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Methodological Quality Assessment with the AGREE II Scale and a Comparison of European and American Guidelines for the Treatment of Lyme Borreliosis: A Systematic Review. Pathogens 2021; 10:pathogens10080972. [PMID: 34451436 PMCID: PMC8399315 DOI: 10.3390/pathogens10080972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Most European and American countries recently updated their guidelines on Lyme borreliosis (LB). The aim of this study was to provide a comparative overview of existing guidelines on the treatment of LB in Europe and America and to assess the methodological quality of their elaboration. METHODS A systematic search was carried out in MEDLINE, Google Scholar, and the national databases of scientific societies from 2014 to 2020. Quality was assessed by two independent reviewers using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. RESULTS Twelve guidelines were included. The scores for the AGREE II domains (median ± IQR) were: overall assessment 100 ± 22, scope and purpose 85 ± 46, stakeholder involvement 88 ± 48, rigour of development 67 ± 35, clarity of presentation 81 ± 36, applicability 73 ± 52 and editorial independence 79% ± 54%. Cohen's weighted kappa showed a high agreement (K = 0.90, 95%CI 0.84-0.96). Guidelines were quite homogeneous regarding the recommended molecules (mostly doxycycline in the first intention and ceftriaxone in the second intention), their duration (10 to 28 days), and their dosage. The differences were due to the lack of well-conducted comparative trials. The International Lyme and Associated Diseases Society (ILADS) guidelines were the only ones to suggest longer antibiotics based on an expert consensus. CONCLUSION European and American guidelines for the treatment of LB were quite homogeneous but based on moderate- to low-evidence studies. Well-conducted comparative trials are needed to assess the best molecules, the optimal duration and the most effective doses.
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Lantos PM, Rumbaugh J, Bockenstedt LK, Falck-Ytter YT, Aguero-Rosenfeld ME, Auwaerter PG, Baldwin K, Bannuru RR, Belani KK, Bowie WR, Branda JA, Clifford DB, DiMario FJ, Halperin JJ, Krause PJ, Lavergne V, Liang MH, Meissner HC, Nigrovic LE, Nocton JJJ, Osani MC, Pruitt AA, Rips J, Rosenfeld LE, Savoy ML, Sood SK, Steere AC, Strle F, Sundel R, Tsao J, Vaysbrot EE, Wormser GP, Zemel LS. Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease. Clin Infect Dis 2021; 72:e1-e48. [PMID: 33417672 DOI: 10.1093/cid/ciaa1215] [Citation(s) in RCA: 142] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Indexed: 12/13/2022] Open
Abstract
This evidence-based clinical practice guideline for the prevention, diagnosis, and treatment of Lyme disease was developed by a multidisciplinary panel representing the Infectious Diseases Society of America (IDSA), the American Academy of Neurology (AAN), and the American College of Rheumatology (ACR). The scope of this guideline includes prevention of Lyme disease, and the diagnosis and treatment of Lyme disease presenting as erythema migrans, Lyme disease complicated by neurologic, cardiac, and rheumatologic manifestations, Eurasian manifestations of Lyme disease, and Lyme disease complicated by coinfection with other tick-borne pathogens. This guideline does not include comprehensive recommendations for babesiosis and tick-borne rickettsial infections, which are published in separate guidelines. The target audience for this guideline includes primary care physicians and specialists caring for this condition such as infectious diseases specialists, emergency physicians, internists, pediatricians, family physicians, neurologists, rheumatologists, cardiologists and dermatologists in North America.
