon-therapy borrelia burgdorferi must have survived in the vitreous body. Further investigations are required with respect to the use of other antibiotics or immunosuppressives.
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+10048013
-------------------------------
Neuroborreliosis is a form of borreliosis that affects the central and/or peripheral nervous system. Although it can mimic neurologic and ophthalmologic disorders such as multiple sclerosis and optic neuritis, visual evoked potential (VEP) examination is usually not used in neuroborreliosis diagnostics. Combined VEP testing (pattern-reversal VEPs and VEPs produced in response to linear and radial motion) was performed in 81 patients with neuroborreliosis verified by laboratory results (positive polymerase chain reaction or intrathecal antibodies production). Thirty-four patients reported diplopia or blurred vision related to borreliosis. In 33 (40%) patients the VEPs were delayed: motion-onset VEPs were pathologic in 22 (27%) patients, reversal VEPs in 5 (6%) patients, and both VEP types in 6 (7%) patients. The findings suggest that VEP testing (especially the motion-onset VEP testing) can confirm CNS involvement. Much higher sensitivity of motion-onset VEPs in comparison with reversal VEPs can result from rather selective (earlier) involvement of the magnocellular system or the dorsal stream of the visual pathway
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+17016151
-----------------------------------------------
We present a case of eye involvement -- intermediate uveitis -- during tick-borne borreliosis in a 10-year-old boy. Ophthalmologic examination revealed impaired vision, apparent thick floating whitish opacity in the vitreous humour of the left eye and fine fibres in the vitreous humour of the right eye. Sonographic examination confirmed hyperechogenic opacity in the vitreous humour. An autoimmune process was suspected but not confirmed. Serological examination showed IgG antibodies against three pathogenic borreliae and borderline values of IgM antibodies against Borrelia garinii were found by immunoblot. The boy was treated with intravenous ceftriaxone for 21 days. The subsequent sonographic examination showed only minute sporadic echogenicity. Biomicroscopically, only residual opacity in the vitreous humour was found. Isolated eye involvement of borrelia aetiology is rare. The discussion provides a review of similar cases of uveitis including diagnosis of the eye form as published in literaturę
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+17703406
--------------------------------------------
Koch F, Augustin AJ, Böker .
University Eye Hospital Bonn, Germany.
Borreliosis or Lyme disease, a tick-borne infection with the spirochete Borrelia burgdorferi, can cause various ocular and neurological symptoms. A 41-year-old man had been repeatedly bitten by ticks in June 1992; 6 months later, the patient complained of blurred vision in both eyes of 1-week duration, bifrontal headache that was more pronounced on the right side, and neck pain that had appeared months earlier and was becoming more severe. On ophthalmoscopy, clover-shaped retinal pigment epithelium detachments around the optic disc were observed in both eyes. The patient's visual acuity was reduced to 0.5 in his left eye. Liquor cells and total protein were significantly increased; however, a hemagglutination inhibition test revealed only moderately increased immunoglobulin values. After 2 weeks of daily application of 4 g ceftriaxone disodium, ophthalmological and neurological symptoms disappeared. Even though the immunoglobulin values remained unchanged, neuroborreliosis with involvement of the retinal pigment epithelium was the most probable diagnosis, considering the history of tick bites and headache. The authors assume that the tissue around the optic nerve head, which does not have an effective blood-brain barrier, allowed the spirochetes to spread from the central nervous system into the subpigment-epithelium space, thus causing the observed parapapillary pigment epithelium detachments
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+8646173
----------------------------------
Borrelia-associated crystalline keratopathy
Text
Objective
Crystalline keratopathy can be associated with paraproteinaemia or with infection by micro-organisms. We present a patient with crystalline keratopathy with proof of borellia in the corneal stroma.
Methods
Case report of asymmetric bilateral progressive peripheral crystalline keratopathy in a 67-year-old male patient with a history of recurrent iridocyclitis and polyarthritis under immunosuppression. After a paraproteinaemia had been excluded and due to a progressive visual loss to 0.1 in the right eye, we performed a triple procedure. During the postoperative follow-up, deep stromal crystalline deposits recurred, starting in the periphery. After six months, the graft became diffusely cloudy. One year after keratoplasty, the patient presented with a hyperacute stromal graft rejection, and we performed re-keratoplasty à chaud.
Results
By light- and electronmicroscopy we detected spirochaetes in the corneal specimen. By means of PCR proof of bacterial nucleic acid (16S-rDNA) was feasible. The result of amplification could be assigned to the species Borrelia burgdorferi by sequence analysis. Three months after re-keratoplasty, the patient presented with a clear graft under systemic and local antibiotics, local steroids and systemic immunosuppression.
Conclusions
In bilateral peripherally accentuated ring-shaped crystalline keratopathy resistent to conventional therapy a borrelia-associated interstitial keratitis should be ruled out. Diagnosis could be verified by incisional biopsy. Antibiotic treatment with cephalosporines or tetracyclines may prevent a progression or recurrence after keratoplasty.
http://www.egms.de/en/meetings/dog2004/04dog701.shtml
---------------------------
Cytologically proven seronegative Lyme choroiditis and vitritis.
Schubert HD, Greenebaum E, Neu HC.
Edward S. Harkness Eye Institute, New York, New York.
PURPOSE:
To report on a vitreous specimen in a 53-year-old patient with unilateral choroiditis and vitritis of unknown cause. METHODS: Cytologic examination of a vitreous aspirate stained by the Papanicolaou method. RESULTS: Intravitreal spirochetes consistent with Borrelia burgdorferi were found in this seronegative patient. CONCLUSION: Vitreous specimens of patients with choroiditis and vitritis of unknown cause should be examined cytologically, particularly when serologic results do not corroborate the clinical findings of Lyme disease.
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+8016460
----------------------------
Dietrich T, Geidörfer W, Schlötzer-Schrehardt U, Holbach L, Schoerner C, Seitz B.
From the *Department of Ophthalmology and †Department of Microbiology, Immunology and Hygiene, University Erlangen-Nürnberg, Erlangen, Germany; and the ‡Department of Ophthalmology, Saarland University Hospital, Homburg/Saar, Germany.
PURPOSE::
First report of a patient with Borrelia-associated crystalline keratopathy with intracorneal evidence of Borrelia garinii by polymerase chain reaction (PCR) and electron microscopy (EM). METHODS:: Report of a 67-year-old patient with medical history of recurrent iridocyclitis and arthritis presented with a bilateral, progressive, asymmetric crystalline keratopathy, which was particularly pronounced in the peripheral temporal superior cornea. After penetrating keratoplasty, crystalline keratopathy with stromal haziness recurred. Corneal regrafting was performed. The corneal specimen from the penetrating keratoplasty was examined by light and EM as well as by PCR. RESULTS:: In the explanted corneal graft, as well as retrospectively in the corneal specimen from the first keratoplasty, spirochetelike bodies and fragments were detected by light and EM. Borrelia burgdorferi sensu lato DNA was demonstrated by broad-range (16S rDNA) PCR. A more precise identification as Borrelia garinii serotype 5 was possible by analyses of the flaB and ospA gene sequences. Borrelia-specific serological tests showed borderline titers in immunofluorescence and weak reaction in immunoblot, respectively. CONCLUSIONS:: This case illustrates that borreliae must be considered as a cause of crystalline keratopathy; Borrelia-specific serological tests can be false negative; explanted cornea specimens of etiologically unclear crystalline keratopathy should be analyzed by EM or PCR for detection of pathogens; and prolonged antibiotic treatment might be effective to prevent progression or recurrence of the disease. https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+18434857
------------------------------------------
Lyme disease is a multi-system organ disorder caused by Borrelia burgdorferi. Although ocular manifestations have been reported, these remain a rare feature of the disease. This report shows a 49-years old patient that has been bitten by a tick and as consequence of which developed symptoms of the Lyme disease. In 1998 the patient was hospitalized in our Eye Clinic due to operating treatment of the paralytic strabismus (abductal nerve paralysis), as a rare feature of the Lyme disease. Postoperative squint angle was significantly reduced, but without any temporal movement. Diplopia was still present, though slightly reduced with the use of prism eyeglasses. The improvement of the quality of life was achieved, as well as the patient's satisfaction.
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+16193697
--------------------------------------------
The present paper describes a case of bilateral panuveitis due to Borrelia burgdorferi sensu lato diagnosed by a PCR approach using cerebral spinal fluid. Since the culture of B. burgdorferi takes a long time to grow and the accuracy of serological tests is doubtful in patients, the PCR method of amplifying a B. burgdorferi flagellin could be suitable to make a positive diagnosis in a case of atypical clinical history of Lyme disease.
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+18503173
----------------------------------------------
Amer R, Brannan S, Forrester JV.
Department of Ophthalmology, Aberdeen Royal Infirmary, UK.
Introduction: Lyme disease is a multisystemic disease with protean ocular manifestations. We describe the occurrence of inflammatory choroidal neovascular membrane (CNVM) in two patients suffering from presumed Lyme disease. Methods: Descriptive review of the clinical records of two patients. Results: Patient 1: 16-year-old healthy male presenting with a visual acuity of counting fingers [oculus dexter (OD)] and 6/6 [oculus sinister (OS)] 3 months after a tick bite. He had papillitis and an exudative subretinal macular lesion OD. Treatment was started with intravenous (IV) ceftriaxone; a week later, IV methylprednisolone was administered with a tapering dose of oral steroids thereafter. Three months later, VA had improved to 3/60 OD. Patient 2: 38-year-old healthy female presenting with reduced left-eye vision (6/24) 6 weeks after a tick bite. She also suffered from erythema migrans and arthralgias. She had left-eye papillitis, macular haemorrhages and vascular sheathing. Treatment was started with IV ceftriaxone. One month later, there was profound loss of vision with development of CNVM. Treatment was declined by the patient and eventually retinal fibrosis developed. Conclusion: Inflammatory CNVM has not been described previously in the setting of ocular Lyme borreliosis. We herein describe the occurrence of inflammatory CNVM in two patients whose diagnosis with Lyme disease was clinically based - both were sero-negative. Visual outcome in the two patients was profoundly impaired because of the ensuing macular scar.
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+18507732
---------------------------------------
Bilateral retrobulbar optic neuritis as first signs of Lyme disease.
Todorovic L, Ibisevic M, Alajbegovic A, Suljic-Mehmedika E, Jurisic V.
Clinic for Neurology, Clinical center University of Sarajevo.
Bilateral retrobulbar optic neuritis in young adults are most often caused by demyelinate disease (MS). In all cases where MS was eliminated, we have used selected tests regarding to history, clinical findings and differential diagnosis. Diagnosis of Lyme disease is approved by diagnostic criteria proposed by Center for Control and Prevention of disease. In our case diagnosis of Lyme disease was established by history of illness, clinical findings and positive serlological tests.
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+18669236
-----------------------------------------
Dacryoadenitis and Orbital Myositis Associated With Lyme Disease
To our knowledge, Lyme disease–associated orbital myositis has been serologically confirmed in 3 reported cases.1-3 No cases of dacryoadenitis have been reported in association with this disease entity.
Report of a Case
A 66-year-old, previously healthy woman had a 6-day history of right periorbital edema, erythema, diplopia, pain with eye movement, tearing, nausea, and vomiting. She reported a deer tick bite on the posterior neck 2 months prior that occurred while hunting during the early summer months in northern Wisconsin. The bite was followed by 3 weeks of fever, nausea, diarrhea, weakness, arthralgias, and a diffuse rash, all of which resolved after a 10-day course of ciprofloxacin hydrochloride.
Examination revealed best-corrected visual acuities of 20/20 OD and 20/25 OS as well as no afferent pupillary defect. Intraocular pressure measured 15 mm Hg OU.
http://archopht.ama-assn.org/cgi/conten ... 1165?rss=1
-----------------------------------
Internuclear ophthalmoplegia as the first sign of neuroborreliosis
http://www.springerlink.com/content/2jp2e7qfxweqmleu/
----------------------------------
Neuroretinitis secondary to concurrent infection with cat scratch disease and lyme disease
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+18791545
--------------------------------
BACKGROUND:
Ocular manifestations of Lyme borreliose present with unusual forms of conjunctivitis, keratitis, optic nerve disease, uveitis, vitritis and rarely endophthalmitis.
CASE REPORT: A 57-year-old man working as logger in Sax-ony-Anhalt suffering from an endophthalmitis on his left eye was referred to us. The vision of his left eye was intact light perception and hand motions. The slit-lamp examination revealed severe inflammation of the anterior chamber with hypopyon, posterior synechiae, and opacity of the posterior lens capsule. Funduscopy showed no red reflex, no retinal details. In the local hospital serum analysis was performed and showed in Western-Blot IgM- and IgG-antibodies against Borrelia burgdorferi. Despite of intravenous application of ceftriaxon for 14 days panuveitis persisted, and endophthalmitis developed when antibiotic therapy was finished.
RESULTS: During pars plana vitrectomy a sharply delineated cystic lesion containing yellowish fluid was revealed, and creamy yellow fluid was aspirated. Microscopically in hematoxylineosin stained slides of the aspirate structures consistent with Borrelia burgdorferi were found. Postoperatively vision increased to 1/15. Despite of a second intravenous ceftriaxon treatment for 14 days we observed a retinal vasculitis in the follow up of 6 months.
CONCLUSIONS: Despite intravenous ceftriaxon-therapy borrelia burgdorferi must have survived in the vitreous body. Further investigations are required with respect to the use of other antibiotics or immunosuppressives.
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+10048013
-----------------------------------------
Lyme borreliosis is an underdiagnosed infectious disease caused by a spirochete and transmitted by certain Ixodes ticks. In Lyme disease diagnostic problems are still discussed extensively as the laboratory workup is not standardized and a positive antibody result is not proof of active infection. It is therefore important to appreciate all clinical signs that can prompt us to the diagnostic investigation of Lyme borreliosis. We present a case of a woman with Lyme borreliosis and recurrent unilateral anterior uveitis in her right eye for 2 years, who developed cotton wool spots (CWS) in her left eye, followed by acute and recurrent anterior uveitis in this second eye. An extensive general examination, including blood coagulopathies and ultrasound of the carotid arteries, did not reveal any pathology. The CWS resolved within a few months. The recurrent anterior uveitis could be controlled by topical steroids. After treatment with 2 g of i.v. ceftriaxone
for 3 weeks, she remained free of recurrences for 1 year of observation time. CWS can be the first clinical sign of ocular vascular pathology and/or uveitis. Further investigation will be necessary to confirm the relationship between CWS and ocular borreliosis. In patients with otherwise unexplained CWS, the possibility of an infection with borreliosis should be ruled out carefully.
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+18854948
---------------------------------
Fundus autofluorescence in APMPPE in association with lyme disease
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+12441738
---------------------------------
Molecular Diagnisis of a Bilateral Panuveitis due to Borrelia Burgdorferi Sensu Lato by Cerebral Spinal Fluid Analysis :
http://www.nih.go.jp/JJID/61/214.pdf
---------------------------------
http://www.informaworld.com/smpp/conten ... 542~db=all
-------------------------------------
http://www.infectdis.com/pt/re/idcp/abs ... 28!8091!-1
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Ocular flutter as the first manifestation of Lyme disease
Gyllenborg and Milea Neurology.2009; 72: 291
http://www.neurology.org/cgi/content/sh ... /291?rss=1
-----------------------------------
Ocular flutter is an opsoclonic disorder in which the eyes incontinuously saccadically move around the point of fixation in the field of vision.
http://en.wikipedia.org/wiki/Ocular_flutter
-------------------------------------
Five Cases of Paralytic Strabismus as a Rare Feature of Lyme Disease.
Sauer A, Hansmann Y, Jaulhac B, Bourcier T, Speeg-Schatz C.
Departments of 1Ophthalmology, 2Infectious Disease, Pole Specialty Medecine Ophthalmology Hygiene, and 3Bacteriology, Hopitaux Universitaires de Strasbourg, Strasbourg, France.
Lyme borreliosis is the most common human tick-borne disease in the Northern Hemisphere. The prevalence of Lyme borreliosis is estimated to be 20-100 cases per 100,000 persons in the United States and 100-155 cases per 100,000 persons in Europe [ 1 , 2 ]. It is caused by the spirochete Borrelia burgdorferi sensu lato [ 2 , 3 ]. The course of clinical manifestations is thought to occur in 3 stages: early, disseminated, and chronic [ 2 , 4 ]. Lyme borreliosis can cause a variety of ocular manifestations, and the frequency of these manifestations among cases of Lyme disease involving systemic manifestations is approximately 1% [ 5 ].
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+19193112
------------------------------------
Pérez de Arcelus M, Salinas A, García Layana A.
Departamento de Oftalmología, Clínica Universitaria de Navarra, Pamplona, Spain.
The retina and the choroids are richly vascularised structures and can therefore be colonised by germs via the haematogenous route in the course of a systemic infectious disease. The germs responsible for this type of infection can be fungi, viruses, bacteria and parasites. Ocular candidiasis is outstanding amongst these colonisations because of its frequency; it can manifest itself as an endophthalmitis with a slow and hidden course. The so-called ocular histoplasmosis syndrome, although it is infrequent in our setting, is an important cause of choroidal neovascularisation.
The viruses that most frequently affect the retina are of the herpes type and can produce devastating symptoms in immunoincompetent patients, named acute retinal necrosis syndrome. Retinitis due to cytomegalovirus is more frequent in immunodepressed patients, as in the case of AIDS, but it must also be contemplated in patients with lymphoma and immunomodulatory treatment.
http://www.ncbi.nlm.nih.gov/sites/pubmed/19169295
http://www.ncbi.nlm.nih.gov/entrez/util ... /5213/4405
-----------------------------------
Uncertain reports of orbital myosistis and Jarisch-Herxheimer reaction have also been proposed as a consequence of borreliosis.
In conclusion, ocular involvement in Lyme borreliosis is symptomatic and a routine ophthalmologic evaluation is not recommended in adult patients (younger patients, on the other hand, should be screened due to their poor capacity to complain of ocular disturbances). In order to formulate a rational suspicion of Lyme disease as the cause of ocular inflammation, features must include occurrence in an endemic zone; and/or the report of contact with a tick or of previous erythema migrans; positive serology with presence of IgM in the early stage or high titres of IgG in the later phases. A clear diagnosis, however, remains very difficult. The long-term follow-up of four cases of optic neuritis labelled as Lyme disease because of the positive serology for Borrelia revealed that three patients actually developed demyelinating syndromes.
