Meningitis, cranial neuritis, and radiculoneuritis in Lyme infection
By Linda on Feb 7, 2011 in Infections | comments(0)
Excerpt:
Clinical Findings-Physical examination revealed that the horse was dull,
appeared depressed, was reluctant to raise its neck and head above a
horizontal plane, and had a temperature of 38.5 degrees C (101.3 degrees F).
No radiographic or scintigraphic abnormalities of the neck were found;
however, high plasma fibrinogen concentration and relative lymphopenia were
identified and the horse was seropositive for antibodies against Borrelia
burgdorferi. Analysis of CSF revealed neutrophilic inflammation, and results
of a PCR assay of CSF for B burgdorferi DNA were positive. Immunologic
testing revealed severe B-cell lymphopenia and a low serum IgM concentration
consistent with common variable immunodeficiency.Treatment and Outcome-The horse responded well to doxycycline treatment (10
mg/kg [4.5 mg/lb], PO, q 12 h for 60 days) and returned to normal exercise.
However, 60 days after treatment was discontinued, the horse again developed
a stiff neck and rapidly progressive neurologic deficits, including severe
ataxia and vestibular deficits. The horse’s condition deteriorated rapidly
despite IV oxytetracycline treatment, and the horse was euthanatized.
Postmortem examination revealed leptomeningitis, lymphohistiocytic
leptomeningeal vasculitis, cranial neuritis, and peripheral radiculoneuritis
with Wallerian degeneration; findings were consistent with a diagnosis of
neuroborreliosis.Clinical Relevance-Nervous system infection with B burgdorferi should be
considered in horses with evidence of meningitis and high or equivocal serum
anti-B burgdorferi antibody titers. Evaluation of immune function is
recommended in adult horses evaluated because of primary bacterial
meningitis.
