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Frahier H, Klopfenstein T, Brunel AS, Chirouze C, Bouiller K. Characteristics of patients consulted for suspected Lyme neuroborreliosis in an endemic area. Ticks Tick Borne Dis 2024; 15:102353. [PMID: 38761786 DOI: 10.1016/j.ttbdis.2024.102353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 05/20/2024]
Abstract
INTRODUCTION Some patients with unexplained neurological symptoms sought care for presumed Lyme neuroborreliosis (LNB). We aimed to compare patients' characteristics with and without LNB. MATERIAL AND METHODS All patients consulting for LNB suspicion and having a lumbar puncture between 2014 and 2020 in a high endemic area of Lyme borreliosis were included in the study. RESULTS One hundred fifty-five patients were included. Forty-five patients (29 %) had LNB (mean age: 57.6 years, 28.9 % of women) including 17 with isolated intrathecal synthesis. One hundred and ten patients had no LNB (mainly neurological (29 %) and rheumatological diseases (19 %)). Non-neurological symptoms were similar in patients with LNB and patients with no LNB (asthenia, 31 % vs. 46 %, p = 0.14, arthralgia 20 % vs. 31 %, p = 0.14) with the exception of myalgia, which was less frequent in patients with LNB (4.4 % vs. 19.1 % p = 0.02). In multivariable analysis, factors associated with LNB were presence of facial nerve palsy (OR = 5.7), radiculopathy (OR = 11.3), positive Lyme serology (OR = 5.4) and duration of symptoms less than 3 months (OR = 4.48). Patients with isolated intrathecal synthesis had a longer duration of symptoms (3 vs 1 months) than patients with pleocytosis. Asthenia (5.9 % vs. 32.1 %), headaches (0 % vs. 39.3 %) neuropathic pain (17.6 % vs. 50 %) and facial palsy (11.8 % vs. 39.3 %) were less frequent in patients with isolated intrathecal synthesis than patients with pleocytosis. The presence of isolated subjective neurological symptoms (paresthesia, memory disorders, insomnia, irritability, asthenia, headaches) was reported in 7/17 (41 %) of patients with isolated intrathecal synthesis, 2/28 (7.1 %) in patients with pleocytosis and 75/110 (68 %) in patients without LNB (p < 0.001). CONCLUSION More than one quarter of patients consulted for suspected LNB had non-neurologic symptoms, whether or not they have a LNB. Concerning patients with isolated intrathecal synthesis, the question of presence of sequelae with a spontaneously cured disease or an active Lyme borreliosis requiring antibiotic remain.
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Affiliation(s)
- Hélène Frahier
- Besançon University Hospital, Department of Infectious and Tropical Diseases, F-25000 Besançon, France
| | - Timothée Klopfenstein
- Nord Franche-Comté Hospital, Department of Infectious Diseases, 90400, Trevenans, France
| | - Anne-Sophie Brunel
- Besançon University Hospital, Department of Infectious and Tropical Diseases, F-25000 Besançon, France
| | - Catherine Chirouze
- Franche-Comté university, CHU Besançon, UMR-CNRS 6249 Chrono-environnement, Department of Infectious and Tropical Diseases, F-25000 Besançon, France
| | - Kevin Bouiller
- Franche-Comté university, CHU Besançon, UMR-CNRS 6249 Chrono-environnement, Department of Infectious and Tropical Diseases, F-25000 Besançon, France.
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Sayad B, Babazadeh A, Barary M, Hosseinzadeh R, Ebrahimpour S, Afshar ZM. Lyme neuroborreliosis: A case report. Clin Case Rep 2023; 11:e7702. [PMID: 37554577 PMCID: PMC10405229 DOI: 10.1002/ccr3.7702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/23/2023] [Accepted: 06/29/2023] [Indexed: 08/10/2023] Open
Abstract
KEY CLINICAL MESSAGE Lyme neuroborreliosis is the manifestation of Lyme borreliosis that impacts the nervous system. It gives rise to various neurological and psychiatric conditions, and its diagnosis is challenging. The timely administration of antibiotics is effective. ABSTRACT A male patient, aged 55, was admitted to the emergency department due to the sudden onset of tonic-clonic seizures. All standard laboratory examinations yielded unremarkable outcomes, except a favorable Wright and 2-mercaptoethanol test. The examination of cerebrospinal fluid revealed the presence of 380 white blood cells per milliliter. The protein level was also elevated, while the glucose level was within the normal range. The results of the serologic tests indicated the presence of both IgG and IgM antibodies to Borrelia burgdorferi. Following the administration of ceftriaxone, a significant improvement was observed in the patient's medical status, and he was subsequently discharged. Lyme neuroborreliosis is the manifestation of Lyme borreliosis that impacts the nervous system. It gives rise to various neurological and psychiatric conditions, and its diagnosis is challenging. The timely administration of antibiotics is effective in treating patients.
