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Vol. 63. Issue 5.
Pages 425-435 (September - October 2021)
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Vol. 63. Issue 5.
Pages 425-435 (September - October 2021)
Update in Radiology
DOI: 10.1016/j.rxeng.2021.07.002
Atypical bacterial infections of the central nervous system transmitted by ticks: An unknown threat
Infecciones bacterianas atípicas del sistema nervioso central transmitidas por garrapatas: una amenaza desconocida
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J. Azcona Sáenza,
Corresponding author
javier.azcona@scsalud.es

Corresponding author.
, D. Herrán de la Galaa, A.M. Arnáiz Garcíab, C.A. Salas Veneroc, E. Marco de Lucasa
a Servicio de Radiodiagnóstico, Hospital Universitario Marqués de Valdecilla, Santander, Spain
b Servicio de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, Santander, Spain
c Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla, Santander, Spain
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Table 1. Clinical stages of Lyme disease.
Abstract

Infections of the central nervous system caused by atypical bacteria are becoming more common. Borrelia burgdorferi and Rickettsia conorii are microorganisms transmitted by ticks; infection with these bacteria result in a wide spectrum of manifestations on imaging. In areas where these tick-borne microorganisms are endemic, including Spain, these infections must be included in the differential diagnosis of patients with a variety of systemic and neurologic symptoms. The clinical presentation of these infections is nonspecific, and CT is normally the initial imaging technique, although MRI is more sensitive to early changes. On MRI, these infections can manifest as small lesions in the deep supratentorial white matter that are hyperintense on T2-weighted/FLAIR sequences. It is fundamental to know the imaging characteristics of the different atypical bacterial infections and their differential diagnoses. Good history taking combined with complementary tests (blood tests and CSF analysis) and the neuroimaging findings can help reach the right diagnosis and enable appropriate treatment, thereby preventing possible neurological sequelae.

Keywords:
Borrelia burgdorferi
Lyme neuroborreliosis
Rickettsia conorii
Magnetic resonance imaging
Leukoencephalopathy
Resumen

Las infecciones del sistema nervioso central causadas por bacterias atípicas se encuentran en aumento. Borrelia burgdorferi y Rickettsia conorii son microorganismos transmitidos por garrapatas cuyas infecciones presentan un amplio abanico de manifestaciones por imagen. Deben considerarse entre los diagnósticos diferenciales ante la presencia de síntomas sistémicos y neurológicos variados en un medio endémico como es España. La presentación clínica de estas infecciones es inespecífica, siendo la tomografía computarizada la técnica de imagen inicial. Sin embargo, la resonancia magnética es más sensible evaluando cambios precoces. Estas infecciones pueden presentarse en la resonancia magnética como pequeñas lesiones hiperintensas en secuencias T2/FLAIR en la sustancia blanca supratentorial profunda. Es fundamental conocer las características radiológicas de las distintas infecciones bacterianas atípicas y sus diagnósticos diferenciales. Una buena historia clínica, combinada con pruebas complementarias (análisis de líquido cefalorraquídeo y serología), y los hallazgos de la neuroimagen ayudan a llegar a un diagnóstico y tratamiento certeros, evitando posibles secuelas neurológicas.

Palabras clave:
Borrelia burgdorferi
Neuroborreliosis de Lyme
Rickettsia conorii
Resonancia magnética
Leucoencefalopatías

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