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Affiliation(s)
- Paul M Lantos
- Duke University School of Medicine, Durham, North Carolina, USA
| | | | | | - Yngve T Falck-Ytter
- Case Western Reserve University, VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA
| | | | - Paul G Auwaerter
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kelly Baldwin
- Geisinger Medical Center, Danville, Pennsylvania, USA
| | | | - Kiran K Belani
- Childrens Hospital and Clinical of Minnesota, Minneapolis, Minnesota, USA
| | - William R Bowie
- University of British Columbia, Vancouver, British Columbia, Canada
| | - John A Branda
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - David B Clifford
- Washington University School of Medicine, St. Louis, Missouri, USA
| | | | | | - Peter J Krause
- Yale School of Public Health, New Haven, Connecticut, USA
| | | | | | | | | | | | | | - Amy A Pruitt
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jane Rips
- Consumer Representative, Omaha, Nebraska, USA
| | | | | | | | - Allen C Steere
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Franc Strle
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Robert Sundel
- Boston Children's Hospital Boston, Massachusetts, USA
| | - Jean Tsao
- Michigan State University, East Lansing, Michigan, USA
| | | | | | - Lawrence S Zemel
- Connecticut Children's Medical Center, Hartford, Connecticut, USA
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Abstract
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.
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Affiliation(s)
- Bart Jan Kullberg
- Department of Medicine and Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Hedwig D Vrijmoeth
- Department of Medicine and Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Freek van de Schoor
- Department of Medicine and Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Joppe W Hovius
- Amsterdam University Medical Centers, location AMC, Department of Medicine, Division of Infectious Diseases, and Amsterdam Multidisciplinary Lyme borreliosis Center, Amsterdam, Netherlands
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Jaulhac B, Saunier A, Caumes E, Bouiller K, Gehanno JF, Rabaud C, Perrot S, Eldin C, de Broucker T, Roblot F, Toubiana J, Sellal F, Vuillemet F, Sordet C, Fantin B, Lina G, Sobas C, Gocko X, Figoni J, Chirouze C, Hansmann Y, Hentgen V, Cathebras P, Dieudonné M, Picone O, Bodaghi B, Gangneux JP, Degeilh B, Partouche H, Lenormand C, Sotto A, Raffetin A, Monsuez JJ, Michel C, Boulanger N, Lemogne C, Tattevin P. Lyme borreliosis and other tick-borne diseases. Guidelines from the French scientific societies (II). Biological diagnosis, treatment, persistent symptoms after documented or suspected Lyme borreliosis. Med Mal Infect 2019; 49:335-346. [PMID: 31155367 DOI: 10.1016/j.medmal.2019.05.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 05/07/2019] [Indexed: 11/18/2022]
Abstract
The serodiagnosis of Lyme borreliosis is based on a two-tier strategy: a screening test using an immunoenzymatic technique (ELISA), followed if positive by a confirmatory test with a western blot technique for its better specificity. Lyme serology has poor sensitivity (30-40%) for erythema migrans and should not be performed. The seroconversion occurs after approximately 6 weeks, with IgG detection (sensitivity and specificity both>90%). Serological follow-up is not recommended as therapeutic success is defined by clinical criteria only. For neuroborreliosis, it is recommended to simultaneously perform ELISA tests in samples of blood and cerebrospinal fluid to test for intrathecal synthesis of Lyme antibodies. Given the continuum between early localized and disseminated borreliosis, and the efficacy of doxycycline for the treatment of neuroborreliosis, doxycycline is preferred as the first-line regimen of erythema migrans (duration, 14 days; alternative: amoxicillin) and neuroborreliosis (duration, 14 days if early, 21 days if late; alternative: ceftriaxone). Treatment of articular manifestations of Lyme borreliosis is based on doxycycline, ceftriaxone, or amoxicillin for 28 days. Patients with persistent symptoms after appropriate treatment of Lyme borreliosis should not be prescribed repeated or prolonged antibacterial treatment. Some patients present with persistent and pleomorphic symptoms after documented or suspected Lyme borreliosis. Another condition is eventually diagnosed in 80% of them.
