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Lutaud R, Verger P, Peretti-Watel P, Eldin C. When the patient is making the (wrong?) diagnosis: a biographical approach to patients consulting for presumed Lyme disease. Fam Pract 2024; 41:534-542. [PMID: 36267023 PMCID: PMC9619758 DOI: 10.1093/fampra/cmac116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Media coverage of Lyme disease (LD) has led to an increase in consultations for presumed LD in Europe. However, LD is confirmed in only 10%-20% of patients, with a significant number remaining in a diagnostic dead-end. OBJECTIVES To reach a deeper understanding of how patients themselves contribute to the diagnostic process. To describe the genesis of the LD hypothesis in care pathways. METHODS In 2019, 30 patients from a prospective cohort consulting in the infectious diseases department at University Hospital in Marseille for presumed LD were recruited for semistructured interviews. The inclusion criteria were: suffering from subjective symptoms for 6 months, no clinical or paraclinical argument suggesting current LD. The patients' medical trajectories were collected using a biographical approach. RESULTS The diagnosis of LD was primarily triggered by identification with personal testimonies found on the Internet. Most of patients were leading their own diagnostic investigation. The majority of participants were convinced they had LD despite the lack of medical evidence and the scepticism of their referring GP. CONCLUSION GPs should first systematically explore patients' aetiologic representations in order to improve adherence to the diagnosis especially in the management of medically unexplained symptoms. Long COVID-19 syndrome challenge offers an opportunity to promote active patient involvement in diagnosis.
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Affiliation(s)
- Romain Lutaud
- Department of General Practice, Aix Marseille University, Marseille, France
- UMR UMR 7268 ADES, EFS, CNRS, Aix-Marseille University, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Pierre Verger
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | | | - Carole Eldin
- UMR UVE, Aix Marseille University, IRD, Inserm, Marseille, France
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2
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Dersch R, Torbahn G, Rauer S. Treatment of post-treatment Lyme disease symptoms-a systematic review. Eur J Neurol 2024; 31:e16293. [PMID: 38606630 PMCID: PMC11235603 DOI: 10.1111/ene.16293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/01/2024] [Accepted: 03/19/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND AND PURPOSE Residual symptoms after treatment of Lyme disease, sometimes called post-treatment Lyme disease symptoms (PTLDs), are a matter of ongoing controversy. To guide treatment recommendations, a systematic review was performed of the available literature on specific treatment for PTLDs. METHODS A systematic literature search of MEDLINE and CENTRAL was performed. No restrictions on case definitions, study types or specific interventions were applied to enable a comprehensive overview of the available literature. Risk of bias was assessed using the Cochrane risk of bias tools for randomized controlled trials. Certainty of the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach. Outcomes of interest were quality of life, fatigue, depression and cognition as well as adverse events. RESULTS After screening 1274 records, eight eligible randomized controlled trials were included. Heterogeneity was observed regarding inclusion criteria, intervention, length of treatment and outcome measures. For efficacy outcomes, results are presented narratively due to heterogeneity. Eligible studies show no statistically significant difference between antibiotics and placebo regarding quality of life, cognition and depression. Results for fatigue were inconsistent whilst studies with low risk of bias showed no statistically significant difference between antibiotics and placebo. Meta-analysis of safety outcomes showed statistically significantly more adverse events for antibiotics compared to placebo. CONCLUSIONS Available literature on treatment of PTLDs is heterogeneous, but overall shows evidence of no effect of antibiotics regarding quality of life, depression, cognition and fatigue whilst showing more adverse events. Patients with suspected PTLDs should not be treated with antibiotics.
