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Talbot NC, Spillers NJ, Luther P, Flanagan C, Soileau LG, Ahmadzadeh S, Viswanath O, Varrassi G, Shekoohi S, Cornett EM, Kaye AM, Kaye AD. Lyme Disease and Post-treatment Lyme Disease Syndrome: Current and Developing Treatment Options. Cureus 2023; 15:e43112. [PMID: 37692614 PMCID: PMC10483257 DOI: 10.7759/cureus.43112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/08/2023] [Indexed: 09/12/2023] Open
Abstract
Lyme disease and its treatment implications have become an ever-increasing area of concern within the United States related to the markedly increased prevalence of infection within the last two decades. The presentation, pathophysiology, and epidemiology of Lyme disease have been well studied, and thus treatments for this disease are widely available. While the treatment of its early and late stages is relatively simple with 10-14 day and four-week courses of doxycycline, respectively, the main problem rests in the understanding of the etiology and pathology of post-treatment Lyme disease syndrome (PTLDS). With the time of symptoms onsetting approximately six months after treatment and potentially lasting indefinitely, this syndrome's effect on patients' quality of life could be devastating. Searching on PubMed, Google Scholar, MEDLINE, and ScienceDirect using keywords including Lyme disease, PTLDS, doxycycline, erythema migrans, azlocillin, and treatment, the authors have tried to make clear the different aspects. The authors have reviewed and discussed clinical studies of Lyme disease and its treatments/potential therapeutics as well as PTLDS and its sparse treatments/potential therapeutics.
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Affiliation(s)
- Norris C Talbot
- Radiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Noah J Spillers
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Patrick Luther
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Chelsi Flanagan
- Anesthesiology, University of the Incarnate Word School of Osteopathic Medicine, San Antonio, USA
| | - Lenise G Soileau
- Cellular Biology and Anatomy, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Shahab Ahmadzadeh
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | | | | | - Sahar Shekoohi
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Elyse M Cornett
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Adam M Kaye
- Pharmacy Practice, Thomas J. Long School of Pharmacy and Health Sciences University of the Pacific, Stockton, USA
| | - Alan D Kaye
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
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Oteo JA, Corominas H, Escudero R, Fariñas-Guerrero F, García-Moncó JC, Goenaga MA, Guillén S, Mascaró JM, Portillo A. Executive summary of the consensus statement of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Spanish Society of Neurology (SEN), Spanish Society of Immunology (SEI), Spanish Society of Pediatric Infectology (SEIP), Spanish Society of Rheumatology (SER), and Spanish Academy of Dermatology and Venereology (AEDV), on the diagnosis, treatment and prevention of Lyme borreliosis. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2023; 41:40-45. [PMID: 36621247 DOI: 10.1016/j.eimce.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/01/2022] [Indexed: 01/09/2023]
Abstract
The diagnosis of Lyme borreliosis (LB) is based on the epidemiological history, clinical manifestations and microbiological findings in the early disseminated and late phases of the disease. Related to this fact, microbiological diagnostic techniques have recently appeared. Far from facilitating the diagnosis and the clinical-therapeutic management of LB patients, they are generating confusion. Herein, experts and representatives of Spanish Scientific Societies [Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Spanish Society of Neurology (SEN), Spanish Society of Immunology (SEI), Spanish Society of Pediatric Infectology (SEIP), Spanish Society of Rheumatology (SER), and Spanish Academy of Dermatology and Venereology (AEDV)] exposed the executive summary after reviewing the epidemiology, clinical spectrum, available diagnostic techniques for the diagnosis of Borrelia burgdorferi infection, therapeutic and prevention options of LB. By consensus, recommendations for microbiological diagnosis are offered together with those supporting the therapeutic management and prophylaxis of infection.