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Affiliation(s)
- B Jaulhac
- Laboratoire de bactériologie et cnr des Borrelia, faculté de médecine et centre hospitalo-universitaire, 67000 Strasbourg, France
| | - A Saunier
- Médecine interne et maladies infectieuses, centre hospitalier, 24750 Périgueux, France
| | - E Caumes
- Maladies infectieuses et tropicales, hôpital La Pitié-Salpêtrière, 75013 Paris, France
| | - K Bouiller
- Maladies infectieuses et tropicales, centre hospitalo-universitaire, UMR CNRS 6249 Université Bourgogne Franche Comté, 25000 Besançon, France
| | - J F Gehanno
- Médecine du travail, centre hospitalo-universitaire, 76000 Rouen, France
| | - C Rabaud
- Maladies infectieuses et tropicales, centre hospitalo-universitaire, 54100 Nancy, France
| | - S Perrot
- Centre d'étude et de traitement de la douleur, hôpital Cochin, 75014 Paris, France
| | - C Eldin
- Maladies infectieuses et tropicales, ihu méditerranée infection, centre hospitalo-universitaire Timone, 13000 Marseille, France
| | - T de Broucker
- Neurologie, hôpital Delafontaine, 92300 Saint-Denis, France
| | - F Roblot
- Maladies infectieuses et tropicales, centre hospitalo-universitaire, inserm U1070, 86000 Poitiers, France
| | - J Toubiana
- Service de pédiatrie générale et maladies infectieuses, hôpital Necker-Enfants Malades, AP-HP, 75014 Paris, France
| | - F Sellal
- Département de neurologie, hôpitaux civil, 68000 Colmar, France
| | - F Vuillemet
- Département de neurologie, hôpitaux civil, 68000 Colmar, France
| | - C Sordet
- Rhumatologie, centre hospitalo-universitaire, 67000 Strasbourg, France
| | - B Fantin
- Médecine interne, hôpital Beaujon, université Paris Diderot, Inserm UMR 1137 IAME, 92110 Clichy, France
| | - G Lina
- Microbiologie, centre hospitalo-universitaire, 69000 Lyon, France
| | - C Sobas
- Microbiologie, centre hospitalo-universitaire, 69000 Lyon, France
| | - X Gocko
- Département de médecine générale, faculté de médecine, 42000 Saint-Etienne, France
| | - J Figoni
- Maladies Infectieuses et tropicales, hôpital Avicenne, 93022 Bobigny, France; Santé publique France, 94410 St Maurice, France
| | - C Chirouze
- Maladies infectieuses et tropicales, centre hospitalo-universitaire, UMR CNRS 6249 Université Bourgogne Franche Comté, 25000 Besançon, France
| | - Y Hansmann
- Maladies infectieuses et tropicales, centre hospitalo-universitaire, 67000 Strasbourg, France
| | - V Hentgen
- Pédiatrie, centre hospitalier, 78000 Versailles, France
| | - P Cathebras
- Médecine interne, hôpital Nord, centre hospitalo-universitaire, 42000 Saint-Etienne, France
| | - M Dieudonné
- Centre Max Weber, CNRS, Université Lyon 2, 69000 Lyon, France
| | - O Picone
- Maternité Louis Mourier, 92700 Colombes, France
| | - B Bodaghi
- Ophtalmologie, hôpital La Pitié-Salpêtrière, 75013 Paris, France
| | - J P Gangneux
- Laboratoire de parasitologie-Mycologie, UMR_S 1085 Irset université Rennes1-Inserm-EHESP, centre hospitalo-universitaire, 35000 Rennes, France
| | - B Degeilh
- Laboratoire de parasitologie-Mycologie, UMR_S 1085 Irset université Rennes1-Inserm-EHESP, centre hospitalo-universitaire, 35000 Rennes, France
| | - H Partouche
- Cabinet de médecine générale, Saint-Ouen, département de médecine Générale, faculté de médecine. université Paris Descartes, 93400 Paris, France
| | - C Lenormand
- Dermatologie, hôpitaux universitaires de Strasbourg et faculté de médecine, université de Strasbourg, 67000 Strasbourg, France
| | - A Sotto
- Maladies infectieuses et tropicales, centre hospitalo-universitaire, 30000 Nîmes, France
| | - A Raffetin
- Maladies infectieuses et tropicales, centre hospitalier intercommunal, 94190 Villeneuve-St-Georges, France
| | - J J Monsuez
- Cardiologie, hôpital René Muret, 93270 Sevran, France
| | - C Michel
- Médecine générale, 67000 Strasbourg, France
| | - N Boulanger
- Médecine interne, hôpital Beaujon, université Paris Diderot, Inserm UMR 1137 IAME, 92110 Clichy, France
| | - C Lemogne
- Psychiatrie, hôpital européen Georges-Pompidou, AP-HP.5, Inserm U1266; Université Paris Descartes, 75015 Paris, France
| | - P Tattevin
- Maladies infectieuses et réanimation médicale, hôpital Pontchaillou, centre hospitalo-universitaire, 35033 Rennes, France.
