Neuroborreliosis Late sequelae in tick bites are often misdiagnoses

New guideline Neuroborreliosis cleans up with false assumptions

Just in time for the start of the ticking season 2018, the German Neurological Society (DGN) publishes new recommendations for the diagnosis and treatment of the tick-borne neuroborreliosis disease. It contains guidelines for doctors and patients that have been developed according to strict rules and reflect the current state of scientific medicine.

The new guideline provides information on diagnostic steps and laboratory tests that contribute to the reliable diagnosis of neuroborreliosis and provides an overview of effective therapies. The guideline is not only interesting for doctors. It also provides information for patients to follow a tick bite and provides recommendations for the prevention of Borrelia infection. The guideline is freely available on the DGN website.

No long-term consequences of tick bites

The new guideline provides a clear statement on the supposed late effects of a Borrelia infection, which should occur only years after the sting. "Diseases with persistent nonspecific or untypical symptoms are often not borreliosis," explains Professor Sebastian Rauer from the University Hospital Freiburg in a press release. He has completed the work on the guideline together with Dr. Ing. Stephan Kastenbauer from Munich coordinates.

Wrong assumptions in chronic neuroborreliosis

The S3 guideline on controversial, supposedly chronic neuroborreliosis provides scientific facts. Many physicians have mistakenly assumed that symptoms such as fatigue, difficulty concentrating, chronic fatigue, wandering pains, memory problems, headaches, and other intractable ailments are due to unrecognized or poorly treated Borrelia nervous system infection.

Bad long-term events are the result of misdiagnosis

"Neuroborreliosis is predominantly benign," says Rauer. Bad long-term courses are largely due to misdiagnosis. The reason why those affected do not respond to the prescribed therapies is not that the borrelia survive, but that the patients do not have neuroborreliosis. It is another disease that can not be treated by antibiotics.

Not meaningful tests

The so-called lymphocyte transformation test is often used in diffuse conditions such as chronic fatigue, musculoskeletal pain, fatigue or difficulty concentrating. This test is intended to detect chronic Lyme disease. The guideline does not consider this test to be meaningful.

New recommendations for antibiotic therapy

The guideline recommends treatment with the antibiotics doxycycline, penicillin G, ceftriaxone or cefotaxime. "These substances are equally effective against Borrelia with the same tolerability," advises Rauer. There are too few evaluable study data on the efficacy of other substances or antibiotic combination treatments. Drug treatment with antibiotics should normally not last longer than 14 days for early and 14 to 21 days for late neuroborreliosis.

Long treatments offer no added value

"Prolonged treatment brings no added value, but puts patients at unnecessary risk of serious side effects," warns Rauer. If the antibiotics do not work after two to three weeks, weeks or even months would not work.

Legal resistance

A dispute delayed the publication of the guideline. "With regard to late neuroborreliosis and putative latent long-term infections, there is a great deal of controversy between the scientific societies on the one hand and the patient organizations and the DBG on the other," reports Rauer. The German Lyme Society e.V. and the Lyme Disease and FSME Bund Deutschland e.V. recently tried to stop publication of the guideline with a preliminary injunction. The district court of Berlin overturned this attempt by judgment of 12 March 2018. (Vb)