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Affiliation(s)
- José A Oteo
- Centre of Rickettsiosis and Arthropod-Borne Diseases (CRETAV), Department of Infectious Diseases, San Pedro University Hospital - Centre for Biomedical Research from La Rioja (CIBIR), Logroño, Spain.
| | - Héctor Corominas
- Spanish Society of Rheumatology, Rheumatology and Systemic Autoimmune Diseases Department, Hospital de la Santa Creu i Sant Pau/Hospital Dos de Maig, Barcelona, Spain
| | - Raquel Escudero
- Special Pathogens Reference and Research Laboratory, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain
| | - Fernando Fariñas-Guerrero
- Spanish Society of Immunology. Institute of Clinical Immunology and Infectious Diseases, YNMUN Biomedicine Group, Málaga, Spain
| | - Juan Carlos García-Moncó
- Spanish Society of Neurology. Department of Neurology, Hospital Universitario Basurto, Bilbao, Spain
| | - Miguel A Goenaga
- Infectious Diseases Service, Hospital Donostia, OSI Donostialdea. Instituto BioDonostia, San Sebastián, Spain
| | - Sara Guillén
- Spanish Society of Pediatric Infectology (SEIP), Department of Pediatrics, Hospital Universitario de Getafe, Madrid, Spain
| | - José M Mascaró
- Spanish Academy of Dermatology and Venereology, Department of Dermatology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Aránzazu Portillo
- Centre of Rickettsiosis and Arthropod-Borne Diseases (CRETAV), Department of Infectious Diseases, San Pedro University Hospital - Centre for Biomedical Research from La Rioja (CIBIR), Logroño, Spain
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Vourc'h G, Un K, Berthet E, Frey-Klett P, Le Masson P, Weil B, Lesens O. Design theory to better target public health priorities: An application to Lyme disease in France. Front Public Health 2022; 10:980086. [PMID: 36419992 PMCID: PMC9676681 DOI: 10.3389/fpubh.2022.980086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/11/2022] [Indexed: 11/09/2022] Open
Abstract
In the context of complex public health challenges led by interdependent changes such as climate change, biodiversity loss, and resistance to treatment, it is important to mobilize methods that guide us to generate innovative interventions in a context of uncertainty and unknown. Here, we mobilized the concept-knowledge (CK) design theory to identify innovative, cross-sectoral, and cross-disciplinary research and design programs that address the challenges posed by tick-borne Lyme disease in France, which is of growing importance in the French public health and healthcare systems. Within the CK methodological framework, we developed an iterative approach based on literature analysis, expert interviews, analysis of active French research projects, and work with CK experts to contribute to design "an action plan against Lyme disease." We produced a CK diagram that highlights innovative concepts that could be addressed in research projects. The outcome is discussed within four areas: (i) effectiveness; (ii) environmental sustainability in prevention actions; (iii) the promotion of constructive involvement of citizens in Lyme challenges; and (iv) the development of care protocols for chronic conditions with an unknown diagnosis. Altogether, our analysis questioned the health targets ranging from population to ecosystem, the citizen involvement, and the patient consideration. This means integrating social and ecological science, as well as the multidisciplinary medical patient journey, from the start. CK theory is a promising framework to assist public health professionals in designing programs for complex yet urgent contexts, where research and data collection are still not sufficient to provide clear guidance.