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Hofmann H, Fingerle V, Hunfeld KP, Huppertz HI, Krause A, Rauer S, Ruf B. Cutaneous Lyme borreliosis: Guideline of the German Dermatology Society. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2017; 15:Doc14. [PMID: 28943834 PMCID: PMC5588623 DOI: 10.3205/000255] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Indexed: 02/07/2023]
Abstract
This guideline of the German Dermatology Society primarily focuses on the diagnosis and treatment of cutaneous manifestations of Lyme borreliosis. It has received consensus from 22 German medical societies and 2 German patient organisations. It is the first part of an AWMF (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V.) interdisciplinary guideline: “Lyme Borreliosis – Diagnosis and Treatment, development stage S3”. The guideline is directed at physicians in private practices and clinics who treat Lyme borreliosis. Objectives of this guideline are recommendations for confirming a clinical diagnosis, recommendations for a stage-related laboratory diagnosis (serological detection of IgM and IgG Borrelia antibodies using the 2-tiered ELISA/immunoblot process, sensible use of molecular diagnostic and culture procedures) and recommendations for the treatment of the localised, early-stage infection (erythema migrans, erythema chronicum migrans, and borrelial lymphocytoma), the disseminated early-stage infection (multiple erythemata migrantia, flu-like symptoms) and treatment of the late-stage infection (acrodermatitis chronica atrophicans with and without neurological manifestations). In addition, an information sheet for patients containing recommendations for the prevention of Lyme borreliosis is attached to the guideline.
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Affiliation(s)
- Heidelore Hofmann
- Klinik für Dermatologie und Allergologie der TU München, München, Germany
| | - Volker Fingerle
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit (LGL) Oberschleißheim, Germany
| | - Klaus-Peter Hunfeld
- Zentralinstitut für Labormedizin, Mikrobiologie & Krankenhaushygiene, Krankenhaus Nordwest, Frankfurt, Germany
| | | | | | | | - Bernhard Ruf
- Klinik für Infektiologie Klinik St Georg, Leipzig, Germany
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Bauvin O, Schmutz JL, De Martino S, Busato T, Cribier B, Barbaud A, Wahl D, Bursztejn AC. A foot tumour as late cutaneous Lyme borreliosis: a new entity? Br J Dermatol 2017; 177:1127-1130. [PMID: 28477365 DOI: 10.1111/bjd.15633] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2017] [Indexed: 02/07/2023]
Abstract
Acrodermatitis chronica atrophicans (ACA) is the late cutaneous form of Lyme borreliosis. The early inflammatory phase manifests with a bluish-red discoloration and doughy swelling of the skin. The atrophic phase represents a late-phase process with red discoloration, and a thin and wrinkled appearance of the skin. We present a patient who exhibited a previously undescribed form of late cutaneous Lyme borreliosis (LCLB) with a foot tumour. A 64-year-old woman had a large tumorous lesion on the right sole. The tumour size and deformation of the feet made wearing shoes difficult. On skin histology, a granulomatous lymphohistiocytic infiltrate with plasma cells was noticed. In fact, the patient recalled tick bites 2 or 3 years before. Borrelia burgdorferi (Bb) serology was highly positive and a polymerase chain reaction analysis on the skin biopsy detected Bb sensu lato, genospecies B. afzelii. We diagnosed LCLB and antibiotics were prescribed. On the more recent examination, the tumour had totally disappeared; the skin was atrophic and dry with only few scales. We report an atypical case of European LCLB, suggesting that ACA is not the only possible presentation of LCLB. The diagnosis of ACA is often clinically missed for months or years, and may be mistaken at the inflammation phase for vascular disorders, erysipelas or bursitis/arthritis, and at the atrophic phase for lichen sclerosus atrophicus, morphoea or anetoderma. To our knowledge, no such tumorous LCLB has previously been described.