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Affiliation(s)
- Rick Dersch
- Clinic of Neurology and NeurophysiologyMedical Center—University of FreiburgFaculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Gabriel Torbahn
- Department of PediatricsParacelsus Medical UniversityKlinikum NürnbergUniversitätsklinik der Paracelsus Medizinischen Privatuniversität NürnbergNurembergGermany
| | - Sebastian Rauer
- Clinic of Neurology and NeurophysiologyMedical Center—University of FreiburgFaculty of MedicineUniversity of FreiburgFreiburgGermany
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3
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Tetens MM, Omland LH, Dessau RB, Ellermann-Eriksen S, Andersen NS, Jørgensen CS, Pedersen M, Bodilsen J, Søgaard KK, Bangsborg J, Nielsen ACY, Møller JK, Obel N, Lebech AM. Repeated doxycycline treatment among patients with neuroborreliosis: a nationwide, population-based, registry-based, matched cohort study. Infect Dis (Lond) 2024:1-8. [PMID: 38950593 DOI: 10.1080/23744235.2024.2366526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 06/05/2024] [Indexed: 07/03/2024] Open
Abstract
OBJECTIVES To investigate receipt of antibiotics among patients with neuroborreliosis after initial antibiotic treatment, likely attributable to posttreatment symptoms. METHODS We performed a nationwide, matched, population-based cohort study in Denmark (2009-2021). We included all Danish patients with neuroborreliosis, i.e. a positive Borrelia burgdorferi intrathecal antibody index test and a cerebrospinal fluid leukocyte count ≥10 × 106/l, and initially treated with doxycycline. To form a comparison cohort, we randomly extracted individuals from the general population matched 1:10 to patients with neuroborreliosis on date of birth and sex. The main outcome was receipt of doxycycline, and the secondary outcome was receipt of phenoxymethylpenicillin. We calculated short-term (<1 year) and long-term (≥1 year) hazard ratios (HR) with 95% confidence intervals (95%CI). RESULTS We included 463 patients with neuroborreliosis and 2,315 comparison cohort members. Compared with the comparison cohort members, patients with neuroborreliosis initially treated with doxycycline had increased receipt of additional doxycycline within 1 year (HR: 38.6, 95%CI: 17.5-85.0) and ≥1 years (HR: 3.5, 95%CI: 1.9-6.3). Compared with comparison cohort members, patients with neuroborreliosis had no increased receipt of phenoxymethylpenicillin (<1 year HR 1.0, 95%CI: 0.7-1.3; ≥1 years HR 1.2, 95%CI: 0.9-1.5). CONCLUSIONS After initial antibiotic treatment, patients with neuroborreliosis have increased receipt of doxycycline particularly within one year after initial antibiotic therapy but also subsequently. The lack of increased receipt of phenoxymethylpenicillin suggests that the receipt of doxycycline was not merely due to differences in healthcare-seeking behaviour, increased risk of early Lyme borreliosis due to exposure, or differences in antibacterial usage in general.
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Affiliation(s)
- Malte M Tetens
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Lars Haukali Omland
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Ram B Dessau
- Department of Clinical Microbiology, Zealand University Hospital, Slagelse, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Nanna S Andersen
- Clinical Centre for Emerging and Vector-borne Infections, Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
- Research Unit of Clinical Microbiology, University of Southern Denmark, Odense, Denmark
| | | | - Michael Pedersen
- Department of Clinical Microbiology, Copenhagen University Hospital - Hvidovre Hospital, Copenhagen, Denmark
| | - Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Kirstine K Søgaard
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jette Bangsborg
- Department of Clinical Microbiology, Copenhagen University Hospital - Herlev Hospital, Herlev, Denmark
| | - Alex Christian Yde Nielsen
- Department of Clinical Microbiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Jens Kjølseth Møller
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Microbiology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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4