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Affiliation(s)
- Gwenaël Vourc'h
- INRAE, VetAgro Sup, UMR EPIA, Université Clermont Auvergne, Saint Genès Champanelle, France,INRAE, VetAgro Sup, UMR EPIA, Université de Lyon, Marcy l'Etoile, France
| | - Katherine Un
- INRAE, VetAgro Sup, UMR EPIA, Université Clermont Auvergne, Saint Genès Champanelle, France,INRAE, VetAgro Sup, UMR EPIA, Université de Lyon, Marcy l'Etoile, France,Centre de Gestion Scientifique, i3 UMR CNRS 9217, MINES ParisTech, PSL Research University, Paris, France
| | - Elsa Berthet
- INRAE, AgroParisTech, UMR SADAPT, Université Paris-Saclay, Paris, France,USC 1339, Centre d'Etudes Biologiques de Chizé, INRAE, Villiers-en-Bois, France,UMR 7372 Centre d'Études Biologiques de Chizé, CNRS, Univ. La Rochelle, Beauvoir-sur-Niort, France
| | | | - Pascal Le Masson
- Centre de Gestion Scientifique, i3 UMR CNRS 9217, MINES ParisTech, PSL Research University, Paris, France
| | - Benoit Weil
- Centre de Gestion Scientifique, i3 UMR CNRS 9217, MINES ParisTech, PSL Research University, Paris, France
| | - Olivier Lesens
- Université Clermont Auvergne UMR, CNRS 6023, Laboratoire Microorganismes: Génome Environnement (LMGE), Clermont-Ferrand, France,Service des maladies infectieuses et tropicales, Centre de référence pour la prise en charge des infections ostéo-articulaires complexes (CRIOA), Centre de Référence pour les Maladies Vectorielles liées aux Tiques (CRMVT), 3IHP, CHU, Clermont-Ferrand, France,*Correspondence: Olivier Lesens
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Oteo JA, Corominas H, Escudero R, Fariñas-Guerrero F, García-Moncó JC, Goenaga MA, Guillén S, Mascaró JM, Portillo A. Executive summary of the consensus statement of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Spanish Society of Neurology (SEN), Spanish Society of Immunology (SEI), Spanish Society of Pediatric Infectology (SEIP), Spanish Society of Rheumatology (SER), and Spanish Academy of Dermatology and Venereology (AEDV), on the diagnosis, treatment and prevention of Lyme borreliosis. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Azagi T, Harms M, Swart A, Fonville M, Hoornstra D, Mughini-Gras L, Hovius JW, Sprong H, van den Wijngaard C. Self-reported symptoms and health complaints associated with exposure to Ixodes ricinus-borne pathogens. Parasit Vectors 2022; 15:93. [PMID: 35303944 PMCID: PMC8931963 DOI: 10.1186/s13071-022-05228-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The impact of infections with tick-borne pathogens (TBPs) other than Borrelia burgdorferi (s.l.) and tick-borne encephalitis virus (TBEV) on public health in Europe remains unclear. Our goal is to evaluate whether the presence of these TBPs in ticks can be associated with self-reported health complaints. METHODS We enrolled individuals who were bitten by I. ricinus between 2012 and 2015 and collected their relevant demographic and clinical information using a self-administered online questionnaire. A total of 4163 I. ricinus ticks sent by the participants were subject to molecular analyses for detection of specific TBPs. Associations between the presence of TBPs in ticks and self-reported complaints and symptoms were evaluated by means of a stepwise approach using a generalized linear model (GLM). RESULTS Of 17 self-reported complaints and symptoms significant in the univariate analyses, 3 had a highly significant association (P < 0.01) with at least one TBP in the multivariate analysis. Self-reported Lyme borreliosis was significantly associated (P < 0.001) with B. burgdorferi (s.l.) infection. Facial paralysis was associated (P < 0.01) with infection with B. miyamotoi, N. mikurensis and R. helvetica. Finally, a significant association (P < 0.001) was found between nocturnal sweating and A. phagocytophilum. CONCLUSIONS We found associations between the presence of TBPs in ticks feeding on humans and self-reported symptoms. Due to the subjective nature of such reports and the fact that infection was determined in the ticks and not in the patient samples, further prospective studies utilizing diagnostic modalities should be performed before any clinical outcome can be causally linked to infection with TBPs.
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Affiliation(s)
- Tal Azagi
- Centre for Infectious Diseases Research, National Institute for Public Health and the Environment, P.O. Box 1, Bilthoven, 3720 BA, The Netherlands.
