{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T05:10:33Z","timestamp":1772169033083,"version":"3.50.1"},"reference-count":13,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2014,10,6]],"date-time":"2014-10-06T00:00:00Z","timestamp":1412553600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns4:p>\n                    <ns4:bold>Summary:<\/ns4:bold>\n                  <\/ns4:p>\n                  <ns4:p>In this case report we describe a rare case of bilateral diaphragmatic dysfunction due to Lyme disease.<\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Case report:<\/ns4:bold>\n                  <\/ns4:p>\n                  <ns4:p>\n                    A 62-years-old male presented to the hospital because of flu-like symptoms. During initial evaluation a bilateral diaphragmatic weakness with orthopnea and nocturnal hypoventilation was observed, without a known aetiology. Bilateral diaphragmatic paralysis was confirmed by fluoroscopy with a positive sniff test. The patient was referred to our centre for chronic non-invasive nocturnal ventilation (cNPPV). Subsequent investigations revealed evidence of anti-\n                    <ns4:italic>Borrelia<\/ns4:italic>\n                    seroactivity in EIA-IgG and IgG-blot, suggesting a recent infection with Lyme disease, and resulted in a 4-week treatment with oral doxycycline. The symptoms of nocturnal hypoventilation were successfully improved with cNPPV. However, our patient still shows impaired diaphragmatic function but he is no longer fully dependent on nocturnal ventilatory support.\u00a0\u00a0\u00a0\u00a0\n                  <\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Conclusion:<\/ns4:bold>\n                  <\/ns4:p>\n                  <ns4:p>\n                    Lyme disease should be considered in the differential diagnosis of diaphragmatic dysfunction. It is a tick-borne illness caused by one of the three pathogenic species of the spirochete\n                    <ns4:italic>Borrelia burgdorferi<\/ns4:italic>\n                    , present in Europe. A delay in recognizing the symptoms can negatively affect the success of treatment. Non-invasive mechanical ventilation (NIV) is considered a treatment option for patients with diaphragmatic paralysis.\n                  <\/ns4:p>","DOI":"10.12688\/f1000research.5375.1","type":"journal-article","created":{"date-parts":[[2014,10,6]],"date-time":"2014-10-06T11:15:18Z","timestamp":1412594118000},"page":"235","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Case Report: Bilateral diaphragmatic dysfunction due to Borrelia Burgdorferi"],"prefix":"10.12688","volume":"3","author":[{"given":"Suhail","family":"Basunaid","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chris","family":"van der Grinten","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole","family":"Cobben","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Astrid","family":"Otte","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roy","family":"Sprooten","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rohde","family":"Gernot","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2014,10,6]]},"reference":[{"key":"ref-1","doi-asserted-by":"publisher","first-page":"1306-1307","DOI":"10.1136\/jnnp.2004.046284","article-title":"Diaphragmatic paralysis and respiratory failure as a complication of Lyme disease.","volume":"76","author":"R Abbott","year":"2005","journal-title":"J Neurol Neurosurg Psychiatry."},{"key":"ref-2","first-page":"573-6","article-title":"Lyme disease--United States, 2003\u20132005.","volume":"56","year":"2007","journal-title":"MMWR Morb Mortal Wkly Rep."},{"key":"ref-3","first-page":"87-100","article-title":"Diaphragm function and alveolar hypoventilation.","volume":"45","author":"J Davis","year":"1976","journal-title":"Q J Med."},{"key":"ref-4","doi-asserted-by":"publisher","first-page":"932-942","DOI":"10.1056\/NEJMra1007236","article-title":"Dysfunction of the diaphragm.","volume":"366","author":"F McCool","year":"2012","journal-title":"N Engl J Med."},{"key":"ref-5","doi-asserted-by":"publisher","first-page":"960-70","DOI":"10.1136\/thx.44.11.960","article-title":"Diaphragmatic paresis: pathophysiology, clinical features, and investigation.","volume":"44","author":"G Gibson","year":"1989","journal-title":"Thorax."