# Experience of a Romanian Lyme Borreliosis Centre in the Multidisciplinary Management of Patients Evaluated for Suspected Lyme Neuroborreliosis

## TL;DR

This study from a Romanian Lyme Borreliosis Centre highlights the challenges in diagnosing Lyme neuroborreliosis and shows that it is likely underdiagnosed in the country.

## Contribution

The study provides insights into the epidemiology and differential diagnosis of Lyme neuroborreliosis in a highly endemic area in Romania.

## Key findings

- Only 1.65% of suspected cases met the criteria for definite Lyme neuroborreliosis.
- LNB was excluded in 70.95% of patients, with more demyelinating diseases in this group.
- The study suggests that LNB is underdiagnosed and underreported in Romania.

## Abstract

Lyme neuroborreliosis (LNB) may mimic other neurological diseases, while neurological diseases may be misdiagnosed as LNB. The aims of the study were to contribute to the knowledge regarding the epidemiology and clinical manifestations of LNB, discuss differential diagnosis, and compare characteristics in patients with and without LNB. We present patients evaluated for suspected LNB by the multidisciplinary team of a “Lyme Borreliosis Centre” in a highly endemic area in Romania. A retrospective study was performed between January 2011 and October 2023 on patients referred for suspected LNB based on neurological manifestations and positive serology for Borrelia burgdorferi antibodies using two-tier testing. A lumbar puncture was performed for diagnosis, and the European LNB definition was used for classification. Of three hundred and three LNB suspected patients, five (1.65%) were classified as definite LNB, eighty-three (27.39%) as possible LNB, and in two hundred and fifteen patients (70.95%), LNB was excluded. Comparing the definite/possible to excluded LNB patients, there was no significant difference in neurological symptoms/manifestations. The patients presented fifty-one neurological, twelve rheumatological, and seven psychiatric diagnoses, with significantly more meningitis/encephalitis/myelitis diagnoses in the definite/possible LNB group, and more demyelinating disease and discopathy in the LNB-excluded group. Considering the complex differential diagnoses, access to laboratory diagnostics and multidisciplinary management should be available in centres that evaluate suspected LNB patients. Comparing results with data from the national surveillance system, we conclude that LNB is underdiagnosed/underreported in Romania.