| | - Margriet Harms
- Centre for Infectious Diseases Research, National Institute for Public Health and the Environment, P.O. Box 1, Bilthoven, 3720 BA, The Netherlands
| | - Arno Swart
- Centre for Infectious Diseases Research, National Institute for Public Health and the Environment, P.O. Box 1, Bilthoven, 3720 BA, The Netherlands
| | - Manoj Fonville
- Centre for Infectious Diseases Research, National Institute for Public Health and the Environment, P.O. Box 1, Bilthoven, 3720 BA, The Netherlands
| | - Dieuwertje Hoornstra
- Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers Location, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Lapo Mughini-Gras
- Centre for Infectious Diseases Research, National Institute for Public Health and the Environment, P.O. Box 1, Bilthoven, 3720 BA, The Netherlands
| | - Joppe W Hovius
- Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers Location, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Hein Sprong
- Centre for Infectious Diseases Research, National Institute for Public Health and the Environment, P.O. Box 1, Bilthoven, 3720 BA, The Netherlands
| | - Cees van den Wijngaard
- Centre for Infectious Diseases Research, National Institute for Public Health and the Environment, P.O. Box 1, Bilthoven, 3720 BA, The Netherlands
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The Reply. Am J Med 2022; 135:e78-e79. [PMID: 35249634 DOI: 10.1016/j.amjmed.2021.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 10/23/2021] [Indexed: 11/20/2022]
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Zhou G, Xu X, Zhang Y, Yue P, Luo S, Fan Y, Chen J, Liu M, Dong Y, Li B, Kong J, Wen S, Liu A, Bao F. Antibiotic prophylaxis for prevention against Lyme disease following tick bite: an updated systematic review and meta-analysis. BMC Infect Dis 2021; 21:1141. [PMID: 34749665 PMCID: PMC8573889 DOI: 10.1186/s12879-021-06837-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/22/2021] [Indexed: 12/22/2022] Open
Abstract
Background In areas where Lyme disease is endemic, bites from ticks are common, but no vaccine is currently available against Lyme disease for humans. Therefore, the feasibility of using antibiotic prophylaxis to prevent Lyme disease after a tick bite is worth further exploration. Previous meta-analyses lack sufficient power to demonstrate the efficacy of about antibiotic prophylaxis for the prevention of Lyme disease following a tick bite. In this study, we explored more precise evidence and attempted to identify and update optimum treatment strategies. Methods We searched PubMed, Embase, and the Cochrane Library for studies until March 23, 2021. We included studies if the enrolled patients were randomly allocated to a treatment or control group within 72 h following a tick bite and had no clinical evidence of Lyme disease at enrolment. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines were followed for data abstraction. Two authors (GZZ and XX) independently reviewed the abstracts and identified articles for detailed assessment. We used a random-effects model to calculate the pooled results and reported the 95% confidence interval (CI). Study quality was assessed using a modified Jadad scale, and publication bias was assessed using Egger’s test. We calculated the risk ratio (RR) for the rates of unfavorable events in patients who received intervention versus the control group. This study is registered with PROSPERO, number CRD42021245002. Results Six studies (3,766 individuals) were included. The pooled rate of unfavorable events in persons receiving treatment and the control group were 0.4% (95%CI: 0.1–1.1%) and 2.2% (95%CI: 1.6–3.0%), respectively. The pooled RR was 0.38 (95%CI: 0.22–0.66). Subgroup analysis revealed that the pooled RR was 0.29 (95%CI: 0.14–0.60) in the single-use 200-mg doxycycline group; 0.28 (95%CI: 0.05–1.67) in a 10-day course group (Amoxicillin, Penicillin or tetracycline); and 0.73 (95%CI: 0.25–2.08) in a topical antibiotic treatment group (Azithromycin). Conclusions The available evidence supports the use of antibiotics for the prevention of Lyme disease, and reveals advantages of using single-dose; however, further confirmation is needed.