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+19149119
-----------------------------------
We studied 93 patients with unclassified uveitis from two regions in Japan (Hokkaido and Kanagawa) to assess the contribution of Borrelia species to this condition. The seroprevalence of antibody to Borrelia species was higher in patients from Hokkaido than in those from Kanagawa. The unclassified uveitis of seropositive patients was probably a complication of Lyme borreliosis since (i) the antibody titers were as high as those in clinically diagnosed Lyme disease patients, (ii) healthy controls from Hokkaido showed low seroprevalence in contrast with unclassified uveitis patients from Hokkaido, and (iii) the reaction pattern of antibodies in sera from patients with unclassified uveitis was the same as that in patients with Lyme disease.
This is the first report to reveal the high risk of Lyme borreliosis in patients with unclassified uveitis in regions endemic for Lyme disease. In cases of unclassified uveitis as well as in cases of inflammatory disease of unknown origin, Lyme disease should be taken into consideration, especially in regions in which Lyme disease is endemic, even if it is reported only in animals.
http://cdli.asm.org/cgi/reprint/2/1/53.pdf
-------------------------------
Conjunctival Attachment of a Tick: Clinicopathologic Report of a Case.
Willen C, Mullen GR, Yee J, Read RW.
Department of Ophthalmology, University of Alabama at Birmingham, Birmingham, Alabama.
Attachment by ticks to ocular surfaces is uncommon, but has been reported. The objective of this article is to describe a case of conjunctival tick attachment and a method for removal by conjunctival excision. A 39-year-old man presented to the Emergency Department with a complaint of foreign-body sensation in his right eye. He was found to have a live tick embedded in his conjunctiva. The tick was removed en bloc with surrounding conjunctiva by an ophthalmologist. The arthropod was identified as the larval stage of the Lone Star tick (Amblyomma americanum). The patient did not experience any systemic illnesses or adverse sequelae. Attachment of ticks to the conjunctiva is unlikely to result in disease transmission when the larval stage is involved. However, removal by excision of a surrounding block of conjunctiva is recommended to ensure complete removal of all tick body parts.
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+18514466
------------------------------
http://www.ijo.in/article.asp?issn=0301 ... ulast=Babu
---------------------------------
In Vivo Confocal Microscopy to Confirm the Diagnosis of Borrelia Keratitis? :
http://journals.lww.com/corneajrnl/Cita ... to.18.aspx
---------------------------------
Stage 1 :
- Follicular oedema
- Periorbital conjunctivitis
Stage 2 :
- Anterior/ intermediate euveitis
- peripheral lmultifocal choroiditis
- Panophthalmitis
- Macular oedema
- Cranial nerve palsy
- Optic atrophy
- Neuroretinitis
- Optic neuritis
- AION (arteritic)
- Reversible Horner's Syndrome
- Argyll - Robertson pupil
Stage 3 :
- Stromal / Interstitial keratitis
- Episcleritis
- Scleritis
- Orbital myositis
- Cortical blindness
http://www.teigrandround.com.sg/images/ ... 0YeoTK.pdf
---------------------------------
Abstract
PURPOSE:
To report a rare case of Lyme disease with neuroretinitis from South India.
MATERIALS AND METHODS: Retrospective case report. A 45-year-old lady who hails from the Nagarhole forest in South India presented with a history of tick bite followed by diminution of vision in the left eye. Fundus evaluation of the left eye showed neuroretinitis. Mantoux test, Treponema pallidum hemagglutination test, serum angiotensin converting enzyme, and ELISA for toxoplasmosis and rickettsial infections were negative. ELISA for Lyme disease was positive for IgM antibodies. This was confirmed by Western blot test.
RESULTS: Ocular inflammation resolved with a course of doxycyline and oral steroids. The species of the tick was also identified.
CONCLUSION: This case highlights the need to consider Lyme disease, though rare in India, in the differential diagnosis of neuroretinitis especially if the patient hails from a forest area.
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+20370334
-------------------------------
The ocular manifestations of Lyme Disease :
http://www.ophed.com/drupal/sites/defau ... isease.pdf
--------------------------------
http://informahealthcare.com/doi/abs/10 ... 1003687294
-----------------------------------
Arch Ophthalmol. 2008;126(8):1165-1166.
To our knowledge, Lyme disease–associated orbital myositis has been serologically confirmed in 3 reported cases.1-3 No cases of dacryoadenitis have been reported in association with this disease entity.
Report of a Case
A 66-year-old, previously healthy woman had a 6-day history of right periorbital edema, erythema, diplopia, pain with eye movement, tearing, nausea, and vomiting. She reported a deer tick bite on the posterior neck 2 months prior that occurred while hunting during the early summer months in northern Wisconsin. The bite was followed by 3 weeks of fever, nausea, diarrhea, weakness, arthralgias, and a diffuse rash, all of which resolved after a 10-day course of ciprofloxacin hydrochloride
Examination revealed best-corrected visual acuities of 20/20 OD and 20/25 OS as well as no afferent pupillary defect. Intraocular pressure measured 15 mm Hg OU. There was a mild right exotropia with moderately limited right eye ductions in all fields of gaze. Binocular diplopia was reported 10° to 15° away from primary in all directions.
Moderate right periorbital edema, erythema, and upper eyelid ptosis were present (Figure 1). Mild right-sided proptosis was noted on Hertel exophthalmometry with measurements of 18 mm OD and 16 mm OS. Slitlamp examination revealed mild chemosis and injection of the right conjunctiva, but the results were otherwise unremarkable. Dilated funduscopy was normal bilaterally with no evidence of optic disc edema, subretinal fluid, or posterior segment inflammation.
Given the paucity of clinical or imaging evidence of infectious orbital cellulitis, the patient began receiving oral prednisone (60 mg daily) for presumed orbital inflammation. She improved within 1 week of therapy. However, with a decrease to 50-mg daily therapy, her symptoms worsened until her dose was increased back to 60 mg daily.
Laboratory data revealed an elevated erythrocyte sedimentation rate (108 mm/h), an elevated C-reactive protein level (60 mg/L [to convert to nanomoles per liter, multiply by 9.524]), and a positive Lyme enzyme immunoassay screen (Lyme index value, 3.65; positive result is > 1.21). The complete blood cell count results, thyroid-stimulating hormone level, antineutrophil cytoplasmic antibody level, and rheumatoid factor level were normal.
Based on the positive Lyme serological results, treatment with oral doxycycline (100 mg twice daily) was started for Lyme-associated orbital inflammation. The oral steroid was continued and tapered by 10 mg weekly. Within 2 weeks of starting doxycycline therapy, the patient's symptoms had largely resolved. She completed a 4-week course of doxycycline and an 8-week tapered course of prednisone with complete resolution of her symptoms
http://archopht.ama-assn.org/cgi/conten ... 126/8/1165
----------------------------------
Blanc F, Ballonzoli L, Marcel C, De Martino S, Jaulhac B, de Seze J.
Abstract
Lyme optic neuritis (ON) is a rare disease and only a few cases have been reported. We describe two cases of isolated Lyme ON, one with recurrence 9 months after the appearance of initial symptoms. Diagnosis criteria for multiple sclerosis and neuromyelitis optica were not met. The etiological diagnosis was based on European case definition criteria for neuroborreliosis. Both patients had positive serum and cerebrospinal fluid serology, a positive intrathecal anti-Borrelia antibody index, and a good outcome on ceftriaxone. Specific diagnosis of Lyme ON is important since improvement of visual acuity is possible with specific antibiotherapy, even after many months. Copyright (c) 2010 Elsevier B.V. All rights reserved.
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+20621802
------------------------------
Retrobulbar optic neuritis (RON) is an unusual complication of Lyme disease. The diagnosis of early Lyme disease is difficult, and the relationship between RON and Lyme disease remains controversial. None of the 14 cases of optic neuritis described in the literature in association with Lyme disease fulfilled the Halperin and Sibony criteria for active Lyme disease. We report the first case of acute Lyme disease complicated by RON established using the Halperin and Sibony criteria.
Lyme disease is a multisystem infectious disease caused by tick borne spirochetes of the Borrelia burgdorferi group. Diagnosis of this infection can be difficult and serological testing such as western blot can be useful. Cranial neuropathies are common but RON has been reported in a few isolated cases.1 A causal link between optic neuritis and Lyme disease has not been established and remains controversial. We report a case of active neuro-Lyme disease complicated by RON
http://jnnp.bmj.com/content/78/12/1409.extract
-----------------------------------
http://medical-dictionary.thefreedictio ... c+neuritis
------------------------------------
http://www.ncbi.nlm.nih.gov/pubmed/22469684
---------------------------------
-------------------------------
http://www.ncbi.nlm.nih.gov/pubmed/15937426
-------------------------------
http://journals.lww.com/jneuro-ophthalm ... ult.1.aspx
----------------------------------
The jury may still be out as far as Lyme optic neuritis and retrobulbar neuritis caused by Lyme disease, however these were published after 2005:
http://www.ncbi.nlm.nih.gov/pubmed/16773934
---------------------------------------
-
pogorszenie widzenia, metamorfopsje (zniekształcone widzenie),
utrata pola widzenia/mroczki,zaburzenia widzenia barw, bóle oczu,
zaburzenia motoryki gałek ocznych z towarzyszącym podwójnym
widzeniem obuocznym, ból przy poruszaniu oczami,zez niejasnego
pochodzenia,
-
nawracające stany zapalne wszystkich segmentów oka (zapalenie
spojówek, zapalenie rogówki,zapalenie tęczówki, zapalenie błony
naczyniowej oka,zapalenie ciała rzęskowego, zapalenie
siatkówki,zapalenie tarczy nerwu wzrokowego, zapalenie nerwu
wzrokowego, pozagałkowe zapalenie nerwu wzrokowego), zapalenie
naczyń siatkówki oraz stany zapalne ciała szklistego o różnorodnej
lokalizacji i położeniu (zapalenie ciała szklistego, układowe
zapalenie naczyń siatkówki, zapalenia okołożylne,zapalenie
naczyniówki, zapalenie naczyniówki i siatkówki) mogące obejmować
również plamkę żółtą,
- guz
rzekomy oczodołu, obrzęki i zmiany skórne wokół oczu
-
podwyższone ciśnienie wewnątrzgałkowe jako skutek jaskry wtórnej
w stanach zapalnych
http://lymepoland.com/pliki/Zalecenia_DBG.pdf.
----------------------------------------------------------------------------------------------------
Borelioza z Lyme może powodować wiele objawów ocznych, przybierając różne postacie. Częstotliwość zajęcia narządu wzroku w boreliozie wynosi 2-4%(wg Bodagni), możliwe w każdym stadium choroby, najczęściej jednak w późnych fazach.
Pacjent z zajęciem narządu wzroku w przebiegu choroby z Lyme powinien być traktowany jak z infekcją OUN
U 20 pacjentow . z objawami ocznymi w przebiegu boreliozy stwierdzono u10 :zapalenie błony naczyniowej, 5-zapalenie przydatków oka, 4-objawy neurookulistyczne , 1-centralne zamknięcie żyły siatkówki; kontakt z kleszczem zgłaszało 13 pacjentów
(The expanding clinical spectrum of ocular lyme borreliosis. Mikkilä HO, Seppälä IJ, Viljanen MK, Peltomaa MP, Karma A. Department of Ophthalmology, Helsinki University Central Hospital, Finland. Ophtalmology 2010, PubMed
Wg Golubić i wsp. (Chorwacja) –wśród 11 pacjentów z postacią oczną boreliozy : chorioretinitis- 6; zapalenie grudkowe spojówek 2; zapalenie błony naczyniowej-2; zamknięcie ż.sr.siatkówki-1;pozagałkowe zapalenie n II-1; neuroretinitis -1
[Ocular manifestations of Lyme borreliosis in northwest Croatia]. Golubić D, Vinković T, Turk D, Hranilović J, Slugan I. Zupanijska bolnica Cakovec, Djelatnost za infektologiju.2004;5-6 PubMed
Wg Huppertz (Niemcy) i wsp. w gr. 84 dzieci z zapaleniem stawów na tle boreliozy : narząd wzroku zajęty u 3 pacjentów w postaci zapalenia rogówki i zapalenia błony naczyniowej (anterior uveitis, pars planitis)
Ocular manifestations in children and adolescents with Lyme arthritis. Huppertz HI, Münchmeier D, Lieb W. Children's Hospital, University of Würzburg, Würzburg, Germany. Br.J Ophtalmol. 1999.PubMed.
Borelioza- stadium I
Objawy układowe,Rumień wędrujący,Bóle głowy, złe samopoczucie, zmęczenie,Bóle mięśni i stawów,Powiększone węzły chłonne
Objawy oczne , Zapalenie spojówek, Zapalenie nadtwardówki, Obrzęk okołooczodołowy
Zapalenie spojówek ,Obustronne zaczerwienienie i przekrwienie, Reakcja grudkowa, wydzielina ropna w worku spojówkowym , obrzęk, czasami wylewy podspojówkowe, Zapalenia nadtwardówki i twardówki Występuje b. rzadko- dotyczy I i III stadium choroby,Zapalenia nadtwardówki: proste i guzkowe,Zapalenie ziarninujące twardówki , Zapalenie tkanek oczodołu
Borelioza-stadium II (disseminated)
Objawy układowe Schorzenia układu mięśniowoszkieletowego, Zapalenie opon mózgowych i mózgu, neuropatie obwodowe Zapalenie mięśnia sercowego-bloki przewodnictwa
Objawy oczne Zapalenie błony naczyniowej (zapalenie ziarninujące tęczówki i ciała rzęskowego) Zapalenie części pośredniej błony naczyniowej. Panuveitis Zapalenie naczyń siatkówki Zapalenie nerwu wzrokowego Torbielowaty obrzęk plamki Porażenie nerwów okoruchowych
Zapalenie błony naczyniowej (ZBN) Lokalizacja: odcinek przedni, pośredni, tylny Przebieg: ostry, przewlekły, nawracający Ciężkość: łagodne, ciężkie Charakter: ziarninujące czy nieziarninujące
Zapalenie błony naczyniowejobjawy kliniczne: Triada: ból, zaczerwienienie, światłowstręt ,Spadek ostrości wzroku, męty, łzawienie ,Wysięk w komorze przedniej, osady na śródbłonku rogówki, zrosty przednie , Vitritis, wysięki w okolicy pars plana („kule śnieżne”), pływające męty, może przebiegać z wtórnym zajęciem siatkówki-zapalenie naczyń, obrzęk torbielowaty plamki
Borelioza a zapalenie błony naczyniowej ,Wg. Jumper z.b.n. na tle boreliozy stanowi reakcję immunologiczną na bezpośrednie zakażenie tkanek oka.
DNA bakterii (met. PCR) znaleziono w próbce ciała szklistego pobranego w biopsji diagnostycznej, bad. histologiczne również potwierdziło obecność krętka w próbce.
Wg. innych autorów objawy oczne mogą stanowić reakcję autoimmunologiczną. Wg. Bodaghi: patogeneza kontrowersyjna- bezpośrednie zakażenie oka i opóźniony mechanizm nadwrażliwości zaangażowane są w rożnych okresach choroby.
Krętek może wnikać do oczu i pozostawać w formie utajonej, wywołując zarówno wczesne i późne objawy.
Zapalenie n II i siatkówki- neuroretinitis
Spadek ostrości wzroku, zaburzenie widzenia barwnego, mroczek centralny w polu widzenia Przekrwienie i obrzęk tarczy n II , Płomykowate krwotoczki okołotarczowe ,Obrzęk plamki w postaci gwiazdy
Zapalenie n II i siatkówkineuroretinitis
Porażenie nerwów czaszkowych w neuroboreliozie .Inwazja krętka do układu nerwowego- zapalenie opon m-rdz. z zajęciem nerwów czaszkowych (VII, VIII, IX, X, XII)
Może być izolowane porażenie jako mono- lub poli- neuritis (wg.A. Sauer).
Zajęcie nerwów gałkoruchowych najczęściej dotyczy n VI-odwodzącego, rzadziej n III i IV
Neuroborelioza- porażenie n VI
Dwojenie, zez zbieżny, ograniczenie odwodzenia
WUG w celu zmniejszenia dwojenia (twarz w kierunku działania porażonego mięśnia)
Leczenie: systemowe ,Miejscowe: zasłonki, pryzmaty, toksyna botulinowa.
Neuroborelioza- porażenie n VI
Borelioza-Stadium III - trwałe Objawy układowe ,Encefalopatia ,Przewlekłe zap. stawów Zapalenie rdzenia kręgowego ,Zaburzenia psychiczne, Limfoadenopatia ,
Objawy oczne ,Przewlekłe zapalenie wewnątrzgałkowe ,Czasami zapalenie nadtwardówki ,Śródmiąższowe zapalenie rogówki
Zapalenie rogówki - objawy kliniczne:
Światłowstręt, czerwone oko, pogorszenie ostrości wzroku.
W lampie szczelinowej stwierdza się: śródmiąższowe przymglenie rogówki, łagodny obrzęk zrębu, odczyn zapalny w komorze przedniej oka, nawracające zapalenie prowadzi do neowaskularyzacji rogówki.
Wywiad -bardzo istotny, pomaga nam w poszukiwaniu czynnika etiologicznego zapalenia.
Zapalenie rogówki
Leczenie zapalenia rogówki
W leczeniu stosujemy antybiotyki miejscowo, początkowo co godzinę przez 24-48 godzin, następnie co 2 godziny przez kolejne 48 godzin, a następnie 4 razy na dobę przez tydzień.Podawane są również cykloplegiki w celu zniesienia bólu wywołanego skurczem mięśnia rzęskowego oraz zapobiegania zrostom tylnym, czasami wymagane podanie leków przeciwbólowych.
Podsumowanie
Borelioza- jako jednostka chorobowa wymaga współpracy lekarzy wielu specjalności, w tym również okulisty.
Pacjent z boreliozą, zgłaszający problemy z widzeniem powinien być zawsze konsultowany i objęty opieką Poradni Okulistycznej
http://www.slideshare.net/ArturGrabos/objawy-oczne-boreliozy
------------------------------------------------------------------------------------
Porażenie nerwów zewnątrzgałkowych w neuroboreliozie
http://www.slideshare.net/ArturGrabos/poraenie-nerww-zewntrzgakowych-w-neuroboreliozie
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Objawy oczne Boreliozy
https://www.podyplomie.pl/okpd_online/articles/17600
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Borelioza oczna - ocularborreliosis
Tlumaczenie : geodeta.
