NS Infection - Spirochaetes

Question 1

What are the main spirochaete infections of the CNS?

Answer 1

Lymes Disease (Borrelia Burgorferi)
Syphilis (Trepomena Pallidum)
Leptospirosis (Leptospira Interrogans)

Question 2

How is Lyme’s Disease Spread?

Answer 2

Vector Borne, ticks in wooded areas

Question 3

How does Lyme’s Disese present?

Answer 3

Its a multi system disease that comes in 3 stages:

Question 4

Describe Stage 1 of Lyme’s Disease?

Answer 4

Early localised infection (first month) with erythema migrans rash at site of bite possibly with flu symptoms

Question 5

Describe stage 2 of Lyme’s Disease?

Answer 5

Early Disseminated Infection over weeks->months

Spreads through lymph or blood to 1 or more systems (Musculoskeletal & Neurological are most common)

More PNS than CNS manifestations

Question 6

What are the neurological manifestations of lymes disease?

Answer 6

• Mononeuropathy
• Myelitis
• Painful Radiculoneuropathy
• Cranial Neuropathy
• Meningo-encephalitis
  PNS more than CNS

And in stage 3 can get subacute encephalopathy and encephalomyelitis

Question 7

How do we investigate/treat Lymes DIsease?

Answer 7

• Serology
• CSF Lymphocytosis & PCR
• Brain/Spine MRI if CNS manifestations
• Nerve Conduction study/EMG If PNS manifestations

Prolonged Treatment with IV Ceftriaxone or Oral Doxycycline

Question 8

How does syphilis affect the brain?

Answer 8

Syphilis comes in 3 stages
Primary -> Secondary -> Latent -> Tertiary

So Tertiary syphilis can present as neurosyphilis years or decades after infection

Question 9

How do we investigate/treat Neurosyphilis?

Answer 9

• Treponema Specific and non-specific antibody tests
• LP for raised Lymphocytes, intrathecal (in spinal cord) antibody production and PCR

Treat with High dose Penicillin

Question 10

How long does Lymes Disease take to reach stage 3?

Answer 10

Months to years after exposure

Notably it occurs after a period of latency between stage 2&3