MUSCLE INVOLVEMENT IN BORRELIA-BURGDORFER I INFECTIONS

Systemic infections with Borrelia burgdorferi (Lyme disease) can cause muscle disorders in up to 40% of all cases. In descending frequency, pure myalgias, fibromyalgias, myositides and fasciitides have been des cribed. The pure myalgias occur in the stages I and II according to St eere. They normally disappear without specific treatment. Fibromyalgia occurs in the context of other clinical manifestations of the infecti on, but a delay of onset of many months is also possible. These entiti es are probably not directly due to the infectious agent, representing para-infectious complications of Lyme disease. Thus, antibiotics are ineffective. The treatment of choice is analogous to the treatment of idiopathic generalised fibromyalgia (tricyclic antidepressants, aerobi c training, physiotherapy, psychosomatic treatment). However, the prog nosis is usually poor. Myositis can occur during all stages of the dis ease. The histopathological examination reveals either a solely inters titial myositis, focal myositis or necrotizing myopathy. Antibiotic tr eatment is usually very effective. Differentiation from idiopathic pol y- or dermatomyositis is rarely a problem. Fasciitis occurs in both st ages II and III of Lyme disease. Phenomenologically, they can be very similar to the Shulman syndrome. The success of antibiotic treatment i s dependent essentially on whether or not permanent deficits such as f ibrous contractures have already occurred at treatment onset. The pres ent review surveys the litrature on muscular complications associated with Lyme disease, their etiology and pathogenesis, laboratory finding s and data from other technical investigations, therapy and prognosis.