CENTRAL NERVOUS SYSTEM INVASION IN EARLY LYME DISEASE

早期疾病中的中枢神经系统侵袭

• 批准号: 6273873
• 负责人: PATRICIA K COYLE
• 金额: $ 15.55万
• 依托单位: STATE UNIVERSITY NEW YORK STONY BROOK
• 依托单位国家: 美国
• 财政年份: 1998
• 资助国家: 美国
• 起止时间: 1998-04-01 至 1999-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6273873
• 关键词: Borrelia; Lyme disease; attention; central nervous system disorders; cerebrospinal fluid; clinical research; human subject; longitudinal human study; microorganism immunology; neurologic manifestations; neuropsychological tests; outcomes research; pathologic process

Lyme disease, due to the spirochete Borrelia burgdorferi, is a major emerging infection in our country. Neurologic involvement has become the significant morbidity of this infection, but has not been well studied. Effective public health poll is being hampered by lack off basic information on clinical and laboratory features and pathogenetic mechanisms of Lyme disease. The objective of this proposal is to identify the frequency, clinical correlate and outcome of central nervous system (CNS) infection in early Lyme disease. This study will focus on 3 adult case groups (N=100) with newly acquired infection: 1) single lesion erythema migrans (EM) (N=25); 2) multifocal EM (N=25); 3) neurologic Lyme disease (N=50). All eligible patient will meet Centers for Disease Control and Prevention diagnostic criteria for Lyme disease. After an initial comprehensive evaluation (self report forms to assess clinical symptoms, psychosocial and psychiatric measures, and health outcome; skin, blood and cerebrospinal fluid (CSF) studies; cognitive assessment) subjects will receive standard antibiotic treatment, and then be followed prospectively for 18 months. Comparison groups will be healthy subjects (N=1 00) frequency matched to cases on age, education and gender; and subjects with other neurologic diseases (N=50). Specific Aim 1: To determine the frequency of CNS invasion in early local and disseminated Lyme disease (invasion will be defined by positive CSF culture, Borrelial antigen, Borrelial DNA, or intrathecal Borrelial antibodies); to document neurologic complaints and health function status of early infection patients. Hypothesis: CNS invasion by B. burgdorferi is common during early infection. Corollary: neurologic complaints are frequent in early Lyme disease. Corollary: in this population new onset of headache is a clinical marker of CNS invasion, while CSF IgM reactivity to B.burgdorferi is an immune marker of CNS invasion. Specific Aim 2: To examine the outcome of neurologic involvement in,early Lyme disease. Hypothesis: Following infection, patients with persistent CSF abnormalities (defined as CNS invasion markers; Borrelial immune complexes; or abnormal cell count or protein) will be symptomatic. Corollary: clearance of CSF is associated with clinical improvement. Specific Aim 3: To determine the proportion of early Lyme disease patients who develop late encephalopathy. Question: what proportion of early Lyme patients will develop persistent neurobehavioral dysfunction in domains of attention and memory? This proposal will help characterize the neurologic aspects of early Lyme disease, will aid in diagnosis and management, and will help guide the formulation of a rational and cost effective health care program for Lyme disease.

莱姆病，由于螺旋体伯氏伯氏菌，是主要的 在我国新兴感染。神经系统参与已成为 这种感染的显着发病率，但尚未得到很好的研究。 有效的公共卫生民意调查受到缺乏基本的障碍 有关临床和实验室特征以及致病性的信息 莱姆病的机制。该提议的目的是确定 中枢神经系统的频率，临床相关和结果 （CNS）早期莱姆病的感染。这项研究将重点关注3个成人 病例组（n = 100），新获得感染：1）单病变 红斑迁移（EM）（n = 25）; 2）多焦点EM（n = 25）; 3）神经莱姆 疾病（n = 50）。所有合格的患者将遇到疾病控制中心 和预防莱姆病的诊断标准。首先 全面评估（评估临床症状的自我报告表格， 社会心理和精神病措施以及健康结果；皮肤，血液和 脑脊液（CSF）研究；认知评估）受试者将 接受标准的抗生素治疗，然后预先遵循 18个月。比较组将是健康的受试者（n = 1 00） 与年龄，教育和性别案件相匹配的频率；和主题 其他神经系统疾病（n = 50）。 特定目的1：确定中枢神经系统入侵的频率 和传播的莱姆病（入侵将由CSF阳性定义 培养，骨质抗原，疏松型DNA或鞘内牙本质 抗体）；记录神经系统投诉和健康功能状况 早期感染患者。 假设：B。Burgdorferi在早期很常见的CNS入侵很常见 感染。推论：早期莱姆经常出现神经系统诉讼 疾病。推论：在这个人群中，头痛的新发作是临床 CNS入侵的标记，而CSF IgM对B.burgdorferi的反应性是一种 中枢神经系统入侵的免疫标记。 特定目的2：检查早期神经系统参与的结果 莱姆病。 假设：感染后，患有CSF的患者 异常（定义为CNS入侵标记；骨免疫 复合物；或异常细胞计数或蛋白质）是有症状的。 推论：CSF的清除与临床改善有关。 特定目的3：确定早期莱姆病患者的比例 患有晚期脑病的人。问题：早期莱姆的比例是多少 患者将在域中出现持续的神经行为功能障碍 注意和记忆？ 该建议将有助于表征早期莱姆的神经系统方面 疾病，将有助于诊断和管理，并将有助于指导 为莱姆制定合理且具有成本效益的医疗保健计划 疾病。