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

operated on (laminectomy was performed) because his neurological symptoms mimicked vertebral disc herniation. Similar cases have been reported (67, 104). Although the motoneuron damage rarely resulted in complete palsy, irreversible muscular atrophy developed in two of our patients. Mild and latent paresis was more frequently found. In many cases, neuritis appeared shortly after tick bite or by the appearance of ECM, but all the ACA patients complained of similar symptoms. This is a clear evidence that polyneuritis can be both an early and a late manifestation of Lb (55). The first case of progressive borreliosis was described by Pachner and Steere in 1985 (114) and Ackermann reported on 8 patients (1). We found a similar case in the following year. Since then, a lot of patients and various symptoms have been reported as having late or progressive borreliosis. Although there is no connection between Lb and multiple sclerosis (25, 123,131), the clinical symptoms sometimes may be similar (1, 31, 67, 73, 165). The MRI result can also be similar in both illnesses (39,42,126,165). The diagnosis may be difficult because EEG and CSF findings can be normal in chronic neuroborreliosis (40). Halperin classified the basic types of late neuroborreliosis (43). Memory loss and impairment of cognitive functions were consistently found in these cases, even in the absence of "organic" signs of neurologic disorder. Mild peripheral neuropathies were demonstrated by electrophysiologic methods. Severe dementia and MSlike symptoms (21,92) are exceptional and extreme forms of late neuroborreliosis. Arthritis In a few cases, arthritis may appear in the early stage, at the same time as ECM. Knees are typically involved in Lyme arthritis (51, 53, 54, 144, 147). In our patients, the large joint manifestations appeared typically after a short incubation period. Small joint polyarthritis is frequently found after a longer latency. Arthritis can be the sole manifestation of Lb (34, 51) and can mimic septic arthritis (34,59), juvenile rheumatoid arthritis (82) or Reiter's syndrome (81). Involvement of the temporomandibular joint is typical of Lyme arthritis (52, 144, 147). Beyond several clinical symptoms of LB, B. burgdorferi infections remains inapparent in many cases (3). Acrodermatitis chronica atrophicans ACA has the longest latency period. The pathogen can be cultivated from a biopsy specimen drawn from an area where ACA has existed for as long as 30 years (6). It is a manifestation typical of adulthood (7, 8, 138). There is a clear female predominance (55). ACA is the only form of Lb in which no spontaneous remission occurs. The bluish-red oedematous dermatitis is usually thought to be of vascular origin. Sometimes morphea-like morphology appears (8,83).