Gatunki Stephanii, najbardziej S. tetrandra, są bardzo dobre na zapalenia oczu wywołane przez boreliozę. W rzeczywistości, cały szeroki zakres ocznych objawów boreliozy może być leczony z sukcesem tymi właśnie ziołami. Zioła nie dopuszczają również do zbijania się komórek i chemotaksji oraz zabezpieczają komórki śródbłonkowe. Istnieje możliwość, iż zioła te zakłócają dynamikę
przylegania do siebie komórek borelii. Przede wszystkim odkryto jednak, że te rośliny zwiększają efektywność antybiotyków i innych farmaceutyków w leczeniu nowotworów czy wielorakich wirusów takich jak malaria. Lekarstwa zdezaktywowane przez nowotwory i mikroby dzięki rozmaitym mechanizmom odporności stają się bardzo efektywne kiedy podamy je w połączeniu z ziołami Stephania. Niedawne odkrycia dowodzą również, że Stephania wzmaga działanie
innych ziół.
Szeroki zakres działania tych ziół, odpowiedni dla wielu symptomów boreliozy oraz niezwykła natura ich działania sugerują, iż są one potencjalnie wspaniałymi ziołami dla leczenia choroby z Lyme. Niestety są one trudno dostępne. Szczególnie S. cepharantha. Spore ilości S. tetrandra można zamówić u importerów chińskiej medycyny i generealnie musi ona być przetworzona do
postaci kapsułek, nalewek, wywarów i naparów (patrz źródła). Problemy w zakupie solidnych zapasów tych ziół sa powodem nie uwzględnienia korzenia Stephanii wśród leków opisanych na czele protokołu.
PROBLEMY Z OCZAMI
Krętki borelii atakują wodnisty płyn (ciało szkliste) oka prawie natychmiast po dostaniu się do ciała człowieka. Jest to jeden z powodów dlaczego tak wiele osób z boreliozą mówi o "mętach w ciele szklistym" w ich polu widzenia. To że krętki dostają się do tej części ciała ludzkiego, sprawia
leczenie o wiele trudniejszym gdyż antybiotyki działają bardzo wolno lub wcale w tym środowisku (miejscu).
Główny protokół powinien znacznie pomóc w dolegliwościach ocznych. Jednakże, wiele symptomów infekcji borelią - mętny, rozmazany obraz, ciśnienie w gałce ocznej i inne - mogą zostać usunięte poprzez zioła i suplementy wymienione tutaj. W wielu przypadkach, infekcja
borelią ciała szklistego oka powoduje rodzaj delikatnej jaskry. Rozbicie kolagenu i zapalenie od infekcji bakteryjnej są bardzo podobne do procesów zachodzących w tej chorobie (jaskrze). Jaskra jest chorobą spowodowaną wzrostem ilości płynu wewnątrzgałkowego co powoduje z kolei ciśnienie
wewnątrz oka. Rozmyty obraz jest jednym z objawów. Degeneruje się kolagen. W istocie kolagen w oku psuje się (degraduje) i nie zostaje przetworzony właściwie więc narasta w szkliste oka. To blokuje drenaż płynu z oka i wzrost ciśnienia wewnętrznego. Kiedy ciśnienie wzrasta, nerw wzrokowy może zostać uszkodzony. To powoduje rozmazany, zamglony obraz, utratę pobocznego
widzenia, efekt aureoli wokół świateł, "ślepe" plamki, bóle oczu i zaczerwienienia ( i wiele innych dręczących dolegliwości w boreliozie).
Prawdopodobnie najlepszym ziołem na problemy z oczami jest Stephania root . Vincamina może również okazać się wyjątkowo pomocna. Witamina C wspomaga struktury kolagenu w oczach, jak również Cynk.
PROTOKÓŁ DLA PROBLEMÓW Z OCZAMI:
Stephania root - połowa łyżeczki do herbaty nalewki 3x dziennie
przemywać oczy wywarem
Vincamine - 20mg 3x dziennie
Witamina C - 1000mg 3x dziennie (musujące sole???)
Cynk - 40mg dziennie
KORZEŃ STEPHANII ( STEPHANIA TETRANDRA, STEPHANIA CEPHARANTHA )
RODZINA: Menispermiaceae
UŻYWANA CZĘŚĆ ROŚLINY: korzenie i korzonki, czasami pnącza
DZIAŁANIE: Przeciwobrzękowe, przeciwzapalne, bloker kanału wapniowego,
czynnik rozszerzający naczynia, przeciwzwłóknieniowe, przeciwbólowe,
relaksator mięśni gładkich, przeciwpasożytnicze, przeciwgorączkowe,
przeciwnowotworowe, antybakteryjne, moczopędne, przeciw artretyczny, środek
uspokajający, przeciwastmatyczny.
FUNKCJA W BORELIOZIE: dla zapalenia nerwów, stawów, odmiana oczna boreliozy,
obrzęki, mialgie, immunomodulator
SPECYFICZNE WSKAZANIA: paraliż Bell'a, oczne objawy boreliozy (uveitis,
conjunctivis etc.), artretyzm, neuroborelioza, artretyzm oporny na leczenia
antybiotykami, późne stadia boreliozy układu nerwowego, stawy, skóra.
UWAGA!
Należy uważać z zastosowaniem tych ziół przy boreliozie „sercowej”."
http://forum.gazeta.pl/forum/w,26140,58403509,58403509,Borelioza_oczna_ocularborreliosis.html
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okulistyka :
11.4. Borelioza (choroba z Lyme)
Chorobę
tę wywołują krętki. Jest przenoszona przez kleszcze wskutek ich
ukąszenia. Objawy oczne boreliozy są częste i mogą być poważne.
Zaliczamy do nich:
światłowstręt,
ból, obrzęk okołooczodołowy,
zapalenie
mięśni oczodołowych,
odcinek
przedni – zapalenie spojówek,
nadtwardówki,
rogówki, zapalenie błony naczyniowej,
odcinek
tylny – zapalenie naczyniówkii siatkówki,
okołożylne
zapalenie siatkówki,
zmiany
neurookulistyczne – zapalenie
siatkówki
i tarczy nerwu II, zapalenie nerwu II,
porażenie
nerwów ruchowych gałek ocznych.
11.5.
Chlamydioza
To
chlamydiowe zakażenie narządów płciowych. Objawy oczne choroby
nie występują często i są to:
grudkowe
zapalenie spojówek (występuje także u noworodków),
obwodowe
podnabłonkowe nacieki rogówkowe,
mikrołuszczki
w górnej części rogówki.
http://www.okulistyka.com.pl/_okulistyka/edu/07.pdf.-----------------------------------------------------------------
Co to jest i jakie są przyczyny?
Zaburzenia ruchów oczu (zwrotów) mogą być spowodowane uszkodzeniem ośrodków i szlaków zarządzających obuocznymi ruchami oczu na skutek chorób neurologicznych. Powstaje wówczas porażenie spojrzenia. Natomiast w zezie porażennym porażenie lub niedowład, czyli częściowe porażenie, dotyczy jednego mięśnia lub kilku mięśni gałki ocznej. Zez ten występuje wskutek uszkodzenia samego mięśnia lub, co zdarza się znacznie częściej, wskutek urazu lub choroby nerwu zaopatrującego dany mięsień.
Przyczyną porażenia mogą być choroby lub urazy ośrodkowego układu nerwowego (guzy, tętniaki, stwardnienie rozsiane, miastenia, choroby zakaźne, gościec, zakażenia wirusowe, borelioza, zatrucia).
http://okulistyka.mp.pl/objawychoroboczu/show.html?id=86449
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Zaćma / katarakta - Borelioza i Bartonella
Bacterial tick-borne diseases caused by Bartonella spp., Borrelia burgdorferi sensu lato, Coxiella burnetii, and Rickettsia spp. among patients with cataract surgery.
CONCLUSIONS:
Presence of DNA of yet uncultured and undescribed species of Bartonella in eye liquid indicates past infection with this pathogen. Specific antibodies to B. burgdorferi sensu lato and Bartonella sp. are detected more frequently in patients with cataract compared to the control group. This could indicate a possible role of these organisms in the pathological processes within the eyeball, leading to changes in the lens. Further studies are needed to identify Bartonella species, as well as to recognize the infectious mechanisms involved in cataract development
---------------------------------------------
RECENT FINDINGS:
Vision-threatening ophthalmic manifestations are relatively common in Lyme disease and Rocky Mountain spotted fever. Ocular involvement is rare in babesiosis, tick-borne relapsing fever, Powassan encephalitis, ehrlichiosis, anaplasmosis, and Colorado tick fever.There are clear guidelines for diagnosis and treatment of Lyme disease; however, confusion and misinformation among the general public as well as controversy about chronic or late-stage Lyme disease can impact the evaluation of ophthalmic disease. Furthermore, there are many gaps in our knowledge regarding the pathophysiology of ocular borreliosis although it seems likely that Lyme uveitis is rare in the United States.
http://www.ncbi.nlm.nih.gov/pubmed/27585218
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Abstract
Fortunately, involvement of the eye is uncommon in lyme disease. But when the eyes can be affected in many different ways by the disease.
In the early stage of the disease, many persons have conjunctivitis. In this condition, commonly called pink eye, the eyes are red and uncomfortable, and there is a discharge of pus. Unlike many forms of conjunctivitis, the type that occurs in lyme disease is not contagious.
In later stages of the disease, inflammation of the eye may develop. Parts of the eye that may be affected include the uvea, the middle layer inside the eye, the cornea, part of the outer coat of the eye; the iris, the colored circle around the pupil, and the choroid, a layer of blood vessels in the eye. Ocular symptoms can include sensitivity to light and floaters (spots in front of the eyes).
Inflammation of the optic nerve (optic neuritis) also can occur, which results in visual loss. Loss of vision can result from inflammation in the brain as well.
Persons who develop Bell’s palsy may be unable to blink or close their eyes. This dries the cornea and can result in an infection or even a hole in the cornea, which can endanger vision if not treated promptly.
Klinik und Poliklinik für Augenheilkunde, Martin-Luther-Universität, Halle-Wittenberg.
BACKGROUND: Borrelia burgdorferi is the cause of erythema chronicum migrans and Lyme disease. Ticks like Ixodes ricinus are responsible for transmission. Frequently, the tick bite is not noticed by the patient. Eye manifestations, such as keratoconjunctivitis, scleritis, chronic uveitis, vitritis, chorioretinitis, optic nerve disease, orbital myositis and paresis of the eye muscles, often occur after a long period of time and vary greatly. PATIENTS AND METHODS: We present below the case reports of a man 38 years old and a woman of 31, each with manifestation of an ocular Borrelia infection (papillitis and panuveitis, respectively). RESULTS: By antibody-screening with the ELISA technique and Western Blot analysis we were able to prove the serological infection. After specific antibiotic therapy, ocular inflammation improved rapidly, as did visual acuity. The papillitis only healed partially. CONCLUSIONS: In case of therapy-resistant inflammation of the eye we have to exclude general infections because cortisone therapy alone may result in worsening the condition. VECP can be used effectively in the differential diagnosis of papilloedemas. Early diagnosis and therapy of an acute Borrelia infection restrict the extent of the lesions and prevent ocular and general late manifestations. Seronegative values in subjects strongly suspected of having Lyme disease do not necessarily exclude the diagnosis of Lyme disease.
Department of Ophthalmology, University of Helsinki, Finland.
PURPOSE:
Ocní klinika LF UK, Plzen.
The authors present an account of two patients with anterior uveitis in the second stage of Lyme borreliosis. The draw attention to diagnostic problems of the disease from the ophthalmological aspect
Wilk CM, Bialasiewicz AA, Ruprecht KW, Naumann GO.
Augenklinik mit Poliklinik, Universität Erlangen-Nürnberg.
Two patients with bilateral extensive confluent choroidal lesions, exudative retinal detachments, positive lyme serology and a typical history are documented: A 32-year-old woman presented 14 days after a "flu-like" illness with bilateral acute extensive choroidal lesions and exudative retinal detachments (OD from 5 to 8:30 o'clock, OS from 5 to 8 o'clock, both including the macula) accompanied by a mild lymphocytic meningitis. The laboratory work-up revealed increased serum and CSF titers of antibodies against Borrelia burgdorferi (Lyme immunofluorescent test (IFT) and Lyme-IgM IFT) which declined after a 14-day treatment with doxycycline (200 mg/d), CSF titers non-detectable (serum IgG: from 1:640 to 1:320, serum IgM: from 1:40 to 1:20). A distinct improvement with visual acuity increasing from OD 0.2/OS 0.3 p to OD/OS 0.8 p was observed after seven days of treatment. A 40-year-old man with a 14-day history of tick-bite developed the same, though more severe ocular findings and a lymphocytic meningitis. The serological work-up revealed increased antibody titers against Borrelia burgdorferi (ELISA); the IgM titer was normal. After a 10-day treatment with penicillin, antibody titers against the spirochete decreased slightly and the patient's neurologic and ophthalmologic status improved dramatically. Five weeks after admission visual acuity was OD/OS 0.5 (compared to OD/OS 0.1) and has remained at 0.8 p (OD/OS) since the ninth week after onset. The clinical course of the disease and the decreasing lyme serology strongly suggest an infection with Borrelia burgdorferi. The authors propose thorough laboratory work-ups including tests for Lyme disease in selected patients with diffuse choroidal lesions.
Service d'Ophtalmologie, HIA Clermont Tonnerre, BP 41, 29240 Brest-Armées.
INTRODUCTION: The diagnosis of Lyme disease in the presence of an acute optical neuritis always raises a difficult diagnostic problem. We present a case of Lyme-associated Leber's hereditary optic neuropathy (LHON). OBSERVATION: A 17-year-old Eurasian young man presented with left-eye visual impairment for 1 month. This loss of vision acuity in the left eye is related to an optic neuropathy. Mitochondrial DNA testing showed a G to A substitution at position 11778 confirming a diagnosis of LHON. The family history disclosed a case of LHON in a maternal cousin. The mother's family is Asian. Besides, serum examination of anti-Borrelia antibodies was performed and was positive against Borrelia burgdorferi garinii. The patient history indicated that he had been possessing a dog and was living in an endemic area of Lyme disease. But he did not recall receiving a tick bite nor having any erythema chronicum migrans. Initial examination showed bilateral green-red axis colour vision defects which made us fear bilateralisation of the optic neuropathy, which occurred 2 months later (that is 3 months after the onset of symptoms on the left eye). An antibiotic treatment by ceftriaxone was administered for 4 weeks all in all; and a long term ubidecarenone therapy was established. At present, after a 1-year follow up, the eyes' conditions remains unchanged. CONCLUSION: To our knowledge, this would be the first case reporting such an association, in which we can discuss the fortuitous character or the role of the infectious factor in the developing of the mitochondrial pathology. This observation also raises the problem of the positive diagnosis of Lyme disease when tick bite and erythema are absent or underestimated.
Miyashiro MJ, Yee RW, Patel G, Ruiz RS.
Department of Ophthalmology and Visual Science, The University of Texas Medical School at Houston, 77030, USA.
PURPOSE: To report a case of Lyme disease that presented with a single nummular unilateral interstitial keratitis. METHODS: Case report and review of the literature. RESULTS: A 57-year-old black man who had contact with freshly killed deer had a chief complaint of foreign-body sensation in his right eye (OD) that had been diagnosed and treated for herpes simplex stromal keratitis. The patient underwent a systemic workup for interstitial keratitis. All results including RPR and MHA-TP were negative except for Lyme antibody titer (enzyme-linked immunosorbent assay [ELISA]) 178 U/ml (normal, <159 U/ml). CONCLUSION: Interstitial keratitis from Lyme disease has been regarded as a bilateral disease in the literature. We present this infrequent ocular manifestation of Lyme disease as a rare single nummular unilateral presentation
Clínica Oftalmológica, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
Lyme disease is a multisystemic disorder caused by Borrelia burgdorferi spirochete, transmitted by ticks. Mainly described in the northern hemisphere and rarely in Brazil. The purpose of this report is to describe a patient with Lyme disease who developed bilateral tonic pupil as the only remaining sign. A 13-year-old female with Lyme disease, presented with bilateral peripheral facial and oculomotor paralysis. After recovery from neurological abnormalities the patient sustained anisocoria, reduced fotomotor reflex, less than normal amplitude of accommodation, tonic pupil constriction for near objects and slow redialation in both eyes. Dilute 0.1% pilocarpine test was positive in both eyes, confirming the suspicion of bilateral tonic pupil. This is the first case report of bilateral tonic pupil caused by Lyme disease.
Reim H, Reim M.
Augenklinik, Medizinischen Fakultät, Rheinisch-Westfälischen Technischen Hochschule Aachen.
During the years 1988 to 1990 ten patients were observed in the eye clinic of RWTH Aachen with ocular findings of infection with Borrelia burgdorferi. 6 of them showed neuro-ophthalmological signs, 4 had uveitis. In both groups recent infections were documented in fresh and chronic stages of the disease, lasting longer than one year. The various clinical pictures of the disease following infection with Borrelia burgdorferi are described. As a vaccination against Borreliosis is not yet available, it is important to detect the antibodies against Borrelia burgdorferi early enough, to initiate an effective treatment.
Augenklinik mit Poliklinik der Universität Erlangen-Nürnberg.
We report on a 22-year-old white female with bilateral Leber's stellate neuroretinitis occurring 5 weeks after a viral-like illness. Serological tests revealed a seroconversion for Borrelia burgdorferi indicating an etiological connection. During therapy with 200 mg doxycycline daily for 2 weeks on systemically steroids the optic disc swelling and macular star figure resolved. Visual acuity improved from 0.4 to 1.0 in this time period. It is important that the ophthalmologist should consider Lyme-Borreliosis in isolated neuroretinitis, because the prognosis depends on the time when treatment is initiated.
Univ.-Augenklinik mit Poliklinik der Friedrich-Alexander-Universität Erlangen-Nürnberg.
A significant B. burgdorferi seroconversion with an IgM of 1:80 was observed in a patient complaining of loss of vision in his right eye. The finding correlated morphologically with hyperpigmentation and depigmentation in the macular region, similar to pigment epitheliitis or choriocapillaritis. In the course of the following four weeks the IgM decreased by four titer steps. The visual acuity of the patient's right eye recovered from 0.4 on admission to 1.0 on discharge. The angiogram did not reveal any pathology. Since choroidal manifestations have often been documented in patients with B. burgdorferi infections, it is recommended that serological workups be performed in such patients. Studies in larger groups of patients are necessary to establish the relevance of this case report and its significance concerning infection as a cause of choriocapillaritis.
