Dtsch Med Wochenschr 2021; 146(11): 728-732
DOI: 10.1055/a-1265-4397
Klinischer Fortschritt
Infektiologie

Lyme-Borreliose und Neuroborreliose – Was ist neu?

Lyme borreliosis and Lyme neuroborreliosis – an update
Rick Dersch
1   Klinik für Neurologie und Neurophysiologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert- Ludwigs-Universität Freiburg
,
Volker Fingerle
2   Nationales Referenzzentrum für Borrelien, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Oberschleißheim
› Author Affiliations

Was ist neu?

Diagnostik Zellbasierte Verfahren (z. B. LTT, ELISPOT) sollten nicht für die Diagnosestellung einer Borreliose verwendet werden.

Therapie Eine aktuelle randomisiert-kontrollierte Studie hat bestätigt, dass Doxycyclin- und Betalaktam-Antibiotika gleichwertig eingesetzt werden können. Es gibt keine statistisch signifikanten Unterschiede hinsichtlich neurologischer Symptome nach Therapie und Nebenwirkungen. Dementsprechend wird in der S3-Leitlinie Neuroborreliose kein Präparat bevorzugt empfohlen.

Prognose Mehreren Studien mit Patienten mit antibiotisch behandelter Neuroborreliose zeigen im Langzeitverlauf keine erhöhte Rate an Fatigue im Vergleich zu gesunden Kontrollpersonen. Ebenso findet sich für Lebensqualität, Depression und Kognition kein Unterschied zwischen Patienten mit Neuroborreliose nach Antibiotikatherapie und gesunden Kontrollpersonen im Langzeitverlauf.

Prophylaxe Eine prophylaktische Antibiotikagabe nach Zeckenstich wird derzeit in Deutschland nicht empfohlen.

Abstract

Lyme borreliosis is a tick-borne infectious disease caused by the spirochete bacterium Borrelia burgdorferi sensu lato. Lyme borreliosis is the most frequent zoonosis in Germany.

Most cases show dermatological manifestations, like erythema migrans, followed by infections of the nervous system. Cerebrospinal fluid analysis should be performed if Lyme neuroborreliosis is suspected. Cell-based assays (like LTT or ELISPOT) should not be used when investigating Lyme disease.

A recent randomized controlled trial showed a similar effect of doxycycline compared to betalactam-antibiotics regarding neurological symptoms in Lyme neuroborreliosis. This corroborates current German guideline recommendations.

The prognosis of Lyme disease after antibiotic treatment is usually favorable. Frequency of fatigue, depression, impairments in quality of life and cognitive impairment are similar in patients after treatment of Lyme neuroborreliosis when compared to the general population.



Publication History

Article published online:
01 June 2021

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