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2021, vol. 21, br. 2, str. 24-31
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Hronična lajm neuroborelioza
Chronic Lyme neuroborreliosis
aDom zdravlja Kraljevo, Kraljevo bAkademija strukovnih studija, Odsek Visoka zdravstvena škola, Beograd
e-adresa: lesta59@yahoo.com
Sažetak
Uvod: Lajm neuroborelioza je infektivni poremećaj centralnog i/ili perifernog nervnog sistema uzrokovan ubodom krpelja roda Ixodes rici, zaraženog spirohetom Borrelia burgdorferi sensu lato (u Evropi). Bolest se manifestuje kao meningitis, encefalitis, meningoradikulitis, vaskulitis, pareza facijalnog nerva i bolne radikulopatije. Prikaz slučaja: Pacijentkinja stara 44. godine prijavljuje zamor, zaboravnost, glavobolju, konfuziju, depresivnost, pospanost, iritabilnost, nestabilnost, podkolenice su joj utrnule, tabani bride i ne seća se naziva predmeta. Mišićni refleksi podkolenica sniženi. Plantarni odgovor fleksioni, Lazarevićev znak pozitivan obostrano na 45 stepeni od podloge. Bez slabosti dorzalne i plantarne fleksije prstiju stopala. Ispadi senzibiliteta u regiji inervacije nervus peroneusa i tibialisa. Sfinktere kontroliše. Pacijentkinja je imala dijagnostikovanu Lajmsku bolest, pet meseci pre egzarcebacije tegoba. Zbog erythema migrans i subfebrilnosti je rađena dijagnostika i utvrđena seropozitivnost na Boreliju burgdorferi u obe klase antitela imunoenzimskim esejom i potvrdnim Western blot testom. Tada je koristila doksiciklin 200 miligrama /dan, tri nedelje. Analizom cerebrospinalne tečnosti nađena je proteinorahija (0,42 g/ L), normalna glikorahija, pleocitoza i pozitivna intratekalna IgG antitela. Elektromiografija je ukazala na aksonalnu degeneraciju donjih ekstremiteta. Magnetna rezonanca uredna. U terapiju uključen ceftriakson, 2 grama/dan, polivitaminska i analgetska terapija. Neuroborelioza se održavala laboratorijski tokom jednogodišnjeg praćenja. Mentalne tegobe, glavobolje, konfuzija i iritabilnost, neurološki znaci su znatno regresirali. Zaključak: Zlatni standard u dijagnostikovanju neuroborelioze je određivanje intratekalnih antitela. Za definitivnu dijagnozu neophodni su klinički znaci bolesti, pleocitoza i pozitivna antitela. Intratekalna antitela ostaju dugo pozitivna i ne preporučuju se za praćenje efekata terapije.
Abstract
Introduction. Lyme neuroborreliosis is an infectious disorder of the central and/or peripheral nervous system caused by the tick stump of the genus Ixodes rici, infected with species Borrelia burgdorferi sensu lato (in Europe). The disease manifests as meningitis, encephalitis, meningoradiculitis, vasculitis, paresthesia of the facial nerve and painful radiculopathy. Case report. A 44-year-old patient reports fatigue, forgetfulness, headache, confusion, depression, drowsiness, irritability, instability, her undercooks are crushed, sheeps of a bride and does not recall being called an object. Muscular reflexes of the undergrowth are reduced. Plantar response flexion, Lazarevic sign is positive at 45 degrees from the surface. No weakness of the dorsal and plantar flexion of the fingers of the feet. Relieves sensitivity in the region of inertia nerv peroneus and tibialis. Sphincters were fine. The patient had a diagnosed Lyme disease, five months prior to the exacerbation of anxiety. Due to erythema migrans and subfebrility, diagnosis and seropositivity to Borrelia burgdorferi were established in both classes of the enzymelinked immunosorbent assay antibodies and a confirmed Western blot test. She took doxycycline 200 milligrams/day, three weeks. The analysis of cerebrospinal fluid revealed proteinhorn (0.42 g/L), normal glycorrhachia, pleocytosis, and positive intrathecal IgG antibodies. Electromyography pointed to axonal degeneration of the lower extremities. The magnetic resonance is neat. The therapy includes ceftriaxone, 2 grams/day, vitamins and analgesic therapy. Neuroborreliois was maintained by the laboratory during one-year follow-up. Mental disorders, headaches, confusion and irritability, neurological signs have significantly regressed. Conclusion. The gold standard in diagnostics of neuroborelliosis is the determination of intrathecal antibodies. For the definitive diagnosis, clinical signs of disease, pleocytosis and positive antibodies are necessary. Intrathecal antibodies remain long positive and they are not recommended for monitoring for the effects of therapy.
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