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Neuroborreliose

Neuroborreliosis

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Zusammenfassung

Die Neuroborreliose ist klinisch und laborchemisch meist gut zu diagnostizieren. Leitsymptome sind radikuläre Schmerzen sowie Paresen der Extremitäten und des N. facialis. Die Vielzahl weiterer seltener neurologischer Symptome lässt sich durch die Liquoranalyse in der Regel gut zuordnen. Die Therapie mit Doxycyclin (oral), Cephalosporinen der 3. Generation (Ceftriaxon, Cefotaxim) oder Penicillin G (i.v.) orientiert sich an der klinischen Symptomatik (zentral, peripher). Das Post-Lyme-Syndrom ist eine diffuse Beschreibung unspezifischer Beschwerden, die keine sichere Kausalität mit einer vorausgegangen Borrelieninfektion aufweisen. Die Pathogenese ist unklar, eine Erregerpersistenz kann, bei unauffälligem Liquor und fehlendem Behandlungserfolg von Antibiotika in gut geplanten Studien, weitestgehend ausgeschlossen werden.

Summary

Neuroborreliosis is easily diagnosed by means of clinical symptoms and laboratory findings. Guiding symptoms are radicular pain and pareses of the extremities and the facial nerve. There is a great number of further less frequently occurring neurological symptoms, which can be attributed to a borrelial infection only by appropriate investigations of the CSF. Radiculitis is cured adequately by oral doxycycline while symptoms of the central nervous system are probably better treated intravenously by ceftriaxone, cefotaxime or penicillin G. Post-Lyme syndrome is a diffuse description of non-specific complaints, which are not the explicit result of a former infection with B. burgdorferi. As further antibiotics do not help and the CSF is unremarkable in most patients, a persistent infection with B. burgdorferi s.l. in all probability can be excluded.

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  1. Neurologische Klinik, Klinikum Pforzheim, Kanzlerstraße 2-6, 75175, Pforzheim, Deutschland

    R. Kaiser

  2. Konsiliarlabor für Ehrlichien, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit (LGL), Dienststelle Oberschleißheim, Nationales Referenzzentrum für Borrelien, Oberschleißheim, Deutschland

    V. Fingerle

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Kaiser, R., Fingerle, V. Neuroborreliose. Nervenarzt 80, 1239–1251 (2009). https://doi.org/10.1007/s00115-009-2788-z

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