Department of Ophthalmology, University of Helsinki, Finland.
PURPOSE:
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+7832219
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PURPOSE:
To describe a case of uveitis that is associated with Borrelia hermsii relapsing fever. DESIGN: Interventional case report.
METHODS: A 12-year-old boy with two weeks of relapsing fevers 10 days after camping in remote eastern Oregon was examined. Borrelia hermsii immunoglobulin M and G levels were markedly elevated. Intravenous ceftriaxone, followed by four weeks of oral cephuroxime was administered, but the patient developed unilateral floaters and blurred vision in association with anterior and intermediate uveitis.
RESULTS: Doxycycline was administered for presumed residual infection. Four weeks later, the visual acuity had improved. The anterior chamber was quiet, and topical corticosteroid was tapered successfully.
CONCLUSION: Although rare, Borrelia hermsii should be included in the list of spirochetal diseases that are associated with uveitis.
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Meier P, Blatz R, Gau M, Spencker FB, Wiedemann P.
Klinik und Poliklinik für Augenheilkunde der Universität Leipzig.
BACKGROUND: Ocular manifestations of Lyme borreliose present with unusual forms of conjunctivitis, keratitis, optic nerve disease, uveitis, vitritis and rarely endophthalmitis. CASE REPORT: A 57-year-old man working as logger in Sax-ony-Anhalt suffering from an endophthalmitis on his left eye was referred to us. The vision of his left eye was intact light perception and hand motions. The slit-lamp examination revealed severe inflammation of the anterior chamber with hypopyon, posterior synechiae, and opacity of the posterior lens capsule. Funduscopy showed no red reflex, no retinal details. In the local hospital serum analysis was performed and showed in Western-Blot IgM- and IgG-antibodies against Borrelia burgdorferi. Despite of intravenous application of ceftriaxon for 14 days panuveitis persisted, and endophthalmitis developed when antibiotic therapy was finished. RESULTS: During pars plana vitrectomy a sharply delineated cystic lesion containing yellowish fluid was revealed, and creamy yellow fluid was aspirated. Microscopically in hematoxylineosin stained slides of the aspirate structures consistent with Borrelia burgdorferi were found. Postoperatively vision increased to 1/15. Despite of a second intravenous ceftriaxon treatment for 14 days we observed a retinal vasculitis in the follow up of 6 months. CONCLUSIONS: Despite intravenous ceftriaxon-therapy borrelia burgdorferi must have survived in the vitreous body. Further investigations are required with respect to the use of other antibiotics or immunosuppressives.
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+10048013
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Neuroborreliosis is a form of borreliosis that affects the central and/or peripheral nervous system. Although it can mimic neurologic and ophthalmologic disorders such as multiple sclerosis and optic neuritis, visual evoked potential (VEP) examination is usually not used in neuroborreliosis diagnostics. Combined VEP testing (pattern-reversal VEPs and VEPs produced in response to linear and radial motion) was performed in 81 patients with neuroborreliosis verified by laboratory results (positive polymerase chain reaction or intrathecal antibodies production). Thirty-four patients reported diplopia or blurred vision related to borreliosis. In 33 (40%) patients the VEPs were delayed: motion-onset VEPs were pathologic in 22 (27%) patients, reversal VEPs in 5 (6%) patients, and both VEP types in 6 (7%) patients. The findings suggest that VEP testing (especially the motion-onset VEP testing) can confirm CNS involvement. Much higher sensitivity of motion-onset VEPs in comparison with reversal VEPs can result from rather selective (earlier) involvement of the magnocellular system or the dorsal stream of the visual pathway
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+17016151
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We present a case of eye involvement -- intermediate uveitis -- during tick-borne borreliosis in a 10-year-old boy. Ophthalmologic examination revealed impaired vision, apparent thick floating whitish opacity in the vitreous humour of the left eye and fine fibres in the vitreous humour of the right eye. Sonographic examination confirmed hyperechogenic opacity in the vitreous humour. An autoimmune process was suspected but not confirmed. Serological examination showed IgG antibodies against three pathogenic borreliae and borderline values of IgM antibodies against Borrelia garinii were found by immunoblot. The boy was treated with intravenous ceftriaxone for 21 days. The subsequent sonographic examination showed only minute sporadic echogenicity. Biomicroscopically, only residual opacity in the vitreous humour was found. Isolated eye involvement of borrelia aetiology is rare. The discussion provides a review of similar cases of uveitis including diagnosis of the eye form as published in literaturę
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+17703406
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Koch F, Augustin AJ, Böker .
University Eye Hospital Bonn, Germany.
Borreliosis or Lyme disease, a tick-borne infection with the spirochete Borrelia burgdorferi, can cause various ocular and neurological symptoms. A 41-year-old man had been repeatedly bitten by ticks in June 1992; 6 months later, the patient complained of blurred vision in both eyes of 1-week duration, bifrontal headache that was more pronounced on the right side, and neck pain that had appeared months earlier and was becoming more severe. On ophthalmoscopy, clover-shaped retinal pigment epithelium detachments around the optic disc were observed in both eyes. The patient's visual acuity was reduced to 0.5 in his left eye. Liquor cells and total protein were significantly increased; however, a hemagglutination inhibition test revealed only moderately increased immunoglobulin values. After 2 weeks of daily application of 4 g ceftriaxone disodium, ophthalmological and neurological symptoms disappeared. Even though the immunoglobulin values remained unchanged, neuroborreliosis with involvement of the retinal pigment epithelium was the most probable diagnosis, considering the history of tick bites and headache. The authors assume that the tissue around the optic nerve head, which does not have an effective blood-brain barrier, allowed the spirochetes to spread from the central nervous system into the subpigment-epithelium space, thus causing the observed parapapillary pigment epithelium detachments
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+8646173
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Borrelia-associated crystalline keratopathy
Text
Objective
Crystalline keratopathy can be associated with paraproteinaemia or with infection by micro-organisms. We present a patient with crystalline keratopathy with proof of borellia in the corneal stroma.
Methods
Case report of asymmetric bilateral progressive peripheral crystalline keratopathy in a 67-year-old male patient with a history of recurrent iridocyclitis and polyarthritis under immunosuppression. After a paraproteinaemia had been excluded and due to a progressive visual loss to 0.1 in the right eye, we performed a triple procedure. During the postoperative follow-up, deep stromal crystalline deposits recurred, starting in the periphery. After six months, the graft became diffusely cloudy. One year after keratoplasty, the patient presented with a hyperacute stromal graft rejection, and we performed re-keratoplasty à chaud.
Results
By light- and electronmicroscopy we detected spirochaetes in the corneal specimen. By means of PCR proof of bacterial nucleic acid (16S-rDNA) was feasible. The result of amplification could be assigned to the species Borrelia burgdorferi by sequence analysis. Three months after re-keratoplasty, the patient presented with a clear graft under systemic and local antibiotics, local steroids and systemic immunosuppression.
Conclusions
In bilateral peripherally accentuated ring-shaped crystalline keratopathy resistent to conventional therapy a borrelia-associated interstitial keratitis should be ruled out. Diagnosis could be verified by incisional biopsy. Antibiotic treatment with cephalosporines or tetracyclines may prevent a progression or recurrence after keratoplasty.
http://www.egms.de/en/meetings/dog2004/04dog701.shtml
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Cytologically proven seronegative Lyme choroiditis and vitritis.
Schubert HD, Greenebaum E, Neu HC.
Edward S. Harkness Eye Institute, New York, New York.
PURPOSE:
To report on a vitreous specimen in a 53-year-old patient with unilateral choroiditis and vitritis of unknown cause. METHODS: Cytologic examination of a vitreous aspirate stained by the Papanicolaou method. RESULTS: Intravitreal spirochetes consistent with Borrelia burgdorferi were found in this seronegative patient. CONCLUSION: Vitreous specimens of patients with choroiditis and vitritis of unknown cause should be examined cytologically, particularly when serologic results do not corroborate the clinical findings of Lyme disease.
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+8016460
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Dietrich T, Geidörfer W, Schlötzer-Schrehardt U, Holbach L, Schoerner C, Seitz B.
From the *Department of Ophthalmology and †Department of Microbiology, Immunology and Hygiene, University Erlangen-Nürnberg, Erlangen, Germany; and the ‡Department of Ophthalmology, Saarland University Hospital, Homburg/Saar, Germany.
PURPOSE::
First report of a patient with Borrelia-associated crystalline keratopathy with intracorneal evidence of Borrelia garinii by polymerase chain reaction (PCR) and electron microscopy (EM). METHODS:: Report of a 67-year-old patient with medical history of recurrent iridocyclitis and arthritis presented with a bilateral, progressive, asymmetric crystalline keratopathy, which was particularly pronounced in the peripheral temporal superior cornea. After penetrating keratoplasty, crystalline keratopathy with stromal haziness recurred. Corneal regrafting was performed. The corneal specimen from the penetrating keratoplasty was examined by light and EM as well as by PCR. RESULTS:: In the explanted corneal graft, as well as retrospectively in the corneal specimen from the first keratoplasty, spirochetelike bodies and fragments were detected by light and EM. Borrelia burgdorferi sensu lato DNA was demonstrated by broad-range (16S rDNA) PCR. A more precise identification as Borrelia garinii serotype 5 was possible by analyses of the flaB and ospA gene sequences. Borrelia-specific serological tests showed borderline titers in immunofluorescence and weak reaction in immunoblot, respectively. CONCLUSIONS:: This case illustrates that borreliae must be considered as a cause of crystalline keratopathy; Borrelia-specific serological tests can be false negative; explanted cornea specimens of etiologically unclear crystalline keratopathy should be analyzed by EM or PCR for detection of pathogens; and prolonged antibiotic treatment might be effective to prevent progression or recurrence of the disease.
Department of Ophthalmology, Aberdeen Royal Infirmary, UK.
Introduction: Lyme disease is a multisystemic disease with protean ocular manifestations. We describe the occurrence of inflammatory choroidal neovascular membrane (CNVM) in two patients suffering from presumed Lyme disease. Methods: Descriptive review of the clinical records of two patients. Results: Patient 1: 16-year-old healthy male presenting with a visual acuity of counting fingers [oculus dexter (OD)] and 6/6 [oculus sinister (OS)] 3 months after a tick bite. He had papillitis and an exudative subretinal macular lesion OD. Treatment was started with intravenous (IV) ceftriaxone; a week later, IV methylprednisolone was administered with a tapering dose of oral steroids thereafter. Three months later, VA had improved to 3/60 OD. Patient 2: 38-year-old healthy female presenting with reduced left-eye vision (6/24) 6 weeks after a tick bite. She also suffered from erythema migrans and arthralgias. She had left-eye papillitis, macular haemorrhages and vascular sheathing. Treatment was started with IV ceftriaxone. One month later, there was profound loss of vision with development of CNVM. Treatment was declined by the patient and eventually retinal fibrosis developed. Conclusion: Inflammatory CNVM has not been described previously in the setting of ocular Lyme borreliosis. We herein describe the occurrence of inflammatory CNVM in two patients whose diagnosis with Lyme disease was clinically based - both were sero-negative. Visual outcome in the two patients was profoundly impaired because of the ensuing macular scar.
Todorovic L, Ibisevic M, Alajbegovic A, Suljic-Mehmedika E, Jurisic V.
Clinic for Neurology, Clinical center University of Sarajevo.
Bilateral retrobulbar optic neuritis in young adults are most often caused by demyelinate disease (MS). In all cases where MS was eliminated, we have used selected tests regarding to history, clinical findings and differential diagnosis. Diagnosis of Lyme disease is approved by diagnostic criteria proposed by Center for Control and Prevention of disease. In our case diagnosis of Lyme disease was established by history of illness, clinical findings and positive serlological tests.
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+18669236
To our knowledge, Lyme disease–associated orbital myositis has been serologically confirmed in 3 reported cases.1-3 No cases of dacryoadenitis have been reported in association with this disease entity.
Report of a Case
A 66-year-old, previously healthy woman had a 6-day history of right periorbital edema, erythema, diplopia, pain with eye movement, tearing, nausea, and vomiting. She reported a deer tick bite on the posterior neck 2 months prior that occurred while hunting during the early summer months in northern Wisconsin. The bite was followed by 3 weeks of fever, nausea, diarrhea, weakness, arthralgias, and a diffuse rash, all of which resolved after a 10-day course of ciprofloxacin hydrochloride.
Examination revealed best-corrected visual acuities of 20/20 OD and 20/25 OS as well as no afferent pupillary defect. Intraocular pressure measured 15 mm Hg OU.
http://archopht.ama-assn.org/cgi/conten ... 1165?rss=1
http://www.springerlink.com/content/2jp2e7qfxweqmleu/
BACKGROUND:
Ocular manifestations of Lyme borreliose present with unusual forms of conjunctivitis, keratitis, optic nerve disease, uveitis, vitritis and rarely endophthalmitis.
CASE REPORT: A 57-year-old man working as logger in Sax-ony-Anhalt suffering from an endophthalmitis on his left eye was referred to us. The vision of his left eye was intact light perception and hand motions. The slit-lamp examination revealed severe inflammation of the anterior chamber with hypopyon, posterior synechiae, and opacity of the posterior lens capsule. Funduscopy showed no red reflex, no retinal details. In the local hospital serum analysis was performed and showed in Western-Blot IgM- and IgG-antibodies against Borrelia burgdorferi. Despite of intravenous application of ceftriaxon for 14 days panuveitis persisted, and endophthalmitis developed when antibiotic therapy was finished.
RESULTS: During pars plana vitrectomy a sharply delineated cystic lesion containing yellowish fluid was revealed, and creamy yellow fluid was aspirated. Microscopically in hematoxylineosin stained slides of the aspirate structures consistent with Borrelia burgdorferi were found. Postoperatively vision increased to 1/15. Despite of a second intravenous ceftriaxon treatment for 14 days we observed a retinal vasculitis in the follow up of 6 months.
CONCLUSIONS: Despite intravenous ceftriaxon-therapy borrelia burgdorferi must have survived in the vitreous body. Further investigations are required with respect to the use of other antibiotics or immunosuppressives.
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+10048013
-----------------------------------------
Lyme borreliosis is an underdiagnosed infectious disease caused by a spirochete and transmitted by certain Ixodes ticks. In Lyme disease diagnostic problems are still discussed extensively as the laboratory workup is not standardized and a positive antibody result is not proof of active infection. It is therefore important to appreciate all clinical signs that can prompt us to the diagnostic investigation of Lyme borreliosis. We present a case of a woman with Lyme borreliosis and recurrent unilateral anterior uveitis in her right eye for 2 years, who developed cotton wool spots (CWS) in her left eye, followed by acute and recurrent anterior uveitis in this second eye. An extensive general examination, including blood coagulopathies and ultrasound of the carotid arteries, did not reveal any pathology. The CWS resolved within a few months. The recurrent anterior uveitis could be controlled by topical steroids. After treatment with 2 g of i.v. ceftriaxone
for 3 weeks, she remained free of recurrences for 1 year of observation time. CWS can be the first clinical sign of ocular vascular pathology and/or uveitis. Further investigation will be necessary to confirm the relationship between CWS and ocular borreliosis. In patients with otherwise unexplained CWS, the possibility of an infection with borreliosis should be ruled out carefully.
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+18854948
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Fundus autofluorescence in APMPPE in association with lyme disease
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+12441738
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Molecular Diagnisis of a Bilateral Panuveitis due to Borrelia Burgdorferi Sensu Lato by Cerebral Spinal Fluid Analysis :
http://www.nih.go.jp/JJID/61/214.pdf
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Abstract
Lyme disease is a tick-borne illness caused by the spirochete Borrelia burgdorferi . On occasions, patients with Lyme disease present with isolated cranial nerve palsies; multiple palsies have rarely been reported in the literature.We discuss the case of a patient, who presented with a third nerve palsy and bilateral seventh nerve palsies and was subsequently diagnosed as suffering from Lyme disease.To our knowledge, this is the first reported case of Lyme disease presenting with this combination of neurological signs. A 53-year-old male from the Scottish Western Isles presented with a two-day history of double vision. On examination, he was found to have a left third cranial nerve palsy and a left seventh cranial nerve palsy. Five days later, the patient developed a right seventh cranial nerve palsy. Serum and CSF enzymelinked immunosorbent assay (ELISA) and Western blot analysis were both positive for Lyme disease as was CSF polymerase chain reaction (PCR) analysis. Subsequently, the patient gave a history of multiple tick bites over the previous few years. He was commenced on appropriate antibiotic therapy and oral prednisolone. A rapid improvement in his condition was noted. This case demonstrates the importance of considering the diagnosis of Lyme disease in patients with multiple cranial neuropathies, especially those residing in, or with a history of travel to, endemic areas. In addition, it illustrates how early diagnosis, with the institution of appropriate therapy, leads to a prompt improvement in neurological symptoms and signs
Lyme disease is a tick-borne illness caused by the spirochete Borrelia burgdorferi . On occasions, patients with Lyme disease present with isolated cranial nerve palsies; multiple palsies have rarely been reported in the literature.We discuss the case of a patient, who presented with a third nerve palsy and bilateral seventh nerve palsies and was subsequently diagnosed as suffering from Lyme disease.To our knowledge, this is the first reported case of Lyme disease presenting with this combination of neurological signs. A 53-year-old male from the Scottish Western Isles presented with a two-day history of double vision. On examination, he was found to have a left third cranial nerve palsy and a left seventh cranial nerve palsy. Five days later, the patient developed a right seventh cranial nerve palsy. Serum and CSF enzymelinked immunosorbent assay (ELISA) and Western blot analysis were both positive for Lyme disease as was CSF polymerase chain reaction (PCR) analysis. Subsequently, the patient gave a history of multiple tick bites over the previous few years. He was commenced on appropriate antibiotic therapy and oral prednisolone. A rapid improvement in his condition was noted. This case demonstrates the importance of considering the diagnosis of Lyme disease in patients with multiple cranial neuropathies, especially those residing in, or with a history of travel to, endemic areas. In addition, it illustrates how early diagnosis, with the institution of appropriate therapy, leads to a prompt improvement in neurological symptoms and signs
http://www.informaworld.com/smpp/conten ... 542~db=all
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[Case Reports and Reviews: Case Report]
Touray, Musa*; Saiah, Lila*; Ombelli, Julien*; Sovilla, Jean-Yves†; Wyss, Pierre*
*Department of Internal Medicine, Regional Hospital of Yverdon, Rue Entremont, 1400 Yverdon, Switzerland and †Neurology Private Practitioner Rue Entremont, Yverdon, Switzerland.
