L-637. Delay in Treatment in Neuroborreliosis and Impact on Prognosis
Session: Poster Session: New Issues With Central Nervous System Infections
Saturday, October 25, 2008: 12:00 AM
Room: Hall C
Background: An important clinical consequence of infection with Borrelia burgdorferi is neuroborreliosis, which have potential long-tem sequelae if not treated. Even after antibiotic therapy persistent symptoms are reported. The clinical impact of delay in treatment, however, is not well described. Methods: We performed a population-based epidemiological study of all cases of neuroborreliosis in North Jutland County, Denmark in the period 1998-2006 (n=84) based on the demonstration of intrathecal antibody production against B burgdorferi. From clinical records the information on patient delay from first clinical symptom until health-care contact as well as doctors delay from initial examination until start of neuroborreliosis therapy were determined. Patients were treated intravenously with penicillin or ceftriaxone for a minimum of 14 days. Results: The clinical presentation of patients varied considerably, and many disorders were considered during the examinations of the patients. The median patient’s delay was 7 days (range 1-63 days) and the median doctor’s delay was 19 days (range 1-380 days). Following therapy the outcome was assessed after 6 months by a questionnaire or a report from the general physician (n=76). A total of 60 patients (79 %) had completely recovered, whereas 16 (21 %) had persistent sequelae to neuroborreliosis. The median total delay (patient and doctor delay) was 35 days in patients fully recovering, whereas it was longer (64 days) in patients with persistent sequelae. The outcome in patients with a delay < 28 days was significantly better (39/44 (89%) without sequelae) as compared to patients with a delay > 28 days (21/32 (66%) without sequelae), OR 0.24; 95% CI [0.12-0.30], P < 0.02. Baseline demographic and clinical characteristics were not related to outcome. Conclusions: Delay in appropriate antibiotic therapy of neuroborreliosis increases the frequency of long-term sequelae.
Henrik Nielsen, Aalborg Hospital, Aalborg, Denmark, Niels Krabbe, Aalborg Hospital, Tove Ejlertsen, MD, Department of Clinical Microbiology, Aalborg Hospital, Aarhus, Denmark and  H. Nielsen, None.