[Neurologic diseases transmitted by ticks]. / Durch Zecken übertragene neurologische Krankheiten.

Apart from causing various dermatological disorders, ticks, which also widespread in our part of the world, can transmit diseases that affect the nervous system. The difficulty of carrying out differential diagnosis and the possibility of administering causal treatment in cases of meningopolyneuritis Garin-Bujadoux-Bannwarth and progressive Borrelian encephalomyelitis are giving rise to demands for an improvement in immunodiagnosis.

[Enlarged spectrum of tick transmitted spirochaetoses]. / Zum erweiterten Spektrum zeckenübertragener Spirochätosen.

After the successful identification of Borrelia burgdorferi as the cause of Lyme disease, a new tick-borne infection occurring in the United States, almost identical spirochaetes have been isolated from the tick Ixodes ricinus in Europe. As a result, the spirochaetal aetiology of skin diseases, which had long been recognized as tick-borne infections, namely erythema chronicum migrans with its neurological complications of the tick-borne meningopolyneuritis of Garin-Bujadoux-Bannwarth, acrodermatitis chronica atrophicans and lymphadenosis cutis benigna, could be confirmed by means of microbiological, histological and serological methods. On the basis of case histories it had already been assumed for some time that anetodermia maculosa and the localised sclerodermas might also be caused by a tick-borne agent. The results of serological investigations have now strengthened this assumption, although microbiological confirmation is still lacking.

[Meningopolyneuritis (Garin-Bujadoux, Bannwarth) erythema chronicum migrans disease of the nervous system transmitted by ticks]. / Durch Zecken übertragene Meningo-Polyneuritis (Garin-Bujadoux, Bannwarth) Erythema-chronicum-migrans-Krankheit des Nervensystems.

The clinical spectrum of this remarkable non-syphilitic spirochaetosis (spirochaeta infection) of the nervous system is described in light of 53 further cases with reference to our earlier description of 47 cases. As the etiological diagnosis is not possible in all cases the knowledge of clinical courses is especially important. Males are affected almost twice as often as women. The disease is especially prevalent in the sixth decade. Usually, the syndrome begins in the warm season with exquisite pain and other sensory irritations in combination with marked malaise. Initial signs during the winter as well as painless clinical courses were also noted. About one half of the patients remembered contact with arthropodes or a chronic migrating erythema. In most cases (95%), asymmetrical peripheral signs followed the painful stage. More than two thirds of the patients showed affection of cranial nerves, usually facial palsy. Twenty percent demonstrated paresis of the extremities alone, the combination of involvement of cranial nerves and extremities was noted in one third of the cases. The sensory signs were usually only mild. Occasionally, the neurological impairment was limited to isolated sensory impairment. In contrast to the closely related Lyme disease, central nervous affection as well as cardiac and arthritic involvement is rare: 34 percent demonstrated mild psychopathological impairment; in one case a Babinski-phenomenon was elicited. Knee joint pain and gonarthritis were found in one case each. Even though meningeal signs were usually absent, the CSF showed alterations suggestive of chronic lymphocytic meningitis in all cases. At the same time, local synthesis of all three immune globulins was documented, especially of IgM (85%).

[Chronic erythema migrans and tick-transmitted meningopolyneuritis (Garin-Bujadoux-Bannwarth): Borrelia infections?]. / Erythema chronicum migrans und durch Zecken übertragene Meningopolyneuritis (Garin-Bujadoux-Bannwarth): Borrelien-Infektionen?

Antibodies against Borrelia duttoni using indirect immunofluorescence could be demonstrated in 6 patients with erythema chronicum migrans and in 8 persons with tick-borne meningopolyneuritis. Significant increases of IgG and IgM antibody titres in the course of the disease and IgG antibodies in the CSF indicate recent contact with Borrelia duttoni or a closely related agent. Demonstration by fluorescence serology of spirochaetaceae in Ixodes ricinus in two sites of infection equally indicate such an aetiology. The immunofluorescence test for patient sera used here improves the diagnosis of erythema chronicum migrans infection and of its various organ manifestations. Results are similar to those in Lyme disease in the United States.