What are the indications for lumbar puncture in patients with Lyme disease?

Lyme neuroborreliosis (LNB) is a tick-borne disease of the nervous system, caused by the spirochete Borrelia burgdorferi. Having entered the host at the site of the tick bite, the spirochetes can initially cause a local inflammatory reaction, called erythema migrans. If left untreated, the Borrelia can disseminate in the second stage of the disease and invade the central nervous system, causing LNB. The diagnosis of LNB is based on a compatible clinical picture (meningitis, cranial neuritis or radiculoneuritis), lymphocytic pleocytosis in the cerebrospinal fluid (CSF) and intrathecal Borrelia burgdorferi-specific antibody production. As the clinical picture of LNB may be unspecific, a lumbar puncture to analyze the CSF is usually mandatory for confirmation of the suspected diagnosis. The indications for a lumbar puncture and the limitations of the different diagnostic procedures are the main topics of this review. In addition, a short overview of the epidemiology and the therapeutic principles of LNB is given.