Die Lyme-Borreliose und ihre Bedeutung für den HNO-Arzt*

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Abstract
Lyme disease is a tick-borne multisystemic Borrelia infection to which the following diseases belong: erythema migrans, lymphadenosis benigna cutis, lymphocytic meningoradiculitis (Bannwarth''s syndrome), Lyme-arthritis and acrodermitis chronica atrophicans. The infection rate of ticks with Borrelia Burgdorferi in Germany amounts to 13,6% compared to the infection with the European spring summer meningoencephalitis virus with 1,1.permill.. Recent investigations show that lipopolysaccharides and interleukin-1 play an important role in the pathogenesis of Lyme disease. Lipopolysaccharides (LPS) are a constitutive part of the outer wall of gram negative bacteria. Its biological activities include pyrogeicity, mitogenicity for lymphocytes and the induction of interleukin-1 (IL-1). IL-1 is the major macrophage-derived immunoregulatory protein. Lyme disease is characterized by a variety of symptoms which could be explained by the effects of IL-1 on host systems. These symptoms include: fever, malaise, erythema migrans and arthritis. The clinical course can be divided into three stages. Erythema migrains, lymphadenosis benigna cutis and general symptoms characterize the first stage. In the second stage disorders of the heart and the neurological system may follow including Bannwarth''s syndrome. 60% of the patients develop facial palsy and 30% of these patients bilateral palsy. In 40% of all cases the facial palsy is the only motor disorder. Other cranial nerves can also be affected. The third stage consists of the Lyme-arthritis, acrodermitis chronica atrophicans and encephalomyelitis. The determination of specific spirochetal antibodies in serum and cerebrospinal fluid (CSF) is the most valuable diagnostic aid for this borreliosis. The CSF examination may also be helpful. The CSF leukocyte count, the CSF protein concentration and the CSF-IgG/serum-IgG-index can be elevated. By calculating this index the intrathecal synthesis of IgG can be estimated. The treatment of stage 1 consists of the application of tetracyclin, erythromycin or better penicillin, p.o., the treatment of stage 2 and 3 consists of a high dosage of penicillin applied intravenously. Preliminary results of a study which has not been concluded yet demonstrate that the treatment with cephalosporin may be more effective. 15 patients with Lyme disease have been admitted to our hospital for diagnosis and treatment. Unilateral facial palsy affected 5, bilateral facial palsy 3, uniateral sudden hearing loss 3, bilateral sudden hearing loss 1, bilateral tinnitus 2 and "neuronitis" vestibularis 1 of our patients. With the exception of one patient with bilateral tinnitus, all of our patients fully recovered after having received adequate treatment.

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