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Lyme neuroborreliosis

Halperin, John J.a,b

Current Opinion in Infectious Diseases: June 2019 - Volume 32 - Issue 3 - p 259–264
doi: 10.1097/QCO.0000000000000545
CNS INFECTIONS: Edited by Adarsh Bhimraj

Purpose of review To review the recent evidence clarifying the symptomatology and diagnosis of nervous system Lyme disease.

Recent findings Two-tier testing combining pairs of ELISAs, using C6 or VlsE assays to replace second tier Western blots, may eliminate confusion about test interpretation. Cerebrospinal fluid (CSF) can be informative in diagnosing central nervous system (CNS) Lyme disease, not peripheral nervous system (PNS) disorders. CSF CXCL13 may provide useful adjunctive information in CNS infection; its specificity remains to be defined. Lyme encephalopathy is not indicative of CNS infection. Post treatment Lyme disease symptoms do not occur in patients who have had definite CNS Lyme infection. Whether post treatment Lyme disease symptom (PTLDS) is an actual entity, or reflects anchoring bias when commonly occurring symptoms arise in patients previously treated for Lyme disease, remains to be determined. Regardless, these symptoms do not reflect CNS infection and do not respond to additional antimicrobial therapy.

Summary Serologic testing is robust in individuals with a priori likelihood of infection of greater than 2–6 weeks duration. Western blots provide useful confirmation of screening ELISAs, but may be replaced by second ELISAs. CSF testing, including CXCL13, may be informative in CNS Lyme, not PNS, and is generally normal in Lyme encephalopathy. PTLDS does not occur following CNS infection, and may not be a distinct entity.

aDepartment of Neurosciences, Overlook Medical Center, Summit, NJ

bSidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA

Correspondence to John J. Halperin, MD, Chair, Department of Neurosciences, Overlook Medical Center, 99 Beauvoir Ave., Summit, NJ 07901, USA. Tel: +908 522 3501; e-mail:

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