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Affiliation(s)
- Babak Sayad
- Clinical Research Development Center, Imam Reza HospitalKermanshah University of Medical SciencesKermanshahIran
| | - Arefeh Babazadeh
- Infectious Diseases and Tropical Medicine Research CenterHealth Research Institute, Babol University of Medical SciencesBabolIran
| | - Mohammad Barary
- Student Research Committee, Virtual School of Medical Education and ManagementShahid Beheshti University of Medical SciencesTehranIran
| | | | - Soheil Ebrahimpour
- Infectious Diseases and Tropical Medicine Research CenterHealth Research Institute, Babol University of Medical SciencesBabolIran
| | - Zeinab Mohseni Afshar
- Clinical Research Development Center, Imam Reza HospitalKermanshah University of Medical SciencesKermanshahIran
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Lyme borreliosis and other tick-borne diseases. Guidelines from the French Scientific Societies (I): prevention, epidemiology, diagnosis. Med Mal Infect 2019; 49:318-334. [DOI: 10.1016/j.medmal.2019.04.381] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 04/09/2019] [Indexed: 12/17/2022]
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Briciu VT, Flonta M, Leucuţa D, Cârstina D, Ţăţulescu DF, Lupşe M. A Lyme borreliosis diagnosis probability score - no relation with antibiotic treatment response. Infect Dis (Lond) 2017; 49:373-379. [PMID: 28049383 DOI: 10.1080/23744235.2016.1272134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES (1) To describe epidemiological and clinical data of patients that present with the suspicion of Lyme borreliosis (LB); (2) to evaluate a previous published score that classifies patients on the probability of having LB, following-up patients' clinical outcome after antibiotherapy. METHODS Inclusion criteria: patients with clinical manifestations compatible with LB and Borrelia (B.) burgdorferi positive serology, hospitalized in a Romanian hospital between January 2011 and October 2012. EXCLUSION CRITERIA erythema migrans (EM) or suspicion of Lyme neuroborreliosis (LNB) with lumbar puncture performed for diagnosis. A questionnaire was completed for each patient regarding associated diseases, tick bites or EM history and clinical signs/symptoms at admission, end of treatment and 3 months later. Two-tier testing (TTT) used an ELISA followed by a Western Blot kit. The patients were classified in groups, using the LB probability score and were evaluated in a multidisciplinary team. Antibiotherapy followed guidelines' recommendations. RESULTS Sixty-four patients were included, presenting diverse associated comorbidities. Fifty-seven patients presented positive TTT, seven presenting either ELISA or Western Blot test positive. No differences in outcome were found between the groups of patients classified as very probable, probable and little probable LB. Instead, a better post-treatment outcome was described in patients with positive TTT. CONCLUSION The patients investigated for the suspicion of LB present diverse clinical manifestations and comorbidities that complicate differential diagnosis. The LB diagnosis probability score used in our patients did not correlate with the antibiotic treatment response, suggesting that the probability score does not bring any benefit in diagnosis.
