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

CONCLUSION This analysis is based on data collected for five years. Together with our coworkers, we described the first Hungarian cases and all the important clinical manifestations during that period. Some fairly new data have been derived from the statistical analysis. One is that the incubation period may influence the appearance of clinical symptoms. The longer the period between tick bite and the onset of ECM, the higher the probability of complications. In cases when incubation is longer, symptoms present themselves less rapidly but there is bigger chance of a more serious chronic progressive course. Peripheral neuritis, memory loss and mental disturbances, as well as small joint arthritis are more common after a longer latency period. We are convinced that the outcome of infection is determined soon after the tick bite. Fast antibody response is a sign of systemic infection even when clinical symptoms are still absent. Physicians should be familiar with the symptoms and signs of Lb and aware of the possibility of both false negative and false positive serological results. Flagellar antigen ELISA is more sensitive than IFA in the early cases. Facial palsy, when it is bilateral or accompanied by meningitis, is very probably caused by Bb. The relapsing cases are usually idiopathic. Facial palsy caused by Bb has a more serious onset but a better outcome in comparison with the idiopathic forms. In Bannwarth's syndrome, not only high CSF protein but also low CSF sugar is frequently found. The combination of chronic lymphocytic pleocytosis + elevated CSF protein + decreased glucose content is generally considered to be typical of tuberculous meningitis. Our results show that this rare CSF profile is a regular finding also in Lyme meningitis. Especially in cases of chronic lymphocytic meningitis accompanied by radiculoneuritis, the probability of borrelia infection is very high. In spite of the generally accepted opinion, in our experience Lb cannot be assigned to stages on the basis of the organ manifestations. All the organ manifestations (e.g. dermatological, cardiological, neurological and rheumatological) have acute, subacute, chronic and chronic progressive forms. The efficacy of penicillin and tetracycline was compared in ECM patients. A significantly faster improvement was seen in the penicillin- than in the tetracycline(usually doxycycline-) treated group. The rate of improvement was even more influenced by the dosage regime of these antibiotics. Low-dose administration can hardly shorten the duration of erythema chronicum migrans, while high-dose treatment is significantly more effective. Half of the Hungarian Lb cases presented with ECM, one third had neurological symptoms and 18% showed frank arthritis. All the tick-infested territories of Hungary are infected by Bb. The largest number of Lb cases were bitten by ticks in Western Hungary, along the northern coastline of Lake Balaton and in the mountains of Buda.