A retrospective observational study of Lyme neuroborreliosis in the southwest of England

Petridou, Christina, Lovett, Joanna, Ross Russell, Amy, Jeppesen, Catherine, Sheridan, Liz, Okyere, Sharon, Saeed, Kordo, Lee, Mihye and Dryden, Matthew (2020) A retrospective observational study of Lyme neuroborreliosis in the southwest of England. Clinical Infection in Practice, 6, [100017]. (doi:10.1016/j.clinpr.2020.100017).

Abstract

Background
Lyme disease is endemic in the UK with a high incidence in southwest England. Neurological symptoms are the most common complication.

Aim
To review the clinical manifestations and management of Lyme neuroborreliosis in Southwest England.

Design and setting
Six hospitals in Hampshire participated in this retrospective, observational study.

Methods
Patients with neurological symptoms and a positive screening ELISA followed by confirmatory immunoblots between January 2015 and December 2017 were contacted and a questionnaire completed. Information gathered included demographics, tick exposure, symptoms, sequelae, investigations and treatment.

Results
Seventy-two patients were included; 71% initially presented to their GP, 26% were children, a preceding tick bite was reported in 24% and erythema migrans in 36%. The most common symptom was unilateral facial nerve palsy. Central nervous system manifestations were uncommon. Only 13 patients had a lumbar puncture. All patients received effective antibiotics, apart from 2 who were not treated but recovered fully. Treatment duration varied with 55% of patients receiving either a shorter or longer duration than recommended by the EFNS and BIA during the study period. Patients given longer courses did not report fewer sequelae. Complete resolution was reported in 72%. The remainder complained mainly of subjective symptoms.

Conclusions
Most patients were diagnosed and managed on clinical grounds and did not undergo invasive investigations. Patients were given effective antibiotics although the difference in duration was marked; recent NICE guidelines recommending 3 weeks of antibiotics may help standardise this. The majority improved with no sequelae. This is the largest UK study focusing exclusively on neuroborreliosis with particular emphasis on management and outcome.

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Contributors

Author: Kordo Saeed

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