Dtsch Med Wochenschr 2020; 145(01): 19-28
DOI: 10.1055/a-0793-4513
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© Georg Thieme Verlag KG Stuttgart · New York

Lyme-Borreliose: Kutane und neurologische Manifestationen, Falldefinitionen und Therapie

Lyme Borreliosis: Cutaneous and Neurologic Manifestations, Case Definitions and Therapy
Cora Scheerer
,
Rick Dersch
,
Hans-Iko Huppertz
,
Heidelore Hofmann
Further Information

Publication History

Publication Date:
08 January 2020 (online)

Abstract

Lyme borreliosis is the most common zoonosis in Germany with an incidence of up to 138/100 000. More than 90 % of all cases show dermatological manifestations. Early manifestations are erythema migrans, multiple erythemata migrantia, and (less frequently) borrelial lymphocytoma. A typical late manifestation is acrodermatitis chronica atrophicans. Lyme neuroborreliosis is much less common with an incidence of about 0.8/100 000 inhabitants in Germany. Bannwarth’s syndrome (painful radiculoneuritis) is the most common manifestation of Lyme neuroborreliosis in adults followed by meningitis. International case definitions exist regarding the likelihood of Lyme neuroborreliosis on the basis of diagnostic test results. A CSF analysis should be performed in patients with suspected Lyme neuroborreliosis. The first line treatment for dermatological manifestations of Lyme borreliosis is doxycycline, in children and pregnant women amoxicillin. Doxycycline and beta-lactam antibiotics show similar efficacy regarding neurological symptoms and adverse effects for treatment of neurological manifestations. Treatment duration for early manifestations is 10 to 14 days, in Lyme neuroborreliosis it should not exceed 21 days. All manifestations, also Lyme neuroborreliosis, usually show a favourable prognosis after antibiotic treatment. Antibiotic treatment does not show any efficacy in patients with unspecific symptoms and concurrent positive anti-borrelial serology.

Hautsymptome nach Zeckenbiss sind als „Wanderröte“ allgemein bekannt. Borrelien verursachen aber auch andere Manifestationen, deren Falldefinitionen der Praktiker kennen sollte. Ebenso steht bei unspezifischen Beschwerden zuweilen die Frage nach einer Neuroborreliose im Raum, die nicht voreilig mit der Gabe von Antibiotika beantwortet werden darf. Diagnostische Parameter und Therapieoptionen stellt dieser Beitrag kompakt vor.