},{"key":"ref-6","first-page":"47-9","article-title":"[Diaphragmatic paralysis and arthromyalgia caused by Lyme disease].","volume":"20","author":"R Gomez de la Torre","year":"2003","journal-title":"An Med Interna."},{"key":"ref-7","doi-asserted-by":"publisher","first-page":"133-43","DOI":"10.1002\/mus.10337","article-title":"Lyme disease and the peripheral nervous system.","volume":"28","author":"J Halperin","year":"2003","journal-title":"Muscle Nerve."},{"key":"ref-8","first-page":"2075","article-title":"[Fatal meningoradiculoneuritis in Lyme disease].","volume":"15","author":"M Melet","year":"1986","journal-title":"Presse Med."},{"key":"ref-9","doi-asserted-by":"publisher","first-page":"66-71","DOI":"10.1164\/ajrccm\/147.1.66","article-title":"Diaphragmatic dysfunction in neuralgic amyotrophy: an electrophysiologic evaluation of 16 patients presenting with dyspnea.","volume":"147","author":"D Mulvey","year":"1993","journal-title":"Am Rev Respir Dis."},{"key":"ref-10","doi-asserted-by":"publisher","first-page":"604-7","DOI":"10.1007\/BF00868815","article-title":"Neuroborreliosis as a cause of respiratory failure.","volume":"242","author":"M Silva","year":"1995","journal-title":"J Neurol."},{"key":"ref-11","doi-asserted-by":"publisher","first-page":"544-547","DOI":"10.1016\/S0002-9343(97)82271-1","article-title":"Respiratory failure due to Lyme meningoradiculitis.","volume":"103","author":"S Sigler","year":"1997","journal-title":"Am J Med."},{"key":"ref-12","doi-asserted-by":"publisher","first-page":"700-702","DOI":"10.1183\/09031936.99.13370099","article-title":"Diaphragmatic paralysis due to Lyme disease.","volume":"13","author":"J Faul","year":"1999","journal-title":"Eur Respir J."},{"key":"ref-13","doi-asserted-by":"publisher","first-page":"1095","DOI":"10.1007\/s001340100968","article-title":"Tick bite induced respiratory failure. Diaphragm palsy in Lyme disease.","volume":"27","author":"M Winterholler","year":"2001","journal-title":"Intensive Care Med."}],"container-title":["F1000Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/f1000research.com\/articles\/3-235\/v1\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/3-235\/v1\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/3-235\/v1\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2018,12,4]],"date-time":"2018-12-04T15:26:09Z","timestamp":1543937169000},"score":1,"resource":{"primary":{"URL":"https:\/\/f1000research.com\/articles\/3-235\/v1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,10,6]]},"references-count":13,"URL":"https:\/\/doi.org\/10.12688\/f1000research.5375.1","relation":{"has-review":[{"id-type":"doi","id":"10.5256\/f1000research.5738.r7473","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.5738.r7198","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.5738.r7198","asserted-by":"object"},{"id-type":"doi","id":"10.5256\/f1000research.5738.r7473","asserted-by":"object"}]},"ISSN":["2046-1402"],"issn-type":[{"value":"2046-1402","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,10,6]]},"assertion":[{"value":"Indexed","URL":"https:\/\/f1000research.com\/articles\/3-235\/v1#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.5256\/f1000research.5738.r7198, Sezai Celik, Thoracic Surgery Department, Siyami Ersek Cardiothoracic Training Hospital, Istanbul, Turkey, 05 Jan 2015, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/3-235\/v1#referee-response-7198","order":0,"name":"referee-response-7198","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.5738.r7473, W.N. Welvaart, Department of Surgery, Riverland Hospital Tiel, Tiel, The Netherlands, 27 Jan 2015, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/3-235\/v1#referee-response-7473","order":1,"name":"referee-response-7473","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The author(s) declared that no grants were involved in supporting this work","order":2,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Data associated with the article are available under the terms of the Creative Commons Zero \"No rights reserved\" data waiver (CC0 1.0 Public domain dedication).","order":0,"name":"copyright-info","label":"Copyright"}]}}