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Affiliation(s)
- Violeta T Briciu
- a Department of Infectious Diseases , "Iuliu Hatieganu" University of Medicine and Pharmacy , Cluj Napoca , Romania.,b Clinical Hospital of Infectious Diseases , Cluj Napoca , Romania
| | - Mirela Flonta
- b Clinical Hospital of Infectious Diseases , Cluj Napoca , Romania
| | - Daniel Leucuţa
- c Department of Medical Informatics and Biostatistics , Iuliu Hatieganu" University of Medicine and Pharmacy , Cluj Napoca , Romania
| | - Dumitru Cârstina
- a Department of Infectious Diseases , "Iuliu Hatieganu" University of Medicine and Pharmacy , Cluj Napoca , Romania
| | - Doina F Ţăţulescu
- a Department of Infectious Diseases , "Iuliu Hatieganu" University of Medicine and Pharmacy , Cluj Napoca , Romania.,b Clinical Hospital of Infectious Diseases , Cluj Napoca , Romania
| | - Mihaela Lupşe
- a Department of Infectious Diseases , "Iuliu Hatieganu" University of Medicine and Pharmacy , Cluj Napoca , Romania.,b Clinical Hospital of Infectious Diseases , Cluj Napoca , Romania
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Smaranda M, Nicoleta S, Zoltan B, Anca M, Brânduşa Ţ, Adrian A, Rodica B. Lyme Meningoradiculitis: Case Reports and Literature Review. ACTA MEDICA MARISIENSIS 2016. [DOI: 10.1515/amma-2016-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
The clinical manifestations of Lyme disease are protean. The meningoradiculitis is a common and well-recognized complication of neuroborreliosis but can be easily misdiagnosed without a high degree of clinical suspicion, mainly if the tick bite is not present in the medical history. We report two cases of Lyme meningoradiculitis with excellent outcome after appropriate antibiotic therapy. In an endemic area in case of neurological manifestations suggestive for neuroborreliosis the serological testing for B. burgdorferi in serum and cerebrospinal fluid is imperative for the correct diagnosis.
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Affiliation(s)
- Maier Smaranda
- University of Medicine and Pharmacy Tirgu Mures, Romania
- Mures County Clinical Emergency Hospital, Romania
| | - Stirbu Nicoleta
- University of Medicine and Pharmacy Tirgu Mures, Romania
- Mures County Clinical Emergency Hospital, Romania
| | - Bajko Zoltan
- University of Medicine and Pharmacy Tirgu Mures, Romania
- Mures County Clinical Emergency Hospital, Romania
| | - Moţăţăianu Anca
- University of Medicine and Pharmacy Tirgu Mures, Romania
- Mures County Clinical Emergency Hospital, Romania
| | - Ţilea Brânduşa
- University of Medicine and Pharmacy Tirgu Mures, Romania
- Mures County Clinical Emergency Hospital, Romania
| | - Alexandrescu Adrian
- University of Medicine and Pharmacy Tirgu Mures, Romania
- Mures County Clinical Emergency Hospital, Romania
| | - Bălaşa Rodica
- University of Medicine and Pharmacy Tirgu Mures, Romania
- Mures County Clinical Emergency Hospital, Romania
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Wittwer B, Pelletier S, Ducrocq X, Maillard L, Mione G, Richard S. Cerebrovascular Events in Lyme Neuroborreliosis. J Stroke Cerebrovasc Dis 2015; 24:1671-8. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.03.056] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 03/19/2015] [Accepted: 03/27/2015] [Indexed: 12/23/2022] Open
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Blanc F, Jaulhac B, Hansmann Y, Dietemann JL, Tranchant C. Borreliosi di Lyme e neuroborreliosi. Neurologia 2014. [DOI: 10.1016/s1634-7072(14)68869-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Miklossy J. Chronic or late lyme neuroborreliosis: analysis of evidence compared to chronic or late neurosyphilis. Open Neurol J 2012; 6:146-57. [PMID: 23346260 PMCID: PMC3551238 DOI: 10.2174/1874205x01206010146] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Revised: 06/22/2012] [Accepted: 07/02/2012] [Indexed: 12/24/2022] Open
Abstract