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Affiliation(s)
- Guozhong Zhou
- The Institute for Tropical Medicine, School of Basic Medical Sciences, Kunming Medical University, Kunming, 650500, China
| | - Xin Xu
- The Institute for Tropical Medicine, School of Basic Medical Sciences, Kunming Medical University, Kunming, 650500, China
| | - Yu Zhang
- The Institute for Tropical Medicine, School of Basic Medical Sciences, Kunming Medical University, Kunming, 650500, China
| | - Peng Yue
- The Institute for Tropical Medicine, School of Basic Medical Sciences, Kunming Medical University, Kunming, 650500, China
| | - Shiqi Luo
- The Institute for Tropical Medicine, School of Basic Medical Sciences, Kunming Medical University, Kunming, 650500, China
| | - Yuxin Fan
- The Institute for Tropical Medicine, School of Basic Medical Sciences, Kunming Medical University, Kunming, 650500, China
| | - Jingjing Chen
- The Institute for Tropical Medicine, School of Basic Medical Sciences, Kunming Medical University, Kunming, 650500, China
| | - Meixiao Liu
- The Institute for Tropical Medicine, School of Basic Medical Sciences, Kunming Medical University, Kunming, 650500, China
| | - Yan Dong
- The Institute for Tropical Medicine, School of Basic Medical Sciences, Kunming Medical University, Kunming, 650500, China
| | - Bingxue Li
- The Institute for Tropical Medicine, School of Basic Medical Sciences, Kunming Medical University, Kunming, 650500, China
| | - Jing Kong
- The Institute for Tropical Medicine, School of Basic Medical Sciences, Kunming Medical University, Kunming, 650500, China
| | - Shiyuan Wen
- The Institute for Tropical Medicine, School of Basic Medical Sciences, Kunming Medical University, Kunming, 650500, China
| | - Aihua Liu
- The Institute for Tropical Medicine, School of Basic Medical Sciences, Kunming Medical University, Kunming, 650500, China. .,Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities, Kunming Medical University, Kunming, 650500, China.
| | - Fukai Bao
- The Institute for Tropical Medicine, School of Basic Medical Sciences, Kunming Medical University, Kunming, 650500, China. .,Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities, Kunming Medical University, Kunming, 650500, China.
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Abstract
Lyme disease, or Lyme borreliosis, is the most common tickborne disease in the United States and Europe. In both locations, Ixodes species ticks transmit the Borrelia burgdorferi sensu lato bacteria species responsible for causing the infection. The diversity of Borrelia species that cause human infection is greater in Europe; the 2 B. burgdorferi s.l. species collectively responsible for most infections in Europe, B. afzelii and B. garinii, are not found in the United States, where most infections are caused by B. burgdorferi sensu stricto. Strain differences seem to explain some of the variation in the clinical manifestations of Lyme disease, which are both minor and substantive, between the United States and Europe. Future studies should attempt to delineate the specific virulence factors of the different species of B. burgdorferi s.l. responsible for these variations in clinical features.
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Dersch R, Fingerle V. [Lyme borreliosis and Lyme neuroborreliosis - an update]. Dtsch Med Wochenschr 2021; 146:728-732. [PMID: 34062587 DOI: 10.1055/a-1265-4397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Lyme borreliosis is a tick-borne infectious disease caused by the spirochete bacterium Borrelia burgdorferi sensu lato. Lyme borreliosis is the most frequent zoonosis in Germany.Most cases show dermatological manifestations, like erythema migrans, followed by infections of the nervous system. Cerebrospinal fluid analysis should be performed if Lyme neuroborreliosis is suspected. Cell-based assays (like LTT or ELISPOT) should not be used when investigating Lyme disease.A recent randomized controlled trial showed a similar effect of doxycycline compared to betalactam-antibiotics regarding neurological symptoms in Lyme neuroborreliosis. This corroborates current German guideline recommendations.The prognosis of Lyme disease after antibiotic treatment is usually favorable. Frequency of fatigue, depression, impairments in quality of life and cognitive impairment are similar in patients after treatment of Lyme neuroborreliosis when compared to the general population.
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Affiliation(s)
- Rick Dersch
- Klinik für Neurologie und Neurophysiologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert- Ludwigs-Universität Freiburg
| | - Volker Fingerle
- Nationales Referenzzentrum für Borrelien, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Oberschleißheim
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Wormser GP, Warshafsky S, Visintainer P. Postexposure prophylaxis with single-dose doxycycline is effective for prevention of Lyme disease in both the United States and Europe and is also effective for prevention of syphilis and tick-borne relapsing fever. Diagn Microbiol Infect Dis 2021; 100:115367. [PMID: 33780744 DOI: 10.1016/j.diagmicrobio.2021.115367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 02/27/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Gary P Wormser
- Division of Infectious Diseases, New York Medical College, Valhalla, NY, USA.
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