Abstract
Abstract: Several historical and physical examination findings of Lyme disease are yet to be elucidated. In this article, we report that ocular flutter, a saccadic horizontal eye movement, is a diagnostic feature of acute disseminated stage of Lyme disease
Touray, Musa*; Saiah, Lila*; Ombelli, Julien*; Sovilla, Jean-Yves†; Wyss, Pierre*
*Department of Internal Medicine, Regional Hospital of Yverdon, Rue Entremont, 1400 Yverdon, Switzerland and †Neurology Private Practitioner Rue Entremont, Yverdon, Switzerland.
Abstract
Abstract: Several historical and physical examination findings of Lyme disease are yet to be elucidated. In this article, we report that ocular flutter, a saccadic horizontal eye movement, is a diagnostic feature of acute disseminated stage of Lyme disease
http://www.infectdis.com/pt/re/idcp/abs ... 28!8091!-1
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Ocular flutter as the first manifestation of Lyme disease
Gyllenborg and Milea Neurology.2009; 72: 291
http://www.neurology.org/cgi/content/sh ... /291?rss=1
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Ocular flutter is an opsoclonic disorder in which the eyes incontinuously saccadically move around the point of fixation in the field of vision.
http://en.wikipedia.org/wiki/Ocular_flutter
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Five Cases of Paralytic Strabismus as a Rare Feature of Lyme Disease.
Sauer A, Hansmann Y, Jaulhac B, Bourcier T, Speeg-Schatz C.
Departments of 1Ophthalmology, 2Infectious Disease, Pole Specialty Medecine Ophthalmology Hygiene, and 3Bacteriology, Hopitaux Universitaires de Strasbourg, Strasbourg, France.
Lyme borreliosis is the most common human tick-borne disease in the Northern Hemisphere. The prevalence of Lyme borreliosis is estimated to be 20-100 cases per 100,000 persons in the United States and 100-155 cases per 100,000 persons in Europe [ 1 , 2 ]. It is caused by the spirochete Borrelia burgdorferi sensu lato [ 2 , 3 ]. The course of clinical manifestations is thought to occur in 3 stages: early, disseminated, and chronic [ 2 , 4 ]. Lyme borreliosis can cause a variety of ocular manifestations, and the frequency of these manifestations among cases of Lyme disease involving systemic manifestations is approximately 1% [ 5 ].
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+19193112
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Pérez de Arcelus M, Salinas A, García Layana A.
Departamento de Oftalmología, Clínica Universitaria de Navarra, Pamplona, Spain.
The retina and the choroids are richly vascularised structures and can therefore be colonised by germs via the haematogenous route in the course of a systemic infectious disease. The germs responsible for this type of infection can be fungi, viruses, bacteria and parasites. Ocular candidiasis is outstanding amongst these colonisations because of its frequency; it can manifest itself as an endophthalmitis with a slow and hidden course. The so-called ocular histoplasmosis syndrome, although it is infrequent in our setting, is an important cause of choroidal neovascularisation.
The viruses that most frequently affect the retina are of the herpes type and can produce devastating symptoms in immunoincompetent patients, named acute retinal necrosis syndrome. Retinitis due to cytomegalovirus is more frequent in immunodepressed patients, as in the case of AIDS, but it must also be contemplated in patients with lymphoma and immunomodulatory treatment.
http://www.ncbi.nlm.nih.gov/sites/pubmed/19169295
http://www.ncbi.nlm.nih.gov/entrez/util ... /5213/4405
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Ocular involvement in Lyme borreliosis, even though possible in every stage of the disease, is most frequently seen in the late phases (2nd and 3rd). In a German series of children affected by Lyme arthritis, 4% also had ocular inflammation consisting of keratitis or uveitis. 1 In a Finnish cohort of twenty patients with ocular borreliosis, 10 had uveitis, 5 subjects showed ocular adnexa inflammation, 4 had neuro-ophthalmological alterations and one patient developed branch central retinal vein occlusion. Contact with a tick was clearly reported in only 13/20 cases. 2 There are various ocular symptoms of Lyme disease including: pain, visual impairment, photophobia, myodesospia, diplopia and lack of accommodation. 3
To observe ocular signs or symptoms it is not necessary that the site of inoculation of the infection is close to the eyes (as in Figure 1). It is possible to define the following ocular findings, from the anterior to the posterior segment of the eye
Conjunctivitis: often self-limited; when it appears in the 1st stage of the disease it is associated with an influenza-like syndrome in 7-11% of the patients. It is follicular and uni- or bilateral and in the late phases of disease it may be accompanied by sever eyelid edema in 3% of subjects.
Keratitis: typical of the 2nd and 3rd stage of the disease; it may persist even after appropriate systemic antibiotic treatment, suggesting an immunological origin of corneal opacity. It can be disseminated and potentially bilateral, but the most characteristic patterns are “interstitial” or “ulcerative” with peripheral neovascolarisation.
Episcleritis/Scleritis: very rare, almost always related to the late phase of the disease.
Uveitis: the anterior form is infrequently reported in Lyme disease and is possibly associated with papillitis. The case observed in our Institute had exactly these features. It consisted in a serologically-confirmed unilateral papillitis (Figure 2), combined with keratic granulomatous precipitates and iris-lens sinechyae. Ocular involvement appeared during the 2nd stage of the disease, sixty days after the removal of a tick from the forearm. Treatment with amoxicillin for three weeks combined with oral prednisone at decreasing doses was successful in achieving complete visual recovery.
The intermediate form is the most common form of uveitis, often associated with iridocyclitis (parsplanitis). In three cases Borrellia burgdorfori s.l. was isolated from the vitreous by culture or polymerase chain reaction. Only a few reports concern panuveitis; two cases, however, resulted in irreversible visual loss. Signs of posterior uveitis mostly included chorio-retinal involvement.
Retinal infection: macular oedema and vasculitis are the most frequent findings, occasionally complicated by vitreoretinal proliferation and have been described either during the erythema migrans phase or in neuroborreliosis. Venular occlusions and chorio-retinal inflammatory foci are less common manifestations. A recent report has shown cotton wool spots as another possible sign of Lyme retinitis. 4Neuro-ophthalmological alterations: these represent early evidence of neuroborreliosis. Diplopia and visual impairment, with or without meningitis, are the suggestive signs. In case of optic neuritis the concomitant presence of cranial nerve palsies is expected (mostly VI or VII).
To observe ocular signs or symptoms it is not necessary that the site of inoculation of the infection is close to the eyes (as in Figure 1). It is possible to define the following ocular findings, from the anterior to the posterior segment of the eye
Conjunctivitis: often self-limited; when it appears in the 1st stage of the disease it is associated with an influenza-like syndrome in 7-11% of the patients. It is follicular and uni- or bilateral and in the late phases of disease it may be accompanied by sever eyelid edema in 3% of subjects.
Keratitis: typical of the 2nd and 3rd stage of the disease; it may persist even after appropriate systemic antibiotic treatment, suggesting an immunological origin of corneal opacity. It can be disseminated and potentially bilateral, but the most characteristic patterns are “interstitial” or “ulcerative” with peripheral neovascolarisation.
Episcleritis/Scleritis: very rare, almost always related to the late phase of the disease.
Uveitis: the anterior form is infrequently reported in Lyme disease and is possibly associated with papillitis. The case observed in our Institute had exactly these features. It consisted in a serologically-confirmed unilateral papillitis (Figure 2), combined with keratic granulomatous precipitates and iris-lens sinechyae. Ocular involvement appeared during the 2nd stage of the disease, sixty days after the removal of a tick from the forearm. Treatment with amoxicillin for three weeks combined with oral prednisone at decreasing doses was successful in achieving complete visual recovery.
The intermediate form is the most common form of uveitis, often associated with iridocyclitis (parsplanitis). In three cases Borrellia burgdorfori s.l. was isolated from the vitreous by culture or polymerase chain reaction. Only a few reports concern panuveitis; two cases, however, resulted in irreversible visual loss. Signs of posterior uveitis mostly included chorio-retinal involvement.
Retinal infection: macular oedema and vasculitis are the most frequent findings, occasionally complicated by vitreoretinal proliferation and have been described either during the erythema migrans phase or in neuroborreliosis. Venular occlusions and chorio-retinal inflammatory foci are less common manifestations. A recent report has shown cotton wool spots as another possible sign of Lyme retinitis. 4Neuro-ophthalmological alterations: these represent early evidence of neuroborreliosis. Diplopia and visual impairment, with or without meningitis, are the suggestive signs. In case of optic neuritis the concomitant presence of cranial nerve palsies is expected (mostly VI or VII).
Uncertain reports of orbital myosistis and Jarisch-Herxheimer reaction have also been proposed as a consequence of borreliosis.
In conclusion, ocular involvement in Lyme borreliosis is symptomatic and a routine ophthalmologic evaluation is not recommended in adult patients (younger patients, on the other hand, should be screened due to their poor capacity to complain of ocular disturbances). In order to formulate a rational suspicion of Lyme disease as the cause of ocular inflammation, features must include occurrence in an endemic zone; and/or the report of contact with a tick or of previous erythema migrans; positive serology with presence of IgM in the early stage or high titres of IgG in the later phases. A clear diagnosis, however, remains very difficult. The long-term follow-up of four cases of optic neuritis labelled as Lyme disease because of the positive serology for Borrelia revealed that three patients actually developed demyelinating syndromes.
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Early disseminated Lyme disease can be difficult to diagnose because of atypical symptoms and physical findings. A clinical diagnosis must be made in the absence of confirmatory serologic testing to allow
timely therapy. We report a case of a 69-year-old woman who presents with fever, Horner syndrome,
and a 12-cm oval-shaped erythematous macular rash with multiple vesiculopustular eruptions. The patient
recovered after appropriate intravenous antibiotics, but serologic testing only confirmed the diagnosis
4 weeks later. This case also describes an unusual complication involving the neurologic system.
We illustrate the clinical presentation and review the medical literature. Lyme disease should always be
considered in patients from endemic regions with viral-like symptoms or a new rash.
(J Am Board FamMed 2009;22:219 –222.)
timely therapy. We report a case of a 69-year-old woman who presents with fever, Horner syndrome,
and a 12-cm oval-shaped erythematous macular rash with multiple vesiculopustular eruptions. The patient
recovered after appropriate intravenous antibiotics, but serologic testing only confirmed the diagnosis
4 weeks later. This case also describes an unusual complication involving the neurologic system.
We illustrate the clinical presentation and review the medical literature. Lyme disease should always be
considered in patients from endemic regions with viral-like symptoms or a new rash.
(J Am Board FamMed 2009;22:219 –222.)
A 69-year-old healthy jogger from Baltimore County, Maryland, presented with a 4-day history
of right eye pain with progressive drooping of the right upper eyelid (Figure 1). She noted fever and
fatigue during the 2 days before presentation although she denied headache, neck pain, diplopia,
change in speech, facial palsy, extremity numbness,or weakness.
During examination, her temperature was 102°F. The ophthalmologic examination in this
patient was suggestive of Horner syndrome, with 3-mm ptosis on the right, a 2.5-mm right pupil, and
a 4-mm left pupil. A positive cocaine test showed that the affected right pupil had no dilation to
cocaine stimulation compared with normal dilation of the left pupil, confirming the diagnosis of Horner syndrome. Anhidrosis was not noted and the remainder of her neurologic examination was unremarkable
An ophthalmology consult and magnetic resonance imaging scan were initially scheduled as outpatient studies, but near the end of the visit the patient mentioned a “sunburn” in her groin that she attributed to a recent trip to the beach. She had no recollection of recent tick exposure before the onset of symptoms. On examination, we discovered a 12-cm, well-circumscribed, oval-shaped area of
redness with multiple vesiculopustular eruptions in its central region, consistent with an erythema migrans (EM) rash of Lyme disease (Figure 2).Because of the presence of an acute neurologic deficit and a suspicious rash in a previously healthy patient from an area endemic for Lyme disease, a
lumbar puncture was also performed. Cerebrospinal fluid (CSF) analysis revealed 2 white blood cells
(WBCs; 55% polys, 45% monos); 183 red cells; and a CSF protein level of 35. The peripheral WBC count was 4970 with a normal differential.The only abnormalities on a comprehensive metabolic
panel were a mildly elevated aspartate aminotransferase of 78 U/L and an alanine aminotransferase of 69 U/L. Lyme serology was initially negative.
The patient had early Lyme disease based on this clinical presentation, despite the negative Lyme serology. The lack of thrombocytopenia, leukeopenia, anemia, or severe or prolonged fever
led to a low clinical suspicion for anaplasmosis or babesiosis. Because coinfections were not indicated,treatment with a 4-week course of intravenous ceftriaxone, 2 grams per day, was initiated without the addition of doxycycline or antiprotozoal therapy.Several hours after the first dose, the patient developed a transient exacerbation of her fever,sweats, and rash. Fortunately, she made a consistent and dramatic improvement over the next several days (Figure 3).
After 3 weeks of incubation, CSF cultures conducted as part of a research protocol1 grew Borrelia burgdorferi, although blood cultures remained sterile.Her initially negative serum serology to Borrelia burgdorferi, converted to positive when repeated 4 weeks later. The Horner syndrome slowly and completely resolved over the subsequent 2 months.
http://www.jabfm.org/cgi/reprint/22/2/219.pdf
Unusual Presentation of Lyme Disease: Horner Syndrome with Negative Serology
Horner syndrome = http://en.wikipedia.org/wiki/Horner%27s_syndrome
Unusual Presentation of Lyme Disease: Horner Syndrome with Negative Serology
Horner syndrome = http://en.wikipedia.org/wiki/Horner%27s_syndrome
-----------------------------------
Szabo B, Kaucsar E, Carstina D, Pop AM.
Clinica Oftalmologie, Universitatea de Medicina Si Farmacie Iuliu Hatieganu Cluj Napoca, Spitalul Clinic Judetean de Urgenta Cluj Napoca.
We present the case of a patient (a 21-year-old woman) with acute and complete loss vision of the left eye, and severe periodic left ocular and left orbital pain. Visual, acuity right eye = 20/20. Under steroid and nonsteroid general and local treatment, the visual acuity was improved (VA left eye = 0, 1,n.c.) and a central scotoma was developed. Ophthalmoscopic analysis of the left eye showed elevated and blurred optic disk margins, retinal hemorrhages, venous congestion. The diagnosis of borreliosis was based on clinical and ocular findings and determinations of antibodies to Borrelia burgdorferi by enzyme-linked immunosorbent assay and immunoblot analysis, the detection of DNA of B.burgdorferi by polymerase chain reaction and exclusion of other infectious and inflammatory causes (tuberculosis, toxoplasmosis, syphilis and sarcoidosis were excluded). The commonly used blood, urine and spinal fluid tests, cerebral MRI and angiofluorography were also done. The patient received oral ceftriaxone 2gr/daily for 4 weeks, 2 cures and Doxycycline 2 gr/daily, 21 days. Under the treatment, the clinical signs had significantly improved (VA left eye = 20/20), but the central scotoma remained. The case is unusual because only one eye was affected (typically decreased visual acuity occurs on both eyes), other signs of the disease were absent, and the recovery under the antibiotic treatment was excellent.
Clinica Oftalmologie, Universitatea de Medicina Si Farmacie Iuliu Hatieganu Cluj Napoca, Spitalul Clinic Judetean de Urgenta Cluj Napoca.
We present the case of a patient (a 21-year-old woman) with acute and complete loss vision of the left eye, and severe periodic left ocular and left orbital pain. Visual, acuity right eye = 20/20. Under steroid and nonsteroid general and local treatment, the visual acuity was improved (VA left eye = 0, 1,n.c.) and a central scotoma was developed. Ophthalmoscopic analysis of the left eye showed elevated and blurred optic disk margins, retinal hemorrhages, venous congestion. The diagnosis of borreliosis was based on clinical and ocular findings and determinations of antibodies to Borrelia burgdorferi by enzyme-linked immunosorbent assay and immunoblot analysis, the detection of DNA of B.burgdorferi by polymerase chain reaction and exclusion of other infectious and inflammatory causes (tuberculosis, toxoplasmosis, syphilis and sarcoidosis were excluded). The commonly used blood, urine and spinal fluid tests, cerebral MRI and angiofluorography were also done. The patient received oral ceftriaxone 2gr/daily for 4 weeks, 2 cures and Doxycycline 2 gr/daily, 21 days. Under the treatment, the clinical signs had significantly improved (VA left eye = 20/20), but the central scotoma remained. The case is unusual because only one eye was affected (typically decreased visual acuity occurs on both eyes), other signs of the disease were absent, and the recovery under the antibiotic treatment was excellent.
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+19149119
-----------------------------------
We studied 93 patients with unclassified uveitis from two regions in Japan (Hokkaido and Kanagawa) to assess the contribution of Borrelia species to this condition. The seroprevalence of antibody to Borrelia species was higher in patients from Hokkaido than in those from Kanagawa. The unclassified uveitis of seropositive patients was probably a complication of Lyme borreliosis since (i) the antibody titers were as high as those in clinically diagnosed Lyme disease patients, (ii) healthy controls from Hokkaido showed low seroprevalence in contrast with unclassified uveitis patients from Hokkaido, and (iii) the reaction pattern of antibodies in sera from patients with unclassified uveitis was the same as that in patients with Lyme disease.
This is the first report to reveal the high risk of Lyme borreliosis in patients with unclassified uveitis in regions endemic for Lyme disease. In cases of unclassified uveitis as well as in cases of inflammatory disease of unknown origin, Lyme disease should be taken into consideration, especially in regions in which Lyme disease is endemic, even if it is reported only in animals.
http://cdli.asm.org/cgi/reprint/2/1/53.pdf
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Conjunctival Attachment of a Tick: Clinicopathologic Report of a Case.
Willen C, Mullen GR, Yee J, Read RW.
Department of Ophthalmology, University of Alabama at Birmingham, Birmingham, Alabama.