Whether spirochetes persist in affected host tissues and cause the late/chronic manifestations of neurosyphilis was the subject of long-lasting debate. Detection of Treponema pallidum in the brains of patients with general paresis established a direct link between persisting infection and tertiary manifestations of neurosyphilis. Today, the same question is in the center of debate with respect to Lyme disease. The goal of this review was to compare the established pathological features of neurosyphilis with those available for Lyme neuroborreliosis. If the main tertiary forms of neurosyphilis also occur in Lyme neuroborreliosis and Borrelia burgdorferi can be detected in brain lesions would indicate that the spirochete is responsible for the neuropsychiatric manifestations of late/chronic Lyme neuroborreliosis. The substantial amounts of data available in the literature show that the major forms of late/chronic Lyme neuroborreliosis (meningovascular and meningoencephalitis) are clinically and pathologically confirmed. Borrelia burgdorferi was detected in association with tertiary brain lesions and cultivated from the affected brain or cerebrospinal fluid. The accumulated data also indicate that Borrelia burgdorferi is able to evade from destruction by the host immune reactions, persist in host tissues and sustain chronic infection and inflammation. These observations represent evidences that Borrelia burgdorferi in an analogous way to Treponema pallidum is responsible for the chronic/late manifestations of Lyme neuroborreliosis.Late Lyme neuroborreliosis is accepted by all existing guidelines in Europe, US and Canada. The terms chronic and late are synonymous and both define tertiary neurosyphilis or tertiary Lyme neuroborreliosis. The use of chronic and late Lyme neuroborreliosis as different entities is inaccurate and can be confusing. Further pathological investigations and the detection of spirochetes in infected tissues and body fluids are strongly needed.
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Affiliation(s)
- Judith Miklossy
- International Alzheimer Research Center, Alzheimer Prevention Foundation, 1921 Martigny-Croix, Switzerland
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Blin-Rochemaure N, Quinet B. [Should a lumbar puncture be performed in any child with acute peripheral facial palsy and clinical suspicion of Lyme borreliosis?]. Arch Pediatr 2012; 19:1354-61. [PMID: 23116983 DOI: 10.1016/j.arcped.2012.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 07/04/2012] [Accepted: 09/25/2012] [Indexed: 10/26/2022]
Abstract
Lyme borreliosis should be considered in any child affected with acute peripheral facial palsy without obvious cause in endemic areas, especially if it happens from May to November, with a history of erythema migrans, tick bite, or possible exposure during the previous weeks. The clinical appearance of Lyme borreliosis differs between adults and children and according to the geographical origin of the infection: therefore it is difficult to interpret and follow the recommendations for the management and treatment of this disease. Neuroborreliosis is more frequent in Europe than in the United States, and meningitis associated to facial palsy occurs earlier and is more frequent among the European pediatric population, too. When peripheral facial palsy occurs and there is suspicion of Lyme borreliosis, it seems necessary to perform a lumbar puncture in order to support the diagnosis with detection of intrathecal synthesis of specific antibodies, sometimes more abundant than in the serum, and thus to adapt the antibiotic therapy modalities. Parenteral antibiotherapy is recommended if any involvement is detected in the cerebrospinal fluid, while oral antibiotherapy should be prescribed for isolated facial palsies. Follow-up should be made according to clinical symptoms with a close collaboration between pediatricians, infection disease specialists, and ENT specialists.
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Affiliation(s)
- N Blin-Rochemaure
- Service de neuropédiatrie, hôpital Raymond-Poincaré, AP-HP, 104, boulevard Raymond-Poincaré, 92380 Garches, France.
