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. 2025 Aug;53(4):1403-1412.
doi: 10.1007/s15010-024-02461-0. Epub 2025 Jan 2.

Proportion of confirmed Lyme neuroborreliosis cases among adult patients with suspected early European Lyme neuroborreliosis

Katarina Ogrinc  1 , Petra Bogovič  2 , Tereza Rojko  2 , Vera Maraspin  2 , Eva Ružić-Sabljić  3 , Andrej Kastrin  4 , Klemen Strle  5 , Gary P Wormser  6 , Franc Strle  2
Affiliations

Proportion of confirmed Lyme neuroborreliosis cases among adult patients with suspected early European Lyme neuroborreliosis

Katarina Ogrinc et al. Infection. 2025 Aug.

Abstract

Purpose: To determine the frequency of confirmed Lyme neuroborreliosis (LNB) cases in adult patients with three different clinical presentations consistent with early LNB.

Methods: Data were obtained through routine health care at the UMC Ljubljana, Slovenia from 2005 to 2022, using clinical pathways. The patients were classified into three groups: (i) radicular pain of new onset (N = 332); or (ii) involvement of cranial nerve(s) but without radicular pain (N = 997); or (iii) erythema migrans (EM) skin lesion(s) in conjunction with symptoms suggestive of nervous system involvement but without either cranial nerve palsy or radicular pain (N = 240). The diagnosis of LNB considered the following variables: the presence of: (1) neurologic symptoms consistent with LNB (with no other obvious explanation); (2) cerebrospinal fluid (CSF) pleocytosis (> 5 × 106 leukocytes/L); and (3) demonstration of intrathecal synthesis of borrelial antibodies, and/or cultivation of borrelia from CSF, and/or the presence of EM. Patients fulfilling only the first two criteria were interpreted as having possible LNB, while those who satisfied all three criteria were regarded as having confirmed LNB.

Results: Of 1569 adult patients, 348 (22.2%) had confirmed LNB and 70 (4.5%) others had possible LNB. The proportion of confirmed LNB cases was the highest for patients with radicular pain (217/332, 65.4%), followed by the group with EM and neurologic symptoms (47/240, 19.6%), and those with cranial neuritis (84/997, 8.4%).

Conclusion: Only 22% of patients evaluated had confirmed LNB. The proportion of confirmed LNB cases correlated with clinical presentation and was highest among patients with recent onset of radicular pain.

Keywords: Borrelia culture from cerebrospinal fluid; Bannwarth syndrome; Borrelial meningitis; Cranial neuritis; Intrathecal borrelial antibody synthesis; Lyme neuroborreliosis.

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Conflict of interest statement

Declarations. Ethics approval: The planning, conduct, and reporting of the research in this study are in accordance with the Helsinki Declaration. The study was approved by the Medical Ethics Committee of the Ministry of Health of the Republic of Slovenia (0120–552/2023/3). The Ethics Committee waived the need for written informed consent; however, all patients gave verbal consent for the diagnostic approach routinely employed for suspected LNB, that included CSF examination for which consent was provided orally until 2012, but since 2012 all patients provided written consent for the lumbar puncture. Competing interests: G.P.W. reports receiving research grants from Biopeptides, Corp. He has been an expert witness in malpractice cases involving Lyme disease and babesiosis; and is an unpaid board member of the non-profit American Lyme Disease Foundation. K.S. served as a consultant for T2 Biosystems, Roche, BioMerieux, and NYS Biodefense Fund, for the development of a diagnostic assay in Lyme borreliosis. F.S. served on the scientific advisory board for Roche on Lyme disease serological diagnostics and on the scientific advisory board for Pfizer on Lyme disease vaccine, and is an unpaid member of the steering committee of the ESCMID Study Group on Lyme Borreliosis/ESGBOR. Other authors report there are no competing interests to declare.

Figures

Fig. 1
Fig. 1
Flow chart of inclusion of patients with possible and confirmed Lyme neuroborreliosis at UMC Ljubljana in Slovenia, 2005–2022. Abbreviations: LNB, Lyme neuroborreliosis; PFP, peripheral facial palsy; EM, erythema migrans; CSF, cerebrospinal fluid; ITBAS, intrathecal borrelial antibody synthesis. aWithout other obvious reason
Fig. 2
Fig. 2
Seasonality of the beginning of neurologic symptoms in patients with different manifestations of confirmed Lyme neuroborreliosis (n = 348). Abbreviations: BS, Bannwarth syndrome; CN, cranial neuritis (without radicular pain); AM, aseptic meningitis (without radicular pain and/or cranial neuritis)
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