The goal of this paper is to characterize the clinical presentation, serological results, current antibiotic treatment practice, including compliance with current European guidelines, and outcome in adults with Lyme neuroborreliosis (LNB) diagnosed at departments of infectious diseases in Denmark.

Using a nationwide prospective cohort of patients with central nervous system infections, we identified all adults (≥ 18 years of age) treated for LNB at departments of infectious diseases in Denmark from 2015 through 2017. The database contains information on baseline demographics, history of tick bite, erythema migrans, clinical presentation, laboratory results of blood samples, and cerebrospinal (CSF) biochemistry (e.g. specific Borrelia burgdorferi sensu lato (s.l.) antibodies in serum, B. burgdorferi s.l. intrathecal antibody index) as well as antibiotic therapy. Outcome was assessed by the Glasgow Outcome Scale (GOS) and the presence of residual symptoms at follow-up one month after discharge.

We included 194 LNB patients with a median age of 59 years (range 18–85 years, interquartile range [IQR] 47–69 years). The female-to-male ratio was 0.8. A total of 177 of 191 (93 %) of patients had early (second stage) LNB. A history of tick bite or erythema migrans was registered in 75 (39 %) and 49 (25 %) patients, respectively.

The median duration of neurological symptoms before first hospital contact was 21 days (range 0–600 days, IQR 10–42 days). Predominant symptoms consisted of radicular pain in 135 of 194 (70 %), cranial nerve paresis in 88 of 194 (45 %), headache in 71 of 185 (38 %), and extremity paresis in 33 of 194 (17 %) patients. Serum-B. burgdorferi s.l. IgM and/or IgG antibodies were detectable in 166 of 181 (92 %) patients at the time of first CSF investigation. Median duration of antibiotic treatment was 14 days (range 10–35 days, IQR 14–21 days) and 59 (39 %) of the patients received intravenous ceftriaxone and/or benzylpenicillin G throughout treatment.

At the 1-month follow-up, GOS was unfavorable (< 5) in 54 of 193 (28 %) patients. An unfavorable GOS score was more often registered in patients with ≥ 45 days of symptom duration (20 of 45 (44 %) vs. 34 of 145 (23 %); P = 0.006).

In conclusion, a European cohort of adult patients with LNB diagnosed between 2015–2017 presented with classic symptoms and CSF findings. However, a substantial diagnostic delay was still observed. In disagreement with current guidelines, a substantial part of LNB patients were treated with antibiotics longer than 14 days and/or intravenously as route of administration.

本文的目的是描述在丹麦传染病部门诊断出的成人莱姆病（LNB）的临床表现，血清学结果，当前的抗生素治疗实践（包括符合当前的欧洲指南）以及结局的特征。

使用全国范围内的中枢神经系统感染患者的前瞻性队列，我们​​确定了2015年至2017年在丹麦的传染病科接受LNB治疗的所有成年人（≥18岁）。该数据库包含有关基线人口统计学信息，tick史咬伤，迁移性红斑，临床表现，血样实验室检查结果和脑脊液（CSF）生化反应（例如血清中特异的Borrelia burgdorferi sensu lato（sl）抗体，B。burgdorferi sl鞘内抗体指数）以及抗生素治疗。出院后一个月随访，通过格拉斯哥结局量表（GOS）评估结局，并评估残余症状的存在。

我们纳入了194名LNB患者，中位年龄为59岁（范围18-85岁，四分位间距[IQR] 47-69岁）。男女比例为0.8。191名患者中的177名（93％）患有早期（第二阶段）LNB。分别有75（39％）和49（25％）的患者有tick叮咬或红斑偏头痛的病史。

首次就诊之前，神经系统症状的中位持续时间为21天（范围为0–600天，IQR为10–42天）。主要症状包括194例中的135例（70％）的神经痛，194例中的88例（45％）的颅神经轻瘫，185例中的71例（38％）的头痛，194例33例的极度轻瘫（17％）。无血清布氏疏螺旋体SL IgM和/或IgG抗体在第181（92％）患者166是检测在第一CSF调查的时间。抗生素治疗的中位时间为14天（范围为10-35天，IQR为14-21天），在整个治疗过程中，有59位患者（39％）接受了头孢曲松钠和/或苄青霉素G的静脉注射。

在1个月的随访中，193名患者中有54名（28％）的GOS不良（<5）。症状持续时间≥45天的患者中，GOS评分较差（45分之20（44％）与145分之34（23％）； P = 0.006）。

总之，2015年至2017年间在欧洲诊断为LNB的成年患者队列显示出典型症状和CSF发现。然而，仍然观察到实质性的诊断延迟。与目前的指导意见不同，LNB患者中有很大一部分接受了超过14天的抗生素治疗和/或静脉内给药。