Attachment by ticks to ocular surfaces is uncommon, but has been reported. The objective of this article is to describe a case of conjunctival tick attachment and a method for removal by conjunctival excision. A 39-year-old man presented to the Emergency Department with a complaint of foreign-body sensation in his right eye. He was found to have a live tick embedded in his conjunctiva. The tick was removed en bloc with surrounding conjunctiva by an ophthalmologist. The arthropod was identified as the larval stage of the Lone Star tick (Amblyomma americanum). The patient did not experience any systemic illnesses or adverse sequelae. Attachment of ticks to the conjunctiva is unlikely to result in disease transmission when the larval stage is involved. However, removal by excision of a surrounding block of conjunctiva is recommended to ensure complete removal of all tick body parts.
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+18514466
------------------------------
Abstract
Intermediate uveitis (IU) is described as inflammation in the anterior vitreous, ciliary body and the peripheral retina. In the Standardization of Uveitis Nomenclature (SUN) working group's international workshop for reporting clinical data the consensus reached was that the term IU should be used for that subset of uveitis where the vitreous is the major site of the inflammation and if there is an associated infection (for example, Lyme disease) or systemic disease (for example, sarcoidosis). The diagnostic term pars planitis should be used only for that subset of IU where there is snow bank or snowball formation occurring in the absence of an associated infection or systemic disease (that is, "idiopathic"). This article discusses the clinical features, etiology, pathogenesis, investigations and treatment of IU.
The diagnostic term pars planitis should be used only for that subset of IU where there is snow bank or snowball formation occurring in the absence of an associated infection or systemic disease (that is, "idiopathic"). If there is an associated infection (for example, Lyme disease) or systemic disease (for example, sarcoidosis), then the term IU should be used
http://www.ijo.in/article.asp?issn=0301 ... ulast=Babu
---------------------------------
In Vivo Confocal Microscopy to Confirm the Diagnosis of Borrelia Keratitis? :
http://journals.lww.com/corneajrnl/Cita ... to.18.aspx
---------------------------------
Stage 1 :
- Follicular oedema
- Periorbital conjunctivitis
Stage 2 :
- Anterior/ intermediate euveitis
- peripheral lmultifocal choroiditis
- Panophthalmitis
- Macular oedema
- Cranial nerve palsy
- Optic atrophy
- Neuroretinitis
- Optic neuritis
- AION (arteritic)
- Reversible Horner's Syndrome
- Argyll - Robertson pupil
Stage 3 :
- Stromal / Interstitial keratitis
- Episcleritis
- Scleritis
- Orbital myositis
- Cortical blindness
http://www.teigrandround.com.sg/images/ ... 0YeoTK.pdf
---------------------------------
Abstract
PURPOSE:
To report a rare case of Lyme disease with neuroretinitis from South India.
MATERIALS AND METHODS: Retrospective case report. A 45-year-old lady who hails from the Nagarhole forest in South India presented with a history of tick bite followed by diminution of vision in the left eye. Fundus evaluation of the left eye showed neuroretinitis. Mantoux test, Treponema pallidum hemagglutination test, serum angiotensin converting enzyme, and ELISA for toxoplasmosis and rickettsial infections were negative. ELISA for Lyme disease was positive for IgM antibodies. This was confirmed by Western blot test.
RESULTS: Ocular inflammation resolved with a course of doxycyline and oral steroids. The species of the tick was also identified.
CONCLUSION: This case highlights the need to consider Lyme disease, though rare in India, in the differential diagnosis of neuroretinitis especially if the patient hails from a forest area.
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+20370334
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The ocular manifestations of Lyme Disease :
http://www.ophed.com/drupal/sites/defau ... isease.pdf
--------------------------------
A 57-year-old man was referred for a painful acute inferior visual field defect in his right eye.
Fundus examination of the right eye revealed diffuse optic disc oedema compatible with a papillitis. Cerebrospinal fluid (CSF) findings were consistent with lymphocytic meningitis, and serologic tests for Lyme disease were positive in both serum and CSF.
After treatment with ceftriaxone and bolus of methylprednisolone, right eye inferior altitudinal visual field defect persisted despite resolution of papillitis, and fundus examination disclosed a superior optic atrophy in the right eye.
To our knowledge, it is the first reported case of a unilateral Lyme optic neuritis occurring simultaneously to neuroborreliosis and further complicated by non-arteritic anterior ischaemic optic neuropathy
Fundus examination of the right eye revealed diffuse optic disc oedema compatible with a papillitis. Cerebrospinal fluid (CSF) findings were consistent with lymphocytic meningitis, and serologic tests for Lyme disease were positive in both serum and CSF.
After treatment with ceftriaxone and bolus of methylprednisolone, right eye inferior altitudinal visual field defect persisted despite resolution of papillitis, and fundus examination disclosed a superior optic atrophy in the right eye.
To our knowledge, it is the first reported case of a unilateral Lyme optic neuritis occurring simultaneously to neuroborreliosis and further complicated by non-arteritic anterior ischaemic optic neuropathy
-----------------------------------
Arch Ophthalmol. 2008;126(8):1165-1166.
To our knowledge, Lyme disease–associated orbital myositis has been serologically confirmed in 3 reported cases.1-3 No cases of dacryoadenitis have been reported in association with this disease entity.
Report of a Case
A 66-year-old, previously healthy woman had a 6-day history of right periorbital edema, erythema, diplopia, pain with eye movement, tearing, nausea, and vomiting. She reported a deer tick bite on the posterior neck 2 months prior that occurred while hunting during the early summer months in northern Wisconsin. The bite was followed by 3 weeks of fever, nausea, diarrhea, weakness, arthralgias, and a diffuse rash, all of which resolved after a 10-day course of ciprofloxacin hydrochloride
Examination revealed best-corrected visual acuities of 20/20 OD and 20/25 OS as well as no afferent pupillary defect. Intraocular pressure measured 15 mm Hg OU. There was a mild right exotropia with moderately limited right eye ductions in all fields of gaze. Binocular diplopia was reported 10° to 15° away from primary in all directions.
Moderate right periorbital edema, erythema, and upper eyelid ptosis were present (Figure 1). Mild right-sided proptosis was noted on Hertel exophthalmometry with measurements of 18 mm OD and 16 mm OS. Slitlamp examination revealed mild chemosis and injection of the right conjunctiva, but the results were otherwise unremarkable. Dilated funduscopy was normal bilaterally with no evidence of optic disc edema, subretinal fluid, or posterior segment inflammation.
Given the paucity of clinical or imaging evidence of infectious orbital cellulitis, the patient began receiving oral prednisone (60 mg daily) for presumed orbital inflammation. She improved within 1 week of therapy. However, with a decrease to 50-mg daily therapy, her symptoms worsened until her dose was increased back to 60 mg daily.
Laboratory data revealed an elevated erythrocyte sedimentation rate (108 mm/h), an elevated C-reactive protein level (60 mg/L [to convert to nanomoles per liter, multiply by 9.524]), and a positive Lyme enzyme immunoassay screen (Lyme index value, 3.65; positive result is > 1.21). The complete blood cell count results, thyroid-stimulating hormone level, antineutrophil cytoplasmic antibody level, and rheumatoid factor level were normal.
Based on the positive Lyme serological results, treatment with oral doxycycline (100 mg twice daily) was started for Lyme-associated orbital inflammation. The oral steroid was continued and tapered by 10 mg weekly. Within 2 weeks of starting doxycycline therapy, the patient's symptoms had largely resolved. She completed a 4-week course of doxycycline and an 8-week tapered course of prednisone with complete resolution of her symptoms
http://archopht.ama-assn.org/cgi/conten ... 126/8/1165
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Blanc F, Ballonzoli L, Marcel C, De Martino S, Jaulhac B, de Seze J.
Abstract
Lyme optic neuritis (ON) is a rare disease and only a few cases have been reported. We describe two cases of isolated Lyme ON, one with recurrence 9 months after the appearance of initial symptoms. Diagnosis criteria for multiple sclerosis and neuromyelitis optica were not met. The etiological diagnosis was based on European case definition criteria for neuroborreliosis. Both patients had positive serum and cerebrospinal fluid serology, a positive intrathecal anti-Borrelia antibody index, and a good outcome on ceftriaxone. Specific diagnosis of Lyme ON is important since improvement of visual acuity is possible with specific antibiotherapy, even after many months. Copyright (c) 2010 Elsevier B.V. All rights reserved.
https://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+20621802
------------------------------
Retrobulbar optic neuritis (RON) is an unusual complication of Lyme disease. The diagnosis of early Lyme disease is difficult, and the relationship between RON and Lyme disease remains controversial. None of the 14 cases of optic neuritis described in the literature in association with Lyme disease fulfilled the Halperin and Sibony criteria for active Lyme disease. We report the first case of acute Lyme disease complicated by RON established using the Halperin and Sibony criteria.
Lyme disease is a multisystem infectious disease caused by tick borne spirochetes of the Borrelia burgdorferi group. Diagnosis of this infection can be difficult and serological testing such as western blot can be useful. Cranial neuropathies are common but RON has been reported in a few isolated cases.1 A causal link between optic neuritis and Lyme disease has not been established and remains controversial. We report a case of active neuro-Lyme disease complicated by RON
http://jnnp.bmj.com/content/78/12/1409.extract
-----------------------------------
Nerve damage that occurs in the section of the optic nerve located behind the eyeball, is called retrobulbar neuritis, and is most often associated with multiple sclerosis
http://medical-dictionary.thefreedictio ... c+neuritis
------------------------------------
J Clin Neurophysiol. 2012 Apr;29(2):174-80.
Pattern and motion-related visual-evoked potentials in neuroborreliosis: follow-up study.
Szanyi J, Kubová Z, Kremláček J, Langrová J, Vít F, Kuba M, Szanyi J, Plíšek S.
Source
Department of Pathophysiology, Faculty of Medicine in Hradec Králové, Charles University, Czech Republic.
Abstract
Visual-evoked potentials (VEPs) were used for objective testing of visual functions during treatment courses of Lyme neuroborreliosis (LNB) in adult patients in the Czech Republic. In 30 LNB patients with originally delayed VEP latencies, pattern-reversal (R-VEP) and motion onset (M-VEP) VEPs were repeatedly examined within 1 to 8 years. Six patients had Lyme optic neuritis (ON), five of them displayed prolonged latencies in both R-VEPs and M-VEPs, and one had only abnormal R-VEPs. The VEP recovery to normal latency values was in three of them. In the group of 24 LNB patients without ON, 14 patients displayed prolonged latencies only to motion stimuli, and 10 patients had abnormal latencies in both R-VEPs and M-VEPs. During the follow-up period, 7 patients displayed shortening to normal latencies. In 5 patients, VEPs latencies improved only partially, and in the remaining 12 patients, VEPs did not improve at all. This study provides objective evidence that in LNB, most of the patients without clinically manifesting ON display optic pathway involvement-predominantly magnocellular system/dorsal stream function changes. In patients with ON, however, mainly the parvocellular system is affected. About half of the patients without ON improved with a relatively long-time course of latency shortening.
PMID:
22469684
[PubMed - in process]
Pattern and motion-related visual-evoked potentials in neuroborreliosis: follow-up study.
Szanyi J, Kubová Z, Kremláček J, Langrová J, Vít F, Kuba M, Szanyi J, Plíšek S.
Source
Department of Pathophysiology, Faculty of Medicine in Hradec Králové, Charles University, Czech Republic.
Abstract
Visual-evoked potentials (VEPs) were used for objective testing of visual functions during treatment courses of Lyme neuroborreliosis (LNB) in adult patients in the Czech Republic. In 30 LNB patients with originally delayed VEP latencies, pattern-reversal (R-VEP) and motion onset (M-VEP) VEPs were repeatedly examined within 1 to 8 years. Six patients had Lyme optic neuritis (ON), five of them displayed prolonged latencies in both R-VEPs and M-VEPs, and one had only abnormal R-VEPs. The VEP recovery to normal latency values was in three of them. In the group of 24 LNB patients without ON, 14 patients displayed prolonged latencies only to motion stimuli, and 10 patients had abnormal latencies in both R-VEPs and M-VEPs. During the follow-up period, 7 patients displayed shortening to normal latencies. In 5 patients, VEPs latencies improved only partially, and in the remaining 12 patients, VEPs did not improve at all. This study provides objective evidence that in LNB, most of the patients without clinically manifesting ON display optic pathway involvement-predominantly magnocellular system/dorsal stream function changes. In patients with ON, however, mainly the parvocellular system is affected. About half of the patients without ON improved with a relatively long-time course of latency shortening.
PMID:
22469684
[PubMed - in process]
http://www.ncbi.nlm.nih.gov/pubmed/22469684
---------------------------------
Int Ophthalmol. 2011 Dec;31(6):493-5. Epub 2011 Dec 20.
Isolated trochlear palsy secondary to Lyme neuroborreliosis.
Bababeygy SR, Quiros PA.
Source
Doheny Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, 1450 San Pablo Street, DVRC 311, Los Angeles, CA 90033, USA.
Abstract
The objective of the study is to report the first case of isolated trochlear palsy secondary to Lyme neuroborreliosis in an adult. A 22-year-old male presented with history of flu-like illness and headache, accompanied by vertical binocular diplopia, worse on downgaze and better in upgaze and right head tilt. Physical examination revealed trochlear palsy on the left side with a compensatory head tilt to the opposite side. A subsequent workup for trochlear palsy was conducted, including hematological and cerebral spinal fluid serum studies, and magnetic resonance imaging of the brain. Immunoglobulin (Ig)M and IgG antibodies against Borrelia burgdorferi were positive in serum and cerebral spinal fluid (CSF). Symptoms of double vision completely resolved after 3 weeks of antibiotic treatment with intravenous ceftriaxone. CSF studies, in addition to clinical symptoms of vertical double vision and a positive Parks 3-step test, are a good diagnostic tool for B. burgdorferi. Resolution of symptoms was noted after a complete course of intravenous ceftriaxone.
PMID:
22183294
http://www.ncbi.nlm.nih.gov/pubmed/22183294Isolated trochlear palsy secondary to Lyme neuroborreliosis.
Bababeygy SR, Quiros PA.
Source
Doheny Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, 1450 San Pablo Street, DVRC 311, Los Angeles, CA 90033, USA.
Abstract
The objective of the study is to report the first case of isolated trochlear palsy secondary to Lyme neuroborreliosis in an adult. A 22-year-old male presented with history of flu-like illness and headache, accompanied by vertical binocular diplopia, worse on downgaze and better in upgaze and right head tilt. Physical examination revealed trochlear palsy on the left side with a compensatory head tilt to the opposite side. A subsequent workup for trochlear palsy was conducted, including hematological and cerebral spinal fluid serum studies, and magnetic resonance imaging of the brain. Immunoglobulin (Ig)M and IgG antibodies against Borrelia burgdorferi were positive in serum and cerebral spinal fluid (CSF). Symptoms of double vision completely resolved after 3 weeks of antibiotic treatment with intravenous ceftriaxone. CSF studies, in addition to clinical symptoms of vertical double vision and a positive Parks 3-step test, are a good diagnostic tool for B. burgdorferi. Resolution of symptoms was noted after a complete course of intravenous ceftriaxone.
PMID:
22183294
-------------------------------
J Neuroophthalmol. 2005 Jun;25(2):71-82.
Reactive Lyme serology in optic neuritis.
Sibony P, Halperin J, Coyle PK, Patel K.
Source
Department of Ophthalmology and Neurology, State University of New York at Stony Brook, Stony Brook, NY 11794, USA.
Abstract
BACKGROUND:
Establishing a causal relationship between optic neuritis and Lyme disease (LD) has been hampered by technical limitations in serologic diagnosis of LD. Even so, there is a general impression that optic neuritis is a common manifestation of LD.
METHODS:
Retrospective case analysis of Lyme serology in 440 patients with optic neuritis examined between 1993 and 2003 in a single neuro-ophthalmic practice at Stony Brook University Medical Center, Suffolk County, New York, a region hyper-endemic for LD.
RESULTS:
Lyme enzyme-linked immunosorbent assay (ELISA) was positive in 28 (6.4%) patients with optic neuritis, three of whom had syphilis with cross-reactive antibodies. Among the remaining 25 ELISA-positive patients, optic neuritis could be confidently attributed to LD in only one case, a patient with papillitis. The other 24 cases had reactive Lyme serologies related to a history of LD years earlier, asymptomatic exposure, false-positive results, or non-specific humoral expansion. The ELISA in these 24 cases were weakly positive and the Western blots were negative by Centers for Disease Control criteria. There were no significant clinical differences between the 25 seropositive optic neuritis cases and 50 seronegative optic neuritis cases.
CONCLUSIONS:
Based on these cases and a review of the literature, there is insufficient evidence for a causal link between LD and retrobulbar optic neuritis or neuroretinitis. There is sufficient evidence to establish a causal link between LD and papillitis and posterior uveitis.
Comment in
Defining the spectrum of Lyme disease: a difficult proposition. [J Neuroophthalmol. 2005] Defining the spectrum of Lyme disease: a difficult proposition.Pachner AR. J Neuroophthalmol. 2005 Jun; 25(2):67-8.
PMID:
15937426
[PubMed - indexed for MEDLINE]
Reactive Lyme serology in optic neuritis.
Sibony P, Halperin J, Coyle PK, Patel K.
Source
Department of Ophthalmology and Neurology, State University of New York at Stony Brook, Stony Brook, NY 11794, USA.
Abstract
BACKGROUND:
Establishing a causal relationship between optic neuritis and Lyme disease (LD) has been hampered by technical limitations in serologic diagnosis of LD. Even so, there is a general impression that optic neuritis is a common manifestation of LD.
METHODS:
Retrospective case analysis of Lyme serology in 440 patients with optic neuritis examined between 1993 and 2003 in a single neuro-ophthalmic practice at Stony Brook University Medical Center, Suffolk County, New York, a region hyper-endemic for LD.
RESULTS:
Lyme enzyme-linked immunosorbent assay (ELISA) was positive in 28 (6.4%) patients with optic neuritis, three of whom had syphilis with cross-reactive antibodies. Among the remaining 25 ELISA-positive patients, optic neuritis could be confidently attributed to LD in only one case, a patient with papillitis. The other 24 cases had reactive Lyme serologies related to a history of LD years earlier, asymptomatic exposure, false-positive results, or non-specific humoral expansion. The ELISA in these 24 cases were weakly positive and the Western blots were negative by Centers for Disease Control criteria. There were no significant clinical differences between the 25 seropositive optic neuritis cases and 50 seronegative optic neuritis cases.
CONCLUSIONS:
Based on these cases and a review of the literature, there is insufficient evidence for a causal link between LD and retrobulbar optic neuritis or neuroretinitis. There is sufficient evidence to establish a causal link between LD and papillitis and posterior uveitis.
