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Neuroborreliose de Lyme : a propósito de um caso clínico
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A Neuroborreliose de Lyme (NBL) é a forma neurológica da Borreliose de Lyme, causada pelas espiroquetas de Borrelia burgdorferi sensu lato complex transmitidas pela mordida da Ixodes ricinus (‘’carraça’’). Na Europa, a NBL é causada principalmente pela espécie Borrelia garinii, em áreas endémicas, tendo maior incidência durante o verão, em crianças dos 5-14 anos e adultos dos 40-50 anos. Em crianças, apesar da NBL geralmente se apresentar como uma doença ligeira, por vezes, em casos raros, pode estar associada a vasculopatia ou mesmo AVC isquémico. Deste modo, tendo em conta que a sua incidência está a aumentar e o facto de que quando diagnosticada e tratada adequadamente tem um prognóstico muito favorável, é essencial que os profissionais de saúde estejam alerta para a existência destes casos singulares, de modo a reconhecer e tratar a doença. Assim, com este objetivo, é exposto um caso clínico de uma criança previamente saudável, com alterações da consciência, as quais, após realização de RM-CE, se admitem como resultado de um AVC isquémico. Após investigação etiológica do AVC, concluise como causa a NBL que propiciou uma vasculopatia. Com a implementação da terapêutica adequada o doente teve remissão do quadro clínico.
Lyme Neuroborreliosis (LNB) is the neurological form of Lyme Borreliosis, caused by Borrelia burgdorferi sensu lato complex spirochetes transmitted by the bite of Ixodes ricinus (“tick”). In Europe, LNB is caused mainly by the species Borrelia garinii, in endemic areas, having a higher incidence during the summer, in children aged 5-14 years and adults aged 40-50 years. In children, although LNB generally presents as a mild disease, sometimes, in rare cases, it can be associated with vasculopathy or even ischemic stroke. Therefore, taking into consideration that its incidence is increasing and the fact that when diagnosed and treated appropriately has a very favorable prognosis, it is essential that health professionals be aware of the existence of these unique cases, in order to recognize and administer the appropriate therapy for the disease. Thus, with this objective in mind, a clinical case of a previously healthy child is reported. This child presents with alterations of his consciousness, which, after performing MRI, are admitted as a result of an ischemic stroke. After the etiological investigation of the stroke, it is concluded that it was LNB that caused a vasculopathy. With the implementation of appropriate therapy, the patient had a remission of the clinical condition.
Lyme Neuroborreliosis (LNB) is the neurological form of Lyme Borreliosis, caused by Borrelia burgdorferi sensu lato complex spirochetes transmitted by the bite of Ixodes ricinus (“tick”). In Europe, LNB is caused mainly by the species Borrelia garinii, in endemic areas, having a higher incidence during the summer, in children aged 5-14 years and adults aged 40-50 years. In children, although LNB generally presents as a mild disease, sometimes, in rare cases, it can be associated with vasculopathy or even ischemic stroke. Therefore, taking into consideration that its incidence is increasing and the fact that when diagnosed and treated appropriately has a very favorable prognosis, it is essential that health professionals be aware of the existence of these unique cases, in order to recognize and administer the appropriate therapy for the disease. Thus, with this objective in mind, a clinical case of a previously healthy child is reported. This child presents with alterations of his consciousness, which, after performing MRI, are admitted as a result of an ischemic stroke. After the etiological investigation of the stroke, it is concluded that it was LNB that caused a vasculopathy. With the implementation of appropriate therapy, the patient had a remission of the clinical condition.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2020
Palavras-chave
Neuroborreliose de Lyme Acidente vascular cerebral Vasculopatia Pediatria