Dr. Murai Éva szerk.: Parasitologia Hungarica 24. (Budapest, 1991)

Carditis Carditis is a rare form of Lb (150) but the only manifestation which may cause death (97). The first European case of Lyme carditis was described in 1984 (56). Less than two per cent of our cases had heart involvement. In childhood, it is even less frequently observed (11), we found only three children with ECG disturbances. In a report summarizing 66 cases of European Lyme carditis (154), a strong male predominance was found, comparable with our results. Fluctuating AV block was the characteristic symptom in our cases. The usually supraventricular rhythm disturbances may change rapidly (141,154,168) and the AV block may lead to asystolia (127, 153). Temporary pacemaker treatment was needed in three of our cases. Pacemaker implantation may be needed in 20-30% of carditis patients (4,141,154). Pericarditis is rare, but a little pericardial fluid may be disclosed by echocardiography (46, 85, 141). The incubation time was about one month in our cases. Although chronic carditis has been reported in many publications (30,48,49,137), the course was usually benign and spontaneous improvement was documented in many of our patients. Neurological involvement BS combines all signs of neuroborreliosis: CNS involvement, cranial and peripheral nerve neuritis. All manifestations which cannot be included in this group can be considered as a forme frust of BS. Facial palsy was discussed separately because of its predominance. The other cranial nerves were rarely involved. The detailed discussion of BS is explained by the fact that this manifestation is so characteristic that it can be diagnosed on the basis of the case history, even without examining the patient. Migrating paraesthesia, sometimes severe radicular pains and fatigue are the typical signs (2, 117, 155, 167). The symptoms are often vague and the patients may be misdiagnosed of having a psychosomatic disease. The objective origin of the symptoms would be disclosed by neurophysiological tests (41, 43). In the other group of patients, symptoms resemble vertebral disc herniation (32, 104). Typical BS was seldom accompanied by profound neck stiffness or other meningeal signs. The CSF findings of neuroborreliosis are usually considered to be uncharacteristic. Cell counts of 1-200 are generally reported (44, 50, 66). In the present study, we have noted a higher upper range, with values above 1000 cells/mm

3 in 3.4% of the patients. The presence of plasmocytes in the CSF has been mentioned in few previous studies only (66,149), while in the present study it was shown to be a regular finding in the carefully examined CSF samples. Unfortunately, in most cases of Lyme meningitis the results were given only as "lymphocytic", or "mononuclear cells in the CSF'. Although only 14 CSF samples of Lyme meningitis were examined carefully, 9 out of the 14 contained at least 5% plasmocytes. In Lyme meningitis, CSF protein is stated to be almost invariably elevated (2, 105, 114). Also in our material, the CSF protein level was significantly higher in