Comment in
Defining the spectrum of Lyme disease: a difficult proposition. [J Neuroophthalmol. 2005] Defining the spectrum of Lyme disease: a difficult proposition.Pachner AR. J Neuroophthalmol. 2005 Jun; 25(2):67-8.
PMID:
15937426
[PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/pubmed/15937426
-------------------------------
Journal of Neuro-Ophthalmology:
June 2005 - Volume 25 - Issue 2 - pp 67-68
Editorial
Defining the Spectrum of Lyme Disease: A Difficult Proposition
Pachner, Andrew R MD
Department of Neurology and Neurosciences, UMDNJ-New Jersey Medical School, Newark, NJ.
Address correspondence to Andrew R. Pachner, MD, Department of Neurology and Neurosciences, UMDNJ-New Jersey Medical School, 185 S. Orange Ave, Newark, NJ 07103
Chronic infections are notoriously difficult challenges for the clinician. With respect to determining their clinical spectra, diagnosing them, treating them, or studying their epidemiology, they are daunting. HIV, tuberculosis, syphilis, malaria, and Lyme disease, to name just a few, continue to vex us and make us humbler and wiser physicians.
The study by Sibony et al in this issue of Journal of Neuro-Ophthalmology (citation here) is an effort to determine whether various forms of optic neuropathy are within the spectrum of Lyme disease. The authors used a retrospective chart review of patients within a patient database at SUNY Stony Brook School of Medicine; the school is located in an area endemic for Lyme disease.Out of 440 patients presenting with optic neuritis, the authors found that only five (1%) had compelling evidence that active Borrelia burgdorferi was responsible for, or contributed to, their visual deficit. This would indicate that in an academic center in an endemic area in the United States, extremely few patients with optic neuritis had Lyme disease as a cause, and that it is not a common cause of optic neuritis.
Why did I include the qualifier in the United States in the aforementioned sentence? Because Lyme neuroborreliosis has different clinical phenotypes for different genotypes of infecting subtypes of B. burgdorferi spirochetes. This has been an observation in the human disease (1) and its animal models (2). Thus, the conclusions drawn from the study of Sibony et al may not be readily applicable to Lyme disease in Europe, where the disease has a more aggressive neurologic presentation (3). Not surprisingly, investigators in Europe such as the Finns (4) and the Germans (5), both appropriately quoted in the study of Sibony et al, might dispute the conclusion that optic neuritis is rare in Lyme neuroborreliosis. The difference is likely because of the fact that American neuroborreliosis is caused predominantly by B. burgdorferi sensu stricto, whereas European disease is caused by B. garinii or B. afzelii, and the genetic differences between these subspecies are considerable.
Another issue that the authors did not address is the nagging question of whether our serological assays (enzyme-linked immunosorbent assay and Western blot) are so powerful that they will always be positive in cases of optic neuritis caused by B. burgdorferi. My answer is, possibly not! The concern is that in this chronic infection, it is conceivable that spirochetes can be cleared from the periphery but retained in immune-privileged sites such as the eye or the brain. Thus, an enzyme-linked immunosorbent assay-positive but Western blot-negative patient with optic neuritis could conceivably be infected yet have a localized process without adequate peripheral activation to become Western blot positive. A similar situation occurs in tertiary neurosyphilis, in which the CSF (cerebrospinal fluid) VDRL can be negative in a substantial percentage of cases despite a positive serum FTA-ABS.
These remarks do not detract, of course, from a very nice contribution to the literature by Sibony et al, especially in pointing out that optic nerve involvement in Lyme borreliosis in the United States is predominantly found in the child with meningitis, increased intracranial pressure, and optic disc edema. Retrobulbar neuritis remains very unlikely to be caused by Lyme disease; most likely it has another cause.
REFERENCES
1. Steere AC, Berardi VP, Weeks KE, et al. Evaluation of the intrathecal antibody response to Borrelia burgdorferi as a diagnostic test for Lyme neuroborreliosis. J Infect Dis 1990;161:1203-9.
2. Pachner, AR, Dail D, Bai Y, et al. Genotype determines phenotype in experimental Lyme neuroborreliosis. Ann Neurol 2004;56:361-70.
3. Hansen K, Lebech AM. The clinical and epidemiological profile of Lyme neuroborreliosis in Denmark 1985-1990. A prospective study of 187 patients with Borrelia burgdorferi specific intrathecal antibody production. Brain 1992;115:399-423.
4. Karma A, Seppala I, Mikkila H, Kaakkola, et al. Diagnosis and clinical characteristics of ocular Lyme Borreliosis. Am J Ophthalmol 1995;119:127-35.
5. Preac-Mursic V, Pfister HW, Spiegel H, et al. First isolation of Borrelia burgdorferi from an iris biopsy. J Clin Neuroophalmol 1993;13:155-61.
June 2005 - Volume 25 - Issue 2 - pp 67-68
Editorial
Defining the Spectrum of Lyme Disease: A Difficult Proposition
Pachner, Andrew R MD
Department of Neurology and Neurosciences, UMDNJ-New Jersey Medical School, Newark, NJ.
Address correspondence to Andrew R. Pachner, MD, Department of Neurology and Neurosciences, UMDNJ-New Jersey Medical School, 185 S. Orange Ave, Newark, NJ 07103
Chronic infections are notoriously difficult challenges for the clinician. With respect to determining their clinical spectra, diagnosing them, treating them, or studying their epidemiology, they are daunting. HIV, tuberculosis, syphilis, malaria, and Lyme disease, to name just a few, continue to vex us and make us humbler and wiser physicians.
The study by Sibony et al in this issue of Journal of Neuro-Ophthalmology (citation here) is an effort to determine whether various forms of optic neuropathy are within the spectrum of Lyme disease. The authors used a retrospective chart review of patients within a patient database at SUNY Stony Brook School of Medicine; the school is located in an area endemic for Lyme disease.Out of 440 patients presenting with optic neuritis, the authors found that only five (1%) had compelling evidence that active Borrelia burgdorferi was responsible for, or contributed to, their visual deficit. This would indicate that in an academic center in an endemic area in the United States, extremely few patients with optic neuritis had Lyme disease as a cause, and that it is not a common cause of optic neuritis.
Why did I include the qualifier in the United States in the aforementioned sentence? Because Lyme neuroborreliosis has different clinical phenotypes for different genotypes of infecting subtypes of B. burgdorferi spirochetes. This has been an observation in the human disease (1) and its animal models (2). Thus, the conclusions drawn from the study of Sibony et al may not be readily applicable to Lyme disease in Europe, where the disease has a more aggressive neurologic presentation (3). Not surprisingly, investigators in Europe such as the Finns (4) and the Germans (5), both appropriately quoted in the study of Sibony et al, might dispute the conclusion that optic neuritis is rare in Lyme neuroborreliosis. The difference is likely because of the fact that American neuroborreliosis is caused predominantly by B. burgdorferi sensu stricto, whereas European disease is caused by B. garinii or B. afzelii, and the genetic differences between these subspecies are considerable.
Another issue that the authors did not address is the nagging question of whether our serological assays (enzyme-linked immunosorbent assay and Western blot) are so powerful that they will always be positive in cases of optic neuritis caused by B. burgdorferi. My answer is, possibly not! The concern is that in this chronic infection, it is conceivable that spirochetes can be cleared from the periphery but retained in immune-privileged sites such as the eye or the brain. Thus, an enzyme-linked immunosorbent assay-positive but Western blot-negative patient with optic neuritis could conceivably be infected yet have a localized process without adequate peripheral activation to become Western blot positive. A similar situation occurs in tertiary neurosyphilis, in which the CSF (cerebrospinal fluid) VDRL can be negative in a substantial percentage of cases despite a positive serum FTA-ABS.
These remarks do not detract, of course, from a very nice contribution to the literature by Sibony et al, especially in pointing out that optic nerve involvement in Lyme borreliosis in the United States is predominantly found in the child with meningitis, increased intracranial pressure, and optic disc edema. Retrobulbar neuritis remains very unlikely to be caused by Lyme disease; most likely it has another cause.
REFERENCES
1. Steere AC, Berardi VP, Weeks KE, et al. Evaluation of the intrathecal antibody response to Borrelia burgdorferi as a diagnostic test for Lyme neuroborreliosis. J Infect Dis 1990;161:1203-9.
2. Pachner, AR, Dail D, Bai Y, et al. Genotype determines phenotype in experimental Lyme neuroborreliosis. Ann Neurol 2004;56:361-70.
3. Hansen K, Lebech AM. The clinical and epidemiological profile of Lyme neuroborreliosis in Denmark 1985-1990. A prospective study of 187 patients with Borrelia burgdorferi specific intrathecal antibody production. Brain 1992;115:399-423.
4. Karma A, Seppala I, Mikkila H, Kaakkola, et al. Diagnosis and clinical characteristics of ocular Lyme Borreliosis. Am J Ophthalmol 1995;119:127-35.
5. Preac-Mursic V, Pfister HW, Spiegel H, et al. First isolation of Borrelia burgdorferi from an iris biopsy. J Clin Neuroophalmol 1993;13:155-61.
http://journals.lww.com/jneuro-ophthalm ... ult.1.aspx
----------------------------------
Oftalmologia. 2006;50(1):16-20.
[Lyme disease--a relatively new entity].
[Article in Romanian]
Tsirmpas MD, Tsirmpas D.
Source
Clinica de Oftalmologie, Spitalul Clinic de Urgenta, Militar Central, Bucuresti.
Abstract
PURPOSE: To bring in the attention of the medical personnel a relatively new discovered disease with serious consequences, that is often mistaken with a great multitude of miscellaneous syndromes. Also we want to highlight that it is not a rare disease taken into account its endemicity in Europe and consequently in Romania. SUMMARY: Lyme disease is a bacterial infection caused by a spirochete named "Borrelia Burgdorferi" transmitted to humans by a minuscule tick. It is a multi-systemic illness with ocular involvement as well. The disease mimics other pathologic conditions and because of this goes frequently undiagnosed and consequently untreated. Its ocular involvement may vary from a mild conjunctivitis to uveitis, optic neuritis and sometimes lead to blindness. The disease is endemic in Romania. If it is correctly diagnosed it can be successfully treated with specific antibiotics administrated orally or i.v.
PMID:
16773934
[PubMed - indexed for MEDLINE]
-----------------------------------------[Lyme disease--a relatively new entity].
[Article in Romanian]
Tsirmpas MD, Tsirmpas D.
Source
Clinica de Oftalmologie, Spitalul Clinic de Urgenta, Militar Central, Bucuresti.
Abstract
PURPOSE: To bring in the attention of the medical personnel a relatively new discovered disease with serious consequences, that is often mistaken with a great multitude of miscellaneous syndromes. Also we want to highlight that it is not a rare disease taken into account its endemicity in Europe and consequently in Romania. SUMMARY: Lyme disease is a bacterial infection caused by a spirochete named "Borrelia Burgdorferi" transmitted to humans by a minuscule tick. It is a multi-systemic illness with ocular involvement as well. The disease mimics other pathologic conditions and because of this goes frequently undiagnosed and consequently untreated. Its ocular involvement may vary from a mild conjunctivitis to uveitis, optic neuritis and sometimes lead to blindness. The disease is endemic in Romania. If it is correctly diagnosed it can be successfully treated with specific antibiotics administrated orally or i.v.
PMID:
16773934
[PubMed - indexed for MEDLINE]
The jury may still be out as far as Lyme optic neuritis and retrobulbar neuritis caused by Lyme disease, however these were published after 2005:
http://www.ncbi.nlm.nih.gov/pubmed/16773934
---------------------------------------
Med Arh. 2008;62(2):117-8.Links
Bilateral retrobulbar optic neuritis as first signs of Lyme disease.
Todorovic L, Ibisevic M, Alajbegovic A, Suljic-Mehmedika E, Jurisic V.
Clinic for Neurology, Clinical center University of Sarajevo.
Bilateral retrobulbar optic neuritis in young adults are most often caused by demyelinate disease (MS). In all cases where MS was eliminated, we have used selected tests regarding to history, clinical findings and differential diagnosis. Diagnosis of Lyme disease is approved by diagnostic criteria proposed by Center for Control and Prevention of disease. In our case diagnosis of Lyme disease was established by history of illness, clinical findings and positive serlological tests.
PMID: 18669236
------------------------------------Bilateral retrobulbar optic neuritis as first signs of Lyme disease.
Todorovic L, Ibisevic M, Alajbegovic A, Suljic-Mehmedika E, Jurisic V.
Clinic for Neurology, Clinical center University of Sarajevo.
Bilateral retrobulbar optic neuritis in young adults are most often caused by demyelinate disease (MS). In all cases where MS was eliminated, we have used selected tests regarding to history, clinical findings and differential diagnosis. Diagnosis of Lyme disease is approved by diagnostic criteria proposed by Center for Control and Prevention of disease. In our case diagnosis of Lyme disease was established by history of illness, clinical findings and positive serlological tests.
PMID: 18669236
J Neurol Sci. 2010 Aug 15;295(1-2):117-9. Epub 2010 Jun 8.
Lyme optic neuritis.
Blanc F, Ballonzoli L, Marcel C, De Martino S, Jaulhac B, de Seze J.
Department of Neurology, University Hospital of Strasbourg, Strasbourg, France.
Abstract
Lyme optic neuritis (ON) is a rare disease and only a few cases have been reported. We describe two cases of isolated Lyme ON, one with recurrence 9 months after the appearance of initial symptoms. Diagnosis criteria for multiple sclerosis and neuromyelitis optica were not met. The etiological diagnosis was based on European case definition criteria for neuroborreliosis. Both patients had positive serum and cerebrospinal fluid serology, a positive intrathecal anti-Borrelia antibody index, and a good outcome on ceftriaxone. Specific diagnosis of Lyme ON is important since improvement of visual acuity is possible with specific antibiotherapy, even after many months.
PMID: 20621802
Lyme optic neuritis.
Blanc F, Ballonzoli L, Marcel C, De Martino S, Jaulhac B, de Seze J.
Department of Neurology, University Hospital of Strasbourg, Strasbourg, France.
Abstract
Lyme optic neuritis (ON) is a rare disease and only a few cases have been reported. We describe two cases of isolated Lyme ON, one with recurrence 9 months after the appearance of initial symptoms. Diagnosis criteria for multiple sclerosis and neuromyelitis optica were not met. The etiological diagnosis was based on European case definition criteria for neuroborreliosis. Both patients had positive serum and cerebrospinal fluid serology, a positive intrathecal anti-Borrelia antibody index, and a good outcome on ceftriaxone. Specific diagnosis of Lyme ON is important since improvement of visual acuity is possible with specific antibiotherapy, even after many months.
PMID: 20621802
---------------------------------------------
J Fr Ophtalmol. 2012 Jan;35(1):17-22. Epub 2011 Jun 22.
Ocular Lyme disease occurring during childhood: five case reports.
[Article in French]
Sauer A, Hansmann Y, Jaulhac B, Bourcier T, Speeg-Schatz C.
Source
Abstract
INTRODUCTION:
Lyme borreliosis (LB) is the most common human tick-borne disease in the Northern hemisphere. The various ophthalmologic manifestations of Lyme borreliosis (LB) during childhood are discussed in this paper.
PATIENTS AND METHODS:
Six children with LB-associated ocular manifestations were treated between 2000 and 2010 in the ophthalmology department of Strasbourg University Hospital (an endemic area). Medical history, ocular and systemic clinical findings, determinations of antibodies related to Borrelia, as well as exclusion of other causes were the diagnosis criteria.
RESULTS:
Two cases of uveitis, two cases of abducens palsies, one case of optical neuropathy, and one case of orbital myositis associated with LB were diagnosed. Systemic findings, such as arthritis, rash, or erythema migrans were mentioned in all cases. Two children also complained of severe knee arthritis. Determination of antibodies was positive in all patients. They were all treated with antibiotics adjusted to individual circumstances and some of them (two cases of uveitis and one of optic neuropathy) also had anti-inflammatory treatment. Resolution of ocular signs, with no relapse, was observed in all patients within two to 12 weeks.
CONCLUSION:
For any unexplained ocular symptom, even in children, LB should be taken into account, especially in endemic areas. Such patients should undergo serological testing. If the clinical presentation is suggestive of LB, a course of oral antibiotics should be used. All in all, permanent defects are extremely rare during the childhood period, even following long-term manifestation at an early age.
Ocular Lyme disease occurring during childhood: five case reports.
[Article in French]
Sauer A, Hansmann Y, Jaulhac B, Bourcier T, Speeg-Schatz C.
Source
Abstract
INTRODUCTION:
Lyme borreliosis (LB) is the most common human tick-borne disease in the Northern hemisphere. The various ophthalmologic manifestations of Lyme borreliosis (LB) during childhood are discussed in this paper.
PATIENTS AND METHODS:
Six children with LB-associated ocular manifestations were treated between 2000 and 2010 in the ophthalmology department of Strasbourg University Hospital (an endemic area). Medical history, ocular and systemic clinical findings, determinations of antibodies related to Borrelia, as well as exclusion of other causes were the diagnosis criteria.
RESULTS:
Two cases of uveitis, two cases of abducens palsies, one case of optical neuropathy, and one case of orbital myositis associated with LB were diagnosed. Systemic findings, such as arthritis, rash, or erythema migrans were mentioned in all cases. Two children also complained of severe knee arthritis. Determination of antibodies was positive in all patients. They were all treated with antibiotics adjusted to individual circumstances and some of them (two cases of uveitis and one of optic neuropathy) also had anti-inflammatory treatment. Resolution of ocular signs, with no relapse, was observed in all patients within two to 12 weeks.
CONCLUSION:
For any unexplained ocular symptom, even in children, LB should be taken into account, especially in endemic areas. Such patients should undergo serological testing. If the clinical presentation is suggestive of LB, a course of oral antibiotics should be used. All in all, permanent defects are extremely rare during the childhood period, even following long-term manifestation at an early age.
-------------------------------
Curr Opin Ophthalmol. 2012 Nov;23(6):485-490.
Optic nerve involvement in Lyme disease.
Träisk F, Lindquist L.
Source
a Department of Clinical Neuroscience and Clinic of Neuro-Ophthalmology, Karolinska Institute, St Erik Eye Hospital, Stockholm b Department of Medicine and Clinic for Infectious Diseases, Karolinska Institute, Karolinska University Hospital, Huddinge, Sweden.