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Girszyn N, Fares J, Proust F, Héron F, Marie I, Lévesque H, Kaminsky P. Le berger et la blanche ingénue. Rev Med Interne 2011; 32:770-2. [DOI: 10.1016/j.revmed.2011.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Accepted: 07/13/2011] [Indexed: 10/17/2022]
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de Broucker T, Martinez-Almoyna L. Diagnostic des méningites chroniques. Rev Med Interne 2011; 32:159-72. [DOI: 10.1016/j.revmed.2010.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 03/26/2010] [Accepted: 04/10/2010] [Indexed: 12/26/2022]
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Gheorghiev C, De Montleau F, Defuentes G. [Alcohol and epilepsy: a case report between alcohol withdrawal seizures and neuroborreliosis]. Encephale 2010; 37:231-7. [PMID: 21703439 DOI: 10.1016/j.encep.2010.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Accepted: 05/12/2010] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This work consists in a study of the links between alcohol, a psychoactive substance and different related epileptic manifestations in order to clarify predominant factors both on conceptual, clinical and therapeutic levels. BACKGROUND If alcohol is a frequent risk factor for seizures, its scientific evidence is less clear and ad hoc literature is rich in controversies and not firmly supported by systematic surveys. Alcohol has variable roles in the physiopathological determinism of seizures, the nosographical status of which needs to be clarified: alcohol withdrawal seizures, alcoholic epilepsy, and sometimes symptomatic epilepsy caused by coincidental disorders. METHODS A synthesis of relevant literature describing the links between alcohol and epilepsy is illustrated by a clinical case: a patient admitted in our psychiatric ward for chronic alcoholism had had two seizures questioning their nosographical status. An infectious process with protean neurological manifestations, neuroborreliosis, was diagnosed. DISCUSSION Three distinct clinical pictures illustrate the links between alcohol and epilepsy: the first, convulsive inebriation corresponds to a seizure during severe acute alcohol intoxication. The second deals with alcohol withdrawal seizures following a partial or complete sudden withdrawal of alcohol; these are the clinical features the most documented in the literature representing, with delirium tremens, the main complication of alcohol withdrawal. The third clinical picture, alcoholic epilepsy, is characterized by repetitive seizures in patients presenting alcohol abuse without former history of epilepsy or other potentially epileptic disorder, and without relationship to alcohol withdrawal or acute alcohol intoxication. Acute and chronic effects of alcohol on central nervous system have been depicted, while a unified classification of alcohol related seizures has been recently established by Bartolomei. This classification based on the Ballenger hypothesis of kindling (1978) could explain withdrawal and hazardous seizures as clinical expressions of the same epileptogenic process over different stages. Although theoretically criticized, such a model offers a conceptual interest while able to unify the varied understanding of convulsive crises related to alcohol, and a practical one, whilst being a basis for a therapeutic approach. Our clinical case illustrates the delay in the diagnosis established after two iterative generalized seizures, 72 hours after the beginning of a programmed weaning of a patient presenting alcohol dependency. If the withdrawal seizure hypothesis was underlined, some data led to symptomatic epilepsy. Firstly atypia, the well-supervised preventive treatment of convulsion did not avoid seizures. Secondly, the EEG showed focal anomalies strongly linked in the literature with a cerebral disorder, which was confirmed by MRI; thirdly, cognitive alterations, which are not usual in alcohol dependency, were observed clinically and confirmed by neuropsychological tests. Finally a neuroborreliosis was diagnosed, while the main neuropsychiatric complications of Lyme disease were described. In accordance with the recommendations made by some authors, it appeared legitimate to consider neuroborreliosis as a potential differential diagnosis of every atypical psychiatric disorder, the interest of such an identification laying in the existence of a specific treatment.
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Affiliation(s)
- C Gheorghiev
- Service de psychiatrie, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, BP 406, 92141 Clamart, France.
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Gueorguiev Penev D, Laurent E, Baron S, Diot E, Bastides F, de Gialluly C, Bernard L, Rusch E. Borréliose de Lyme : recensement des cas adultes hospitalisés en Indre-et-Loire, à partir du PMSI (1999–2006). Rev Epidemiol Sante Publique 2010; 58:339-47. [DOI: 10.1016/j.respe.2010.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Revised: 04/08/2010] [Accepted: 05/27/2010] [Indexed: 10/19/2022] Open
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Martzolff L, Bouhala M, Dukic R, Saraceni O, Wilhelm JM, Bombaron P, Kieffer P. Paralysie du nerf récurrent au cours d’une maladie de Lyme : à propos de deux observations. Rev Med Interne 2010; 31:229-31. [DOI: 10.1016/j.revmed.2009.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2009] [Revised: 07/05/2009] [Accepted: 07/08/2009] [Indexed: 10/19/2022]
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Épidémiologie de la borréliose et de la neuroborréliose de Lyme en France. Rev Neurol (Paris) 2009; 165:694-701. [DOI: 10.1016/j.neurol.2009.04.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2009] [Revised: 04/03/2009] [Accepted: 04/03/2009] [Indexed: 11/21/2022]
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