Frequent Incidence of Lyme Neuroborreliosis in Children in the Czech Republic

Authors: Z. Libá-Vrabelová 1;  J. Kayserová 2;  V. Komárek 1
Authors‘ workplace: Klinika dětské neurologie 1;  Ústav imunologie 2
Published in: Cesk Slov Neurol N 2013; 76/109(1): 63-69
Category: Original Article


Europe is an important endemic area for infection with the Borrelia burgdorferi sensu lato complex that includes several genospecies. Incidence and symptoms vary between areas. B. garinii has high affinity to the central nervous system and is the main genospecies in the Czech Republic. Correct diagnosis of Lyme neuroborreliosis (LNB) is crucial for its therapy. Diagnosis may be difficult and the infection may become chronic. The aim of this study was to determine the incidence of LNB and to establish clinical and laboratory findings in our pediatric patients.

Retrospective evaluation of clinical and laboratory data obtained over a two-year period on 286 children with neurological symptoms (unconsciousness, focal deficit, headache, meningeal syndrome etc.) who underwent a lumbar puncture to exclude neuroinflammation. Antibodies against borrelia (and neurotrophic viruses) in the cerebro­spinal fluid (CSF) and serum were determined. Cytological, immunological and biochemical analysis of CSF were performed as well as the PCR for the presence of borrelial DNA.

An association between neurological symptoms and borrelial infection was confirmed in 58 children (median age 7.44 years; range 0.5–17.5 years). Tick-bite was reported in 53% of children only and skin erythema in none of them. LNB was confirmed with laboratory tests in 53 children. The other 5 children had no laboratory signs of inflammation in the CNS. The main presentations of LNB were peripheral facial nerve palsy (PFNP) in 69% and meningitis in 15%. PFNP of borrelial etiology formed 53% of all PFNP in the period analyzed.

LNB in children in the Czech Republic is very common. Comprehensive diagnostic approach, including lumbar puncture, is crucial. Correct therapy at the right time may prevent the chronic course of the disease.

Key words:
Borrelia burgdorferi – Lyme neuroborre­liosis – peripheral facial nerve palsy

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manu­script met the ICMJE “uniform requirements” for biomedical papers.


1. Rizzoli A, Hauffe HC, Carpi G, Vourc’h GI, Neteler M, Rosà R. Lyme neuroborreliosis in Europe. Eurosur­veillance 2011; 16(27).

2. Křupka M, Raška M, Weigl E. Lymská borelióza – biologie, patogeneze, diagnostika a léčba. Dermatol Prax 2008; 2(5–6): 236–239.

3. Hulínská D, Kybicová K. Diagnostika lymeské borreliózy v Národní referenční laboratoři pro lymeskou borreliózu, SZÚ, 2008 [on-line]. Dostupné z:

4. Skowronek-Bala B, Wesolowska E, Gergont A, Kacinski M. Neuroboreliosis with motoric disturbations in the developmental age. Przegl Lek 2008; 65(11): 810–812.

5. Smith R, Takkinen J. Lyme borreliosis: Europe-wide coordinated surveillance and action needed? Eurosurveillance 2006; 11(25).

6. Kříž B, Beneš Č. Lymeská borrelióza – epidemiologická data, SZÚ, 2010 [on-line]. Dostupné z:

7. Rupprecht TA. Neuroborreliosis: Pathogenesis, Symptoms, Diagnosis, and Treatment: Epidemio­logy [on-line]. Dostupné z:

8. López-Alberola RF. Neuroborreliosis and the pediatric population: a review. Rev Neurol 2006; 42 (Suppl 3): S91–S96.

9. Rupprecht TA, Koedel U, Fingerle V, Pfister HW. The pathogenesis of Lyme neuroborreliosis: from infection to inflammation. Mol Med 2008; 14(3–4): 205–212.

10. Pachner AR. Lyme neuroborreliosis. In: Antel J et al (eds). Clinical neuroimmunology. 2nd ed. Oxford, USA: Oxford University Press 2005: 301–314.