Abstract
PURPOSE OF REVIEW:
The tick-borne spirochete Borrelia burgdorferi sensu lato can cause several neural manifestations from the peripheral and central neural system. There are several case reports in the literature of optic nerve involvement in association with Lyme neuroborreliosis, but clinical guidelines as to when Lyme disease should be considered in optic neuropathy is lacking.
RECENT FINDINGS:
Papilledema caused by raised intracranial pressure in Lyme meningitis seems mainly to affect children, although some adult cases have been reported. Very few cases of retrobulbar optic neuritis, papillitis, neuroretinitis and ischemic optic neuropathy have shown evidence of a strong association with Lyme neuroborreliosis.
SUMMARY:
Optic neuropathy in Lyme neuroborreliosis is rare. The cases reported in the literature are not sufficient for making a list of clinical 'red flags'. However, in adult cases, special attention seems reasonable in patients with painless visual loss, bilateral optic nerve head swelling with or without an elevated cerebrospinal fluid opening pressure. In endemic areas, any optic neuropathy may still be considered for a Lyme neuroborreliosis work-up. The use of accepted criteria for establishing the diagnosis of Lyme neuroborreliosis is emphasised.
PMID: 23047166 [PubMed - as supplied by publisher]
Optic nerve involvement in Lyme disease.
Träisk F, Lindquist L.
Source
a Department of Clinical Neuroscience and Clinic of Neuro-Ophthalmology, Karolinska Institute, St Erik Eye Hospital, Stockholm b Department of Medicine and Clinic for Infectious Diseases, Karolinska Institute, Karolinska University Hospital, Huddinge, Sweden.
Abstract
PURPOSE OF REVIEW:
The tick-borne spirochete Borrelia burgdorferi sensu lato can cause several neural manifestations from the peripheral and central neural system. There are several case reports in the literature of optic nerve involvement in association with Lyme neuroborreliosis, but clinical guidelines as to when Lyme disease should be considered in optic neuropathy is lacking.
RECENT FINDINGS:
Papilledema caused by raised intracranial pressure in Lyme meningitis seems mainly to affect children, although some adult cases have been reported. Very few cases of retrobulbar optic neuritis, papillitis, neuroretinitis and ischemic optic neuropathy have shown evidence of a strong association with Lyme neuroborreliosis.
SUMMARY:
Optic neuropathy in Lyme neuroborreliosis is rare. The cases reported in the literature are not sufficient for making a list of clinical 'red flags'. However, in adult cases, special attention seems reasonable in patients with painless visual loss, bilateral optic nerve head swelling with or without an elevated cerebrospinal fluid opening pressure. In endemic areas, any optic neuropathy may still be considered for a Lyme neuroborreliosis work-up. The use of accepted criteria for establishing the diagnosis of Lyme neuroborreliosis is emphasised.
PMID: 23047166 [PubMed - as supplied by publisher]
-------------------------------
REVIEW ARTICLE
Lyme Disease
Allen C. Steere, M.D.
N Engl J Med 2001; 345:115-125July 12, 2001DOI: 10.1056/NEJM200107123450207
Lyme Disease
Allen C. Steere, M.D.
N Engl J Med 2001; 345:115-125July 12, 2001DOI: 10.1056/NEJM200107123450207
--------------------------------
Ocular Lyme Borreliosis
N Engl J Med 2001; 345:1350-1351November 1, 2001DOI: 10.1056/NEJM200111013451816
To the Editor:
The superb review article on Lyme disease by Steere (July 12 issue)1 omitted a manifestation associated with the disease: ocular Lyme borreliosis. Ocular Lyme borreliosis is probably underdiagnosed not only because of difficulties in the serologic diagnosis of the disease, but also because the clinical ocular features are often not recognized. Uveitis (which may be associated with photophobia, macular edema, retinal vasculitis, and decreased vision), neuroretinitis, and choroiditis with retinal detachment may develop.2 Neuro-ophthalmic manifestations include optic neuropathy and other cranial neuropathies such as abducens-nerve palsy and paresis of the seventh nerve (which may lead to neurotrophic keratopathy) and pseudotumor cerebri. Interstitial keratitis, episcleritis, and follicular conjunctivitis are possible anterior-segment manifestations. Transient worsening of symptoms after the intravenous administration of ceftriaxone as a result of a Jarisch–Herxheimer reaction has also been described.3
These manifestations are important components of the clinical spectrum of Lyme borreliosis. They occasionally develop in the early stages of the disease, but in most cases they are late manifestations. Interestingly, it was Steere and colleagues who first described proven ocular Lyme borreliosis in their 1985 report of a patient who was blinded from severe panophthalmitis and in whose vitreous Borrelia burgdorferi spirochetes were found.4
Michael Colucciello, M.D.
South Jersey Eye Physicians, Moorestown, NJ 08057
N Engl J Med 2001; 345:1350-1351November 1, 2001DOI: 10.1056/NEJM200111013451816
To the Editor:
The superb review article on Lyme disease by Steere (July 12 issue)1 omitted a manifestation associated with the disease: ocular Lyme borreliosis. Ocular Lyme borreliosis is probably underdiagnosed not only because of difficulties in the serologic diagnosis of the disease, but also because the clinical ocular features are often not recognized. Uveitis (which may be associated with photophobia, macular edema, retinal vasculitis, and decreased vision), neuroretinitis, and choroiditis with retinal detachment may develop.2 Neuro-ophthalmic manifestations include optic neuropathy and other cranial neuropathies such as abducens-nerve palsy and paresis of the seventh nerve (which may lead to neurotrophic keratopathy) and pseudotumor cerebri. Interstitial keratitis, episcleritis, and follicular conjunctivitis are possible anterior-segment manifestations. Transient worsening of symptoms after the intravenous administration of ceftriaxone as a result of a Jarisch–Herxheimer reaction has also been described.3
These manifestations are important components of the clinical spectrum of Lyme borreliosis. They occasionally develop in the early stages of the disease, but in most cases they are late manifestations. Interestingly, it was Steere and colleagues who first described proven ocular Lyme borreliosis in their 1985 report of a patient who was blinded from severe panophthalmitis and in whose vitreous Borrelia burgdorferi spirochetes were found.4
Michael Colucciello, M.D.
South Jersey Eye Physicians, Moorestown, NJ 08057
Author/Editor Response
The author replies:
To the Editor: In my original review article on Lyme disease,1 which was published in the Journal 12 years ago, I listed the known clinical manifestations of the infection. With regard to ocular manifestations, the list included reports of conjunctivitis, iritis, choroiditis, retinal hemorrhage or detachment, keratitis, and panophthalmitis. Because of space limitations, I was not able to reiterate this list in the current review.2 Instead, in the section on clinical manifestations and pathogenesis, I presented only the more common clinical manifestations of the infection and reviewed new information about the immunopathogenesis of each of these manifestations, including insights gained from animal models of the infection.
Although I was not able to include information on eye abnormalities or other uncommon manifestations of Lyme disease in my current review, in the section on neurologic involvement I did mention optic neuropathy in children with Lyme disease, citing a recent article.3 This manifestation may result from inflammation of the optic nerve, increased intracranial pressure, or both and may lead to permanent bilateral blindness, a complication that had not yet been reported 12 years ago.
In the current review,2 I stated, “The clinical manifestations of Lyme disease remain basically as they were presented in the Journal 12 years ago.” My hope was that readers who were interested in reviewing the list of clinical manifestations of the infection would refer to the original article.
Allen C. Steere, M.D.
Tufts University School of Medicine, Boston, MA 02111
The author replies:
To the Editor: In my original review article on Lyme disease,1 which was published in the Journal 12 years ago, I listed the known clinical manifestations of the infection. With regard to ocular manifestations, the list included reports of conjunctivitis, iritis, choroiditis, retinal hemorrhage or detachment, keratitis, and panophthalmitis. Because of space limitations, I was not able to reiterate this list in the current review.2 Instead, in the section on clinical manifestations and pathogenesis, I presented only the more common clinical manifestations of the infection and reviewed new information about the immunopathogenesis of each of these manifestations, including insights gained from animal models of the infection.
Although I was not able to include information on eye abnormalities or other uncommon manifestations of Lyme disease in my current review, in the section on neurologic involvement I did mention optic neuropathy in children with Lyme disease, citing a recent article.3 This manifestation may result from inflammation of the optic nerve, increased intracranial pressure, or both and may lead to permanent bilateral blindness, a complication that had not yet been reported 12 years ago.
In the current review,2 I stated, “The clinical manifestations of Lyme disease remain basically as they were presented in the Journal 12 years ago.” My hope was that readers who were interested in reviewing the list of clinical manifestations of the infection would refer to the original article.
Allen C. Steere, M.D.
Tufts University School of Medicine, Boston, MA 02111
-----------------------------
http://www.ncbi.nlm.nih.gov/pubmed/22635283 [no abstract]
http://www.annals.edu.sg/pdf/41VolNo4Ap ... N4p178.pdf [free full text]
http://www.annals.edu.sg/pdf/41VolNo4Ap ... N4p178.pdf [free full text]
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Lyme borreliosis
Ocular inflammation as a manifestation of Lyme borreliosis
BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e4721 (Published 16 July 2012)
Cite this as: BMJ 2012;345:e4721
Jael M Howlett, specialist trainee year 1, ophthalmology1, Adam P Booth, consultant ophthamologist1
Author Affiliations
1Royal Eye Infirmary, Plymouth PL4 6P, UK
Lyme disease has several important ophthalmic manifestations that are important to highlight.1 Self limiting follicular conjunctivitis is probably the most common early ocular manifestation and occurs within the …
Ocular inflammation as a manifestation of Lyme borreliosis
BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e4721 (Published 16 July 2012)
Cite this as: BMJ 2012;345:e4721
Jael M Howlett, specialist trainee year 1, ophthalmology1, Adam P Booth, consultant ophthamologist1
Author Affiliations
1Royal Eye Infirmary, Plymouth PL4 6P, UK
Lyme disease has several important ophthalmic manifestations that are important to highlight.1 Self limiting follicular conjunctivitis is probably the most common early ocular manifestation and occurs within the …
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BMJ 2012;345:e4721 doi: 10.1136/bmj.e4721 (Published 16 July 2012)
LETTERS
LYME BORRELIOSIS
Ocular inflammation as a manifestation of Lyme borreliosis
Jael M Howlett specialist trainee year 1, ophthalmology,
Adam P Booth consultant ophthamologist
Royal Eye Infirmary, Plymouth PL4 6P, UK
Lyme disease has several important ophthalmic manifestations that are important to highlight.1 Self limiting follicular
conjunctivitis is probably the most common early ocular manifestation and occurs within the first few weeks of infection in around 10% of patients. Periorbital oedema has also been reported in the early stage.2 3 Other ocular manifestations include anterior, intermediate, and posterior uveitis; keratitis; and episcleritis.3
Among all cases of uveitis, Lyme disease was the underlying cause in 4.3% of patients, and all patients with Lyme uveitis had posterior ocular manifestations, such as vitritis, retinal vasculitis, or neuroretinitis.4
Photophobia and severe periodic ocular pain can be characteristic symptoms of Lyme borreliosis.3 Doctors should be aware that patients presenting with eye pain, redness, photophobia, or reduced visual acuity could have ocular
manifestations of Lyme disease.
Competing interests: None declared.
1 Duncan CJA, Carle G, Seaton A. Tick bite and early Lyme borreliosis. BMJ
2012;344:e3124. (14 May.)
2 Weinberg RS. Ocular involvement in Lyme disease. Current insight. American Academy
of Ophthalmology, 2008.
3 Mikkila HO, Ilkka JT, Seppala I, Viljanen MK, Peltomaa MP, Karma A. The expanding
clinical spectrum of ocular Lyme borreliosis. Ophthalmology 2000;107:581-7.
4 Mikkila H, Seppala I, Leirisalo-Repo M, Immonen I, Karma A. The etiology of uveitis: the
role of infections with special reference to Lyme borreliosis. Acta Ophthalmol Scand
1997;75:716-9.
Cite this as: BMJ 2012;345:e4721
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Eur J Ophthalmol. 2001 Apr-Jun;11(2):203-6.
Optic nerve lesion following neuroborreliosis: a case report.
Burkhard C, Gleichmann M, Wilhelm H.
Source
Ahaus Eye Hospital, Germany.
Abstract
PURPOSE:
Neuroborreliosis may cause various neuro-ophthalmological complications. We describe a case with a bilateral optic neuropathy.
CASE REPORT:
A 58-year-old female developed facial paresis six weeks after an insect bite. One week later she developed bilateral optic disc swelling with haemorrhages and nerve fibre bundle defects in the lower visual field of the left eye. In CSF and serum, raised IgM and IgG titres to Borrelia burgdorferi were found. Systemic antibiotic treatment led to improvement of the vision and facial paresis, but not all visual field defects resolved, probably due to ischemic lesions of the optic disc.
DISCUSSION/CONCLUSIONS:
In optic nerve lesions due to neuroborreliosis it is difficult to distinguish between inflammatory and ischemic lesions. This patient demonstrated features of an ischemic optic nerve lesion.
PMID:
11456029
[PubMed - indexed for MEDLINE]
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BARTONELLA HENSELAE NEURORETINITIS ASSOCIATED WITH CENTRAL RETINAL VEIN OCCLUSION, CHOROIDAL ISCHEMIA, AND ISCHEMIC OPTIC NEUROPATHY
Purpose: We describe a healthy 37-year-old man with Bartonella henselae (B. henselae) neuroretinitis with concurrent central retinal vein occlusion and ischemic optic neuropathy resulting in optic atrophy and choroidal ischemia.
Methods: Case report.
Results: A 37-year-old man presented with unilateral decreased vision and a fundus examination consistent with neuroretinitis. Further imaging review supported a concurrent diagnosis of central retinal vein occlusion. Although initially negative, repeat serological testing for B. henselae infection was positive. Multimodal imaging displayed severe outer retinal disruption, ischemic optic neuropathy, and choroidal ischemia. The patient demonstrated near complete resolution of fundus findings and restoration of outer retinal architecture. Residual findings included optic disk pallor and ischemic choroidopathy.
Discussion: B. henselae neuroretinitis may be associated with concurrent retinal vascular occlusive disease and ischemic optic neuropathy. Central retinal vein occlusion and choroidal ischemia leading to optic nerve atrophy are additional sequelae further expanding the clinical spectrum of this entity
https://www.ncbi.nlm.nih.gov/pubmed/28700390
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BARTONELLA HENSELAE NEURORETINITIS ASSOCIATED WITH CENTRAL RETINAL VEIN OCCLUSION, CHOROIDAL ISCHEMIA, AND ISCHEMIC OPTIC NEUROPATHY
Purpose: We describe a healthy 37-year-old man with Bartonella henselae (B. henselae) neuroretinitis with concurrent central retinal vein occlusion and ischemic optic neuropathy resulting in optic atrophy and choroidal ischemia.
Methods: Case report.
Results: A 37-year-old man presented with unilateral decreased vision and a fundus examination consistent with neuroretinitis. Further imaging review supported a concurrent diagnosis of central retinal vein occlusion. Although initially negative, repeat serological testing for B. henselae infection was positive. Multimodal imaging displayed severe outer retinal disruption, ischemic optic neuropathy, and choroidal ischemia. The patient demonstrated near complete resolution of fundus findings and restoration of outer retinal architecture. Residual findings included optic disk pallor and ischemic choroidopathy.
Discussion: B. henselae neuroretinitis may be associated with concurrent retinal vascular occlusive disease and ischemic optic neuropathy. Central retinal vein occlusion and choroidal ischemia leading to optic nerve atrophy are additional sequelae further expanding the clinical spectrum of this entity
https://www.ncbi.nlm.nih.gov/pubmed/28700390
----------------------------------------
Branch Retinal Artery Occlusion Associated With Lyme Disease http://archopht.jamanetwork.com/article.aspx…
The expanding clinical spectrum of ocular Lyme borreliosis http://www.aaojournal.org/ar…/S0161-6420(99)00128-1/abstract
CYTOLOGICALLY PROVEN SERONEGATIVE LYME CHOROIDITIS AND VITRITIS http://journals.lww.com/…/Cytologically_Proven_Seronegative…...
Intraocular-central nervous system lymphoma: Clinical features, diagnosis, and outcomes (Lymphoma is Lyme) http://www.sciencedirect.com/…/article/pii/S016164209990341X
Ophthalmologic Complications of Systemic Disease http://www.sciencedirect.com/…/article/pii/S073386270700123X
Lyme disease: A Look Beyond Antibiotics http://healinglymenaturally.webdesigncatalyst.com/…/LymeALo…
Borrelia Hermsii Causing Relapsing Fever and Uveitis http://www.sciencedirect.com/…/article/pii/S0002939406003813
AN EYE ON INFLAMMATORY EYE DISEASE http://www.maneyonline.com/doi/abs/10.1179/acb.2005.044
The eye in systemic infection http://www.sciencedirect.com/…/article/pii/S0140673604172280
Panuveitis Caused by Borrelia Burgdorferi Sensu Lato Infection https://journals.lww.com/…/Panuveitis_Caused_by_Borrelia_Bu…
The expanding clinical spectrum of ocular Lyme borreliosis http://www.aaojournal.org/ar…/S0161-6420(99)00128-1/abstract
CYTOLOGICALLY PROVEN SERONEGATIVE LYME CHOROIDITIS AND VITRITIS http://journals.lww.com/…/Cytologically_Proven_Seronegative…...
Intraocular-central nervous system lymphoma: Clinical features, diagnosis, and outcomes (Lymphoma is Lyme) http://www.sciencedirect.com/…/article/pii/S016164209990341X
Ophthalmologic Complications of Systemic Disease http://www.sciencedirect.com/…/article/pii/S073386270700123X
Lyme disease: A Look Beyond Antibiotics http://healinglymenaturally.webdesigncatalyst.com/…/LymeALo…
Borrelia Hermsii Causing Relapsing Fever and Uveitis http://www.sciencedirect.com/…/article/pii/S0002939406003813
AN EYE ON INFLAMMATORY EYE DISEASE http://www.maneyonline.com/doi/abs/10.1179/acb.2005.044
The eye in systemic infection http://www.sciencedirect.com/…/article/pii/S0140673604172280
Panuveitis Caused by Borrelia Burgdorferi Sensu Lato Infection https://journals.lww.com/…/Panuveitis_Caused_by_Borrelia_Bu…
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