Lyme borreliosis: diagnosis and management

被引:95
作者
Kullberg, Bart Jan [1 ,2 ]
Vrijmoeth, Hedwig D. [1 ,2 ]
van de Schoor, Freek [1 ,2 ]
Hovius, Joppe W. [3 ,4 ]
机构
[1] Radboud Univ Nijmegen, Med Ctr, Dept Med, Nijmegen, Netherlands
[2] Radboud Univ Nijmegen, Med Ctr, Radboudumc Ctr Infect Dis, Nijmegen, Netherlands
[3] Univ Amsterdam, Med Ctr, Dept Med, Div Infect Dis, Amsterdam, Netherlands
[4] Amsterdam Multidisciplinary Lyme Borreliosis Ctr, Amsterdam, Netherlands
来源
BMJ-BRITISH MEDICAL JOURNAL | 2020年 / 369卷
关键词
BURGDORFERI-SENSU-LATO; ACRODERMATITIS CHRONICA ATROPHICANS; POLYMERASE-CHAIN-REACTION; CLINICAL-PRACTICE GUIDELINES; MULTIVALENT OSPA VACCINE; ERYTHEMA MIGRANS; DOUBLE-BLIND; ANTIBIOTIC-TREATMENT; CEREBROSPINAL-FLUID; TICK BITE;
D O I
10.1136/bmj.m1041
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Lyme borreliosis is the most common vectorborne disease in the northern hemisphere. It usually begins with erythema migrans; early disseminated infection particularly causes multiple erythema migrans or neurologic disease, and late manifestations predominantly include arthritis in North America, and acrodermatitis chronica atrophicans (ACA) in Europe. Diagnosis of Lyme borreliosis is based on characteristic clinical signs and symptoms, complemented by serological confirmation of infection once an antibody response has been mounted. Manifestations usually respond to appropriate antibiotic regimens, but the disease can be followed by sequelae, such as immune arthritis or residual damage to affected tissues. A subset of individuals reports persistent symptoms, including fatigue, pain, arthralgia, and neurocognitive symptoms, which in some people are severe enough to fulfil the criteria for post-treatment Lyme disease syndrome. The reported prevalence of such persistent symptoms following antimicrobial treatment varies considerably, and its pathophysiology is unclear. Persistent active infection in humans has not been identified as a cause of this syndrome, and randomized treatment trials have invariably failed to show any benefit of prolonged antibiotic treatment. For prevention of Lyme borreliosis, post-exposure prophylaxis may be indicated in specific cases, and novel vaccine strategies are under development.
引用
收藏
页数:20
相关论文
共 227 条
[1]   Validate or falsify: Lessons learned from a microscopy method claimed to be useful for detecting Borrelia and Babesia organisms in human blood [J].
Aase, Audun ;
Hajdusek, Ondrej ;
Oines, Oivind ;
Quarsten, Hanne ;
Wilhelmsson, Peter ;
Herstad, Tove K. ;
Kjelland, Vivian ;
Sima, Radek ;
Jalovecka, Marie ;
Lindgren, Per-Eric ;
Aaberge, Ingeborg S. .
INFECTIOUS DISEASES, 2016, 48 (06) :411-419
[2]   Success and failure in the treatment of acrodermatitis chronica atrophicans [J].
Aberer, E ;
Breier, F ;
Stanek, G ;
Schmidt, B .
INFECTION, 1996, 24 (01) :85-87
[3]   A phylogenomic and molecular marker based proposal for the division of the genus Borrelia into two genera: the emended genus Borrelia containing only the members of the relapsing fever Borrelia, and the genus Borreliella gen. nov containing the members of the Lyme disease Borrelia (Borrelia burgdorferi sensu lato complex) [J].
Adeolu, Mobolaji ;
Gupta, Radhey S. .
ANTONIE VAN LEEUWENHOEK INTERNATIONAL JOURNAL OF GENERAL AND MOLECULAR MICROBIOLOGY, 2014, 105 (06) :1049-1072
[4]  
Agterof MJ, 2008, NETH J MED, V66, P176
[5]   Diagnosis of Lyme borreliosis [J].
Aguero-Rosenfeld, ME ;
Wang, GQ ;
Schwartz, I ;
Wormser, GP .
CLINICAL MICROBIOLOGY REVIEWS, 2005, 18 (03) :484-+
[6]  
Ang CW, 2011, EUR J CLIN MICROBIOL, V30, P1027, DOI 10.1007/s10096-011-1157-6
[7]  
[Anonymous], 2017, LYM DIS BORR BURGD 2
[8]  
[Anonymous], 2006, LYME BORRELIOSIS EUR
[9]   Borrelial Lymphocytoma in Children [J].
Arnez, Maja ;
Ruzic-Sabljic, Eva .
PEDIATRIC INFECTIOUS DISEASE JOURNAL, 2015, 34 (12) :1319-1322
[10]   Azithromycin Is Equally Effective as Amoxicillin in Children with Solitary Erythema Migrans [J].
Arnez, Maja ;
Ruzic-Sabljic, Eva .
PEDIATRIC INFECTIOUS DISEASE JOURNAL, 2015, 34 (10) :1045-1048