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Affiliation(s)
- O Bauvin
- Dermatology Department, Nancy University Hospital, Vandoeuvre-les-Nancy, France
| | - J-L Schmutz
- Dermatology Department, Nancy University Hospital, Vandoeuvre-les-Nancy, France
| | - S De Martino
- National Borrelia Reference Centre, Strasbourg University Hospital, Strasbourg, France
| | - T Busato
- Vascular Medicine Division and Regional Competence Centre for Rare Vascular And Systemic Autoimmune Diseases, Nancy University Hospital, Vandoeuvre-les-Nancy, France
| | - B Cribier
- Dermatology Department, Strasbourg University Hospital, Strasbourg, France
| | - A Barbaud
- Dermatology Department, Nancy University Hospital, Vandoeuvre-les-Nancy, France
| | - D Wahl
- Vascular Medicine Division and Regional Competence Centre for Rare Vascular And Systemic Autoimmune Diseases, Nancy University Hospital, Vandoeuvre-les-Nancy, France
| | - A-C Bursztejn
- Dermatology Department, Nancy University Hospital, Vandoeuvre-les-Nancy, France
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Bhate C, Schwartz RA. Lyme disease. J Am Acad Dermatol 2011; 64:639-53; quiz 654, 653. [DOI: 10.1016/j.jaad.2010.03.047] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 02/18/2010] [Accepted: 03/03/2010] [Indexed: 12/28/2022]
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&NA;. Treatment with antibacterials gets the ‘tick’ when treating skin manifestations of Lyme disease. DRUGS & THERAPY PERSPECTIVES 2009. [DOI: 10.2165/0042310-200925070-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Abstract
Lyme borreliosis is a multisystem infectious disease caused by tick-transmitted spirochetes of the Borrelia burgdorferi sensu lato complex. The three characteristic cutaneous manifestations are erythema migrans, borrelial lymphocytoma, and acrodermatitis chronica atrophicans. Erythema migrans occurs in acute Lyme borreliosis, lymphocytoma is a subacute lesion, and acrodermatitis is the typical manifestation of late Lyme borreliosis. Clinical appearances of erythema migrans and lymphocytoma (when located on the ear or breast) are characteristic, whereas acrodermatitis is often confused with vascular conditions. The diagnosis of erythema migrans is made clinically. Serologic analyses often yield false-negative results and are not required for the diagnosis. However, serologic proof of the diagnosis in lymphocytoma (approximately 90% positive) and acrodermatitis (100% positive) is mandatory. Histopathologic examination often adds substantial information in patients with skin manifestations of Lyme borreliosis and is recommended in clinically (and serologically) undecided cases of erythema migrans or lymphocytoma and is obligatory in acrodermatitis. Polymerase chain reaction for Borrelia-specific DNA (rather than culture of the spirochete) and immunohistochemical investigations (lymphocytoma) are sometimes necessary adjuncts for the diagnosis. Antibacterial treatment is necessary in all patients to eliminate the spirochete, cure current disease, and prevent late sequelae. Oral doxycycline, also effective against coinfection with Anaplasma phagocytophilum, is the mainstay of therapy of cutaneous manifestations of Lyme borreliosis. Other first-line antibacterials are amoxicillin and cefuroxime axetil. Erythema migrans is treated for 2 weeks, lymphocytoma for 3-4 weeks, and acrodermatitis for at least 4 weeks.
