Therapie und Langzeitverlauf der Neuroborreliose

Zusammenfassung

Die Neuroborreliose ist eine durch Zecken übertragene Infektionskrankheit, verursacht durch das Spirochätenbakterium Borrelia burgdorferi sensu lato. Die klinische Symptomatik wird in charakteristische Früh- und Spätmanifestationen eingeteilt. Neurologische Frühmanifestationen sind deutlich häufiger (ca. 98%) als neurologische Spätmanifestationen. Grundlage der Diagnose ist zunächst eine für eine Neuroborreliose typische Klinik, eine Borrelienserologie und eine Liquoruntersuchung. Eine serologische Diagnostik sollte nur bei typischer Klinik einer Neuroborreliose erfolgen. Zur Bestätigung der Verdachtsdiagnose einer Neuroborreliose ist eine Liquoruntersuchung unumgänglich. Bei der Therapie der Neuroborreliose sind Betalaktamantibiotika und Doxycyclin nach einer systematischen Übersichtsarbeit gleichwertig wirksam und gleich verträglich. Nach vorhandener Evidenz sollte die Therapiedauer 14–21 Tage betragen. Eine randomisierte Studie zu multiplen Manifestationen der Lyme-Borreliose (neben hauptsächlich Neuroborreliose auch Lyme-Arthritis, kutane Manifestationen der Borreliose und Lyme-Karditis) zeigte keinen Vorteil einer mehrmonatigen Antibiotikatherapie gegenüber einer 3-wöchigen Behandlung mit Ceftriaxon. Jedoch gibt es für mehrmonatige antibiotische Therapien Berichte über gravierende Nebenwirkungen bis hin zu Todesfällen. In mehreren Langzeitbeobachtungsstudien zeigt sich bei der Neuroborreliose eine gute Prognose nach antibiotischer Behandlung. Sollten Residualsymptome nach Therapie zurückbleiben sind diese in der Regel milde. Hinsichtlich Lebensqualität, Fatigue, Depression und kognitive Einschränkungen zeigen sich keine Unterschiede zwischen Patienten nach einer behandelten Neuroborreliose und der Allgemeinbevölkerung.

Abstract

Neuroborreliosis is a tick-borne infection caused by the spirochete bacterium Borrelia burgdorferi sensu lato. The clinical symptoms are divided into characteristic early and late manifestations. Early neurological manifestations are more frequent (about 98%) than late neurological manifestations. The diagnosis is based on a typical clinical syndrome, a borrelial serology and a CSF examination. Serological diagnostics should only be performed when typical clinical symptoms are present. In order to confirm the suspected diagnosis of neuroborreliosis, a CSF examination is indispensable. Regarding therapy of neuroborreliosis, beta-lactam antibiotics and doxycycline are equally effective and equally compatible according to a systematic review. According to existing evidence, length of treatment should not exceed 14–21 days. A randomized study regarding multiple manifestations of Lyme borreliosis (including mainly neuroborreliosis but also Lyme arthritis, cutaneous manifestations of borreliosis and Lyme carditis) showed no benefit of antibiotic therapy over months vs. a 3-week treatment with ceftriaxone. However, there are reports of serious side effects, including death associated with several months of antibiotic therapies. In several long-term observation studies, neuroborreliosis showed a good prognosis after antibiotic treatment. If residual symptoms remain after therapy, these are generally mild. There is no difference between quality of life, fatigue, depression and cognitive impairment between patients treated with neuroborreliosis and the general population.

Schlüsselwörter

Lyme Borreliose - Neuroborreliose - evidenzbasierte Medizin - Therapie - Lebensqualität

Keywords

lyme neuroborreliosis - lyme disease - therapy - evidence-based medicine - quality of life

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