11. Ramesh G, Borda JT, Dufour J, Kaushal D, Ramamoorthy R, Lackner AA et al. Interaction of the Lyme disease spirochete Borrelia burgdorferi with brain parenchyma elicits inflammatory mediators from glial cells as well as glial and neuronal apoptosis. Am J Pathol 2008; 173(5): 1415–1427.

12. Dennis VA, Dixit S, O‘Brien SM, Alvarez X, Pahar B, Philipp MT. Live Borrelia burgdorferi spirochetes elicit inflammatory mediators from human monocytes via Toll-like receptor signaling pathway. Infect Immun 2009; 77(3): 1238–1245.

13. Kigerl KA, Lai W, Rivest S, Hart RP, Satoskar AR, Popovich PG. Toll-like receptor (TLR)-2 and TLR-4 regulate inflammation, gliosis, and myelin sparing after spinal cord injury. J Neurochem 2007; 102(1): 37–50.

14. Henningsson AJ, Tjernberg I, Malmvall BE, Forsberg P, Ernerudh J. Indications of Th1 and Th17 responses in cerebrospinal fluid from patients with Lyme neuroborreliosis: a large retrospective study. J Neuroinflammation 2011; 8: 36.

15. Janeway CA et al. T-cell mediated immunity. In: Janeway CA et al (eds). Immunology. 6th ed. New York: Garland Science publishing 2007: 319–362.

16. Hinojosa AE, Garcia-Bueno B, Leza JC, Madrigal JL. CCL2/MCP-1 modulation of microglial activation and proliferation. J Neuroinflammation 2011; 8: 77.

17. Gerszten RE, Garcia-Zepeda EA, Lim YC, Yoshida M, Ding HA, Gimbrone MA jr et al. MCP-1 and IL-8 trigger firm adhesion of monocytes to vascular endothelium under flow conditions. Nature 1999; 398(6729): 718–723.

18. Hildenbrand P, Craven DE, Jones R, Nemeskal P. Lyme neuroborreliosis: manifestations of a rapidly emerging zoonosis. AJNR Am J Neuroradiol 2009; 30(6): 1079–1087.

19. Vrethem M, Widhe M, Ernerudh J, Garpmo U, Forsberg P. Clinical, diagnostic and immunological characteristics of patients with possible neuroborreliosis without intrathecal Ig-synthesis against Borrelia antigen in the cerebrospinal fluid. Neurol Int 2011; 3(1): e2.

20. Widhe M, Jarefors S, Ekerfelt C, Vrethem M, Bergstrom S, Forsberg P et al. Borrelia-specific interferon-gamma and interleukin-4 secretion in cerebrospinal fluid and blood during Lyme borreliosis in humans: association with clinical outcome. J Infect Dis 2004; 189(10): 1881–1891.

21. Herrath MG, Harrison LC. Antigen-induced regulatory T cells in autoimmunity. Nat Rev Immunol 2003; 3(3): 223–232.

22. Mills KH. Regulatory T cells: friend or foe in immunity to infection? Nat Rev Immunol 2004; 4(11): 841–55.

23. Mygland A, Ljøstad U, Fingerle V, Rupprecht T, Schmutzhard E, Steiner I. European Federation of Neurological Societies. EFNS guidelines on the diagnosis and management of European Lyme neuroborreliosis. Eur J Neurol 2010; 17(1): 8–16.

24. European Concerned Action on Lyme Borreliosis; Treatment of Lyme borreliosis in Europe [on-line]. Dostupné z:

25. Stricker RB. Counterpoint: Counterpoint: long--term antibiotic therapy improves persistent symp­toms associated with lyme disease. Clin Infect Dis 2007; 45(2): 149–157.

26. Gurčík L. Súčasné trendy v diagnostike a liečbě neuroboreliózy. Neurol Prax 2009; 10(3): 170–176.

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