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Affiliation(s)
- Robert R Müllegger
- Department of Dermatology, Central Hospital Wiener Neustadt, Wiener Neustadt, Austria.
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Boyé T. Sur quels éléments cliniques, épidémiologiques et biologiques faut-il évoquer la maladie de Lyme? Aspects dermatologiques et ophtalmologiques au cours de la maladie de Lyme. Med Mal Infect 2007; 37 Suppl 3:S175-88. [DOI: 10.1016/j.medmal.2007.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2007] [Accepted: 10/03/2007] [Indexed: 11/26/2022]
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Hansmann Y. Le traitement des phases secondaires et tertiaires de la borréliose de Lyme. Med Mal Infect 2007; 37:479-86. [PMID: 17367972 DOI: 10.1016/j.medmal.2006.01.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2006] [Accepted: 01/15/2006] [Indexed: 12/21/2022]
Abstract
The treatment of secondary and tertiary Lyme borreliosis is difficult because of antibiotic lack of efficacy. This fact may be explained by several factors: the specific pathophysiology, involving not only the presence of bacteria, but also immunological reactions. There is no specific method of diagnosis resulting in difficulties for good indication of treatment and to evaluate treatment efficacy. The literature review shows that ceftriaxone and doxycycline are the two most efficient antibiotics in this indication. Even if the methodology of the published studies is not always convincing, these two antibiotics proved their efficacy in articular as well as in neurological forms of the disease. In the late stage of borreliosis, antibiotics are less efficient. Various treatment modalities with different dosage or duration of treatment cannot let us conclude on a convincing regimen.
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Affiliation(s)
- Y Hansmann
- Service des maladies infectieuses et tropicales, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France.
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12
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Mohseni Zadeh M. Traitement et suivi des phases secondaire et tertiaire de la borréliose de Lyme. Med Mal Infect 2007; 37:368-80. [PMID: 17707605 DOI: 10.1016/j.medmal.2006.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2006] [Accepted: 01/15/2006] [Indexed: 10/22/2022]
Abstract
The aim of this review was to analyze the current strategies of treatment and follow-up of disseminated and late Lyme borreliosis. A comprehensive search was performed using the Medline database. Only relevant reviews, expert guidelines and randomized controlled clinical trials were selected and, if necessary, open trials. Major drugs used in these studies were amoxicillin, doxycycline, penicillin G, and ceftriaxone. Oral administration of antibiotics was preferred in Lyme arthritis whereas parenteral drugs were mostly used in neuroborreliosis. The treatment duration usually ranged from 14 to 30 days. Prolonged antibiotic courses recommended by some authors in post-Lyme syndromes were not validated by several randomized placebo controlled studies. Follow up patterns were analyzed in order to determine possible prognosis parameters allowing to distinguih active Borrelia burgdorferi infection from a sequel of infection.
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Affiliation(s)
- M Mohseni Zadeh
- Service de médecine interne et de maladies infectieuses et tropicales, hôpital civil, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France.