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Shere-Wolfe KD, George N, Al Kibria GM, Silk R, Alexander CS. A Multimodal Ayurveda and Mind-Body Therapeutic Intervention for Chronic Symptoms Attributed to a Postinfectious Syndrome: A Pilot Study. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024; 30:450-458. [PMID: 37844086 DOI: 10.1089/jicm.2023.0234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
Objective: Evaluate feasibility and impact of a multimodal integrative therapeutic intervention in patients presenting with chronic symptoms attributed to a postinfectious syndrome. Design: This was a prospective longitudinal single-center pilot study conducted from January 2019 to December 2020. Setting/Location: University of Maryland Lyme Program, Baltimore Maryland. Subjects: Persons presenting for Lyme evaluation for symptoms attributed to Lyme disease. Interventions: Participants attended two 1-h individual instructional sessions consisting of Ayurveda-based dietary intervention and breath-coordinated mind-body practice to be used for home practice. Outcome measures: Standard measures of impact were obtained at baseline, 1, 3, 6, and 12 months using the following validated survey instruments: Perceived Stress Scale (PSS), PROMIS Global Health v1.2 (GH), and PROMIS 29 v2.0 survey. Results: From 216 patients presenting for Lyme evaluation, 19 participants enrolled with 84% completing the study (N = 16). Baseline PROMIS GH scores consisting of general Physical Health (GPH) and general Mental Health (GMH) scores were lower in the study population than in the general U.S. population. PROMIS 29 scores were higher for fatigue, anxiety, and pain than those in the general U.S. population. Over 12-month period, improvement in both the GPH and GMH was 6.09 (confidence interval [95% CI] = 2.71-9.46; p < 0.001) and 4.65 (95% CI = 1.50-7.80; p = 0.004), respectively. PROMIS 29 scores showed the greatest improvement in fatigue at -7.91 (95% CI = -12.34 to -3.48; p < 0.001), pain interference -5.08 (95% CI = -9.20 to -0.96; p = 0.016), and ability to participate in social roles and activities 7.48 (95% CI = 3.21-11.75; p = 0.001) and least with depression -1.82 (95% CI = -4.74 to 1.10; p = 0.223). Employment status had significant effects on almost all outcome scores. Postinfectious state was associated with improvement in anxiety and PSS scores. Conclusions: A multimodal Ayurvedic and breath-coordinated mind-body therapeutic intervention is feasible and a potential nonpharmacologic therapeutic option for persons presenting with pain, stress, fatigue, physical dysfunction, and sleep disturbance attributed to a postinfectious syndrome. Further research is needed to determine efficacy in this population and in other groups with similar symptom complexes due to postinfectious syndromes.
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Affiliation(s)
- Kalpana D Shere-Wolfe
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Nivya George
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Gulam Muhammed Al Kibria
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rachel Silk
- Division of Infectious Diseases, Institute of Human Virology, Baltimore, MD, USA
| | - Carla S Alexander
- Clinical Care and Research Division, Institute of Human Virology, Baltimore, MD, USA
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5
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Eikeland R, Henningsson AJ, Lebech AM, Kerlefsen Y, Mavin S, Vrijlandt A, Hovius JW, Lernout T, Lim C, Dobler G, Fingerle V, Gynthersen RM, Lindgren PE, Reiso H. Tick-borne diseases in the North Sea region-A comprehensive overview and recommendations for diagnostics and treatment. Ticks Tick Borne Dis 2024; 15:102306. [PMID: 38183851 DOI: 10.1016/j.ttbdis.2023.102306] [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: 08/14/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/08/2024]
Abstract
As part of the NorthTick project, co-funded by the European Union through the European Regional Development Fund and the North Sea Region Programme, specialists in the field of tick-borne diseases from seven North Sea countries co-operated with patient organisations and governmental health care institutions to provide this comprehensive overview of diagnostics and treatment recommendations in the region for Lyme borreliosis, Borrelia miyamotoi infection, tick-borne encephalitis, human granulocytic anaplasmosis, rickettsiosis, neoehrlichiosis and babesiosis. The main conclusion is that the recommendations in these northern countries are essentially the same, with very few differences. This overview presents the current diagnostics and provides useful clinical guidance.
