Lyme borreliosis and peripheral facial palsy

From 1994 to 1996, 114 consecutive patients older than 15 years who present ed at the Department of Infectious Diseases, University Medical Centre, Lju bljana, fulfilled the criteria for inclusion into this study on the borreli al aetiology of peripheral facial palsy (PFP). The study was restricted to patients without a conceivable explanation for their PFP, erythema migrans or history of erythema migrans, clinical signs/symptoms of frank meningitis or any other neurological manifestation in addition to PFP. In 22 (19.3%) of these 114 patients borrelial infection was confirmed by one of the follo wing: in 3 (13.6%) by the isolation of Borrelia burgdorferi sensu late from cerebrospinal fluid (CSF), in 11 (50%) by the presence of intrathecal anti body production, and in 8 (36.4%) by seroconversion to borrelial antigens. Additional 20 (17.5%) patients interpreted as having had a probable borreli al infection, had positive (greater than or equal to 1:256) IFA IgM and/or IgG borrelial serum antibody titres, and in 9 (7.9%) patients borderline bo rrelial antibody titres (1:128) were found (interpreted as a possible infec tion). In 63 (55.3%) patients the serological tests remained negative. Lymphocytic pleocytosis was found at the first visit in 12/22 (54.5%) patie nts with confirmed borrelial infection, in 3/20 (15%) with probable infecti on, in 1/9 (11.1%)with possible infection, and in 10/63 (15.9%) patients wi th symptoms of unknown aetiology. Patients with confirmed borrelial infecti on had abnormal CSF findings significantly more often than did patients wit h symptoms of unknown aetiology (p = 0.0139 for lymphocytic pleocytosis and /or elevated CSF protein levels, and p = 0.0010 for lymphocytic pleocytosis ). Local and systemic signs/symptoms were also more common in patients with confirmed borrelial infection than in those with an symptoms of unknown ae tiology (p = 0.0258). In Slovenia which is a highly endemic region for Lyme borreliosis, borrelia l infection is a frequent cause of PFP in adult patients. PFP may occur ear ly in the course of LB, prior to measurable antibody response, indicating t he need for serologic follow-up. Abnormal CSF results and the presence of a dditional local and/or systemic symptoms are factors indicating a higher po ssibility of borrelial aetiology of PFP and should alert physicians to susp ect LB.