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Ruzić-Sabljić E, Podreka T, Maraspin V, Strle F. Susceptibility of Borrelia afzelii strains to antimicrobial agents. Int J Antimicrob Agents 2005; 25:474-8. [PMID: 15871918 DOI: 10.1016/j.ijantimicag.2005.02.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2004] [Accepted: 02/09/2005] [Indexed: 10/25/2022]
Abstract
The aim of the present study was to determine the susceptibility of Borrelia afzelii strains to antibiotics, and to test the hypothesis that persistence of borrelia in skin, after therapy, is a consequence of resistance to the antibiotic used for treatment. Ten B. afzelii strains isolated from skin of seven adult patients (two with acrodermatitis chronica atrophicans, five with erythema migrans) were studied. In three patients B. afzelii was isolated from erythema migrans lesion before antibiotic therapy and 2-3 months after treatment with cefuroxime axetil (two patients) or with ceftriaxone (one patient). MICs and MBCs for amoxicillin, azithromycin, ceftriaxone, cefuroxime, doxycycline and amikacin were measured. There was total resistance to amikacin but isolates were susceptible to all other antibiotics except one isolate that was resistant to cefuroxime, MIC > 4 mg/L. Comparison of MBC values after 3 and 6 weeks' incubation revealed comparable results for azithromycin and ceftriaxone while for amoxicillin, cefuroxime and doxycycline, some differences were found. In one of the patients from whom there were borrelia isolated before and after treatment with cefuroxime axetil, both isolates were resistant to cefuroxime. In the other two patients, the paired isolates were susceptible to the antibiotic used for therapy.
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Affiliation(s)
- Eva Ruzić-Sabljić
- Institute of Microbiology and Immunology, Medical Faculty Ljubljana, Slovenia.
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14
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Kaiser R. [Clinical courses of acute and chronic neuroborreliosis following treatment with ceftriaxone]. DER NERVENARZT 2004; 75:553-7. [PMID: 15257378 DOI: 10.1007/s00115-003-1560-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Between 1990 and 2000, a total of 101 patients with acute (n=86) or chronic (n=15) neuroborreliosis (proven by clinical data, pleocytosis in the CSF, and elevated Borrelia burgdorferi-specific antibody indices) were treated with 2 g of ceftriaxone per day for either 2 or 3 weeks. The patients were reexamined clinically and serologically after 3, 6, and 12 months. Six (12) months after the antibiotic treatment, about 93% (95%) of the patients with acute neuroborreliosis and 20% (66%) of the patients with chronic neuroborreliosis were cured. One year after treatment, four patients with acute neuroborreliosis still suffered from facial palsy and five with chronic neuroborreliosis still had moderate spastic ataxic gait disturbance. The prognosis of facial palsy in neuroborreliosis is quite similar to that in idiopathic facial palsy, while that in chronic neuroborreliosis largely depends on the time elapsed before diagnosis.
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Affiliation(s)
- R Kaiser
- Neurologische Klinik, Städtisches Klinikum Pforzheim.
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15
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Affiliation(s)
- R Wolf
- Department of Dermatology, Tel-Aviv Sourasky Medical Center, Ichilov Hospital, Israel
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16
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Abstract
The laboratory diagnosis of Lyme borreliosis, the most prevalent vector-borne disease in the United States and endemic in parts of Europe and Asia, is currently based on serology with known limitations. Direct demonstration of Borrelia burgdorferi by culture may require weeks, while enzyme-linked immunosorbent assays for antigen detection often lack sensitivity. The development of the PCR has offered a new dimension in the diagnosis. Capable of amplifying minute amounts of DNA into billions of copies in just a few hours, PCR facilitates the sensitive and specific detection of DNA or RNA of pathogenic organisms. This review is restricted to applications of PCR methods in the diagnosis of human B. burgdorferi infections. In the first section, methodological aspects, e.g., sample preparation, target selection, primers and PCR methods, and detection and control of inhibition and contamination, are highlighted. In the second part, emphasis is placed on diagnostic aspects, where PCR results in patients with dermatological, neurological, joint, and ocular manifestations of the disease are discussed. Here, special attention is given to monitoring treatment efficacy by PCR tests. Last, specific guidelines on how to interpret PCR results, together with the advantages and limitations of these new techniques, are presented.
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Affiliation(s)
- B L Schmidt
- Ludwig Boltzmann Institute for Dermato-Venerological Serodiagnosis, Hospital of Vienna-Lainz, Vienna, Austria
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