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Affiliation(s)
- Randi Eikeland
- Norwegian National Advisory Unit on Tick-Borne Diseases, Sørlandet Hospital, Kristiansand, Norway; Faculty of Health and Sport science, University of Agder, Grimstad, Norway.
| | - Anna J Henningsson
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; National Reference Laboratory for Borreliosis and Other Tick-Borne Bacteria, Clinical Microbiology, Laboratory Medicine, Region Jönköping County, Sweden
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Yvonne Kerlefsen
- Norwegian National Advisory Unit on Tick-Borne Diseases, Sørlandet Hospital, Kristiansand, Norway
| | - Sally Mavin
- Scottish Lyme Disease and Tick-borne Infections Reference Laboratory, Raigmore Hospital, Inverness, UK
| | - Amber Vrijlandt
- Amsterdam UMC, location AMC, Department of Internal Medicine, Section of Infectious Diseases, Amsterdam UMC Multidisciplinary Lyme borreliosis Center, Amsterdam, The Netherlands
| | - Joppe W Hovius
- Amsterdam UMC, location AMC, Department of Internal Medicine, Section of Infectious Diseases, Amsterdam UMC Multidisciplinary Lyme borreliosis Center, Amsterdam, The Netherlands
| | - Tinne Lernout
- Sciensano Epidemiology of infectious diseases, Brussels, Belgium
| | - Chin Lim
- Scottish Lyme Disease and Tick-borne Infections Reference Laboratory, Raigmore Hospital, Inverness, UK
| | - Gerhard Dobler
- Nationales Konsiliarlabor FSME, Institut für Mikrobiologie der Bundeswehr, Munich, Germany
| | - Volker Fingerle
- German National Reference Center for Borreliae, Bavarian Health and Food Safety Authority, Oberschleißheim, Germany
| | - Rosa M Gynthersen
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark
| | | | - Harald Reiso
- Norwegian National Advisory Unit on Tick-Borne Diseases, Sørlandet Hospital, Kristiansand, Norway
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6
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Chavarría-Bencomo IV, Nevárez-Moorillón GV, Espino-Solís GP, Adame-Gallegos JR. Antibiotic resistance in tick-borne bacteria: A One Health approach perspective. J Infect Public Health 2023; 16 Suppl 1:153-162. [PMID: 37945496 DOI: 10.1016/j.jiph.2023.10.027] [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: 09/30/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023] Open
Abstract
The emergence and re-emergence of tick-borne bacteria (TBB) as a public health problem raises the uncertainty of antibiotic resistance in these pathogens, which could be dispersed to other pathogens. The impact of global warming has led to the emergence of pathogenic TBB in areas where they were not previously present and is another risk that must be taken into account under the One Health guides. This review aimed to analyze the existing information regarding antibiotic-resistant TBB and antibiotic-resistance genes (ARG) present in the tick microbiome, considering the potential to be transmitted to pathogenic microorganisms. Several Ehrlichia species have been reported to exhibit natural resistance to fluoroquinolones and typhus group Rickettsiae are naturally susceptible to erythromycin. TBB have a lower risk of acquiring ARG due to their natural habitat, but there is still a probability of acquiring them; furthermore, studies of these pathogens are limited. Pathogenic and commensal bacteria coexist within the tick microbiome along with ARGs for antibiotic deactivation, cellular protection, and efflux pumps; these ARGs confer resistance to antibiotics such as aminoglycosides, beta-lactamase, diaminopyrimidines, fluoroquinolones, glycopeptides, sulfonamides, and tetracyclines. Although with low probability, TBB can be a reservoir of ARGs.
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Affiliation(s)
- Inés Valeria Chavarría-Bencomo
- Facultad de Ciencias Químicas. Universidad Autónoma de Chihuahua, Circuito Universitario s/n. Campus Universitario II., 31125 Chihuahua, Mexico
| | - Guadalupe Virginia Nevárez-Moorillón
- Facultad de Ciencias Químicas. Universidad Autónoma de Chihuahua, Circuito Universitario s/n. Campus Universitario II., 31125 Chihuahua, Mexico.
| | - Gerardo Pavel Espino-Solís
- Laboratorio Nacional de Citometría de Flujo. Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de Chihuahua, Circuito Universitario s/n. Campus Universitario II., 31125 Chihuahua, Mexico
| | - Jaime Raúl Adame-Gallegos
- Facultad de Ciencias Químicas. Universidad Autónoma de Chihuahua, Circuito Universitario s/n. Campus Universitario II., 31125 Chihuahua, Mexico
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7
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Dersch R, Rauer S. Efficacy and safety of pharmacological treatments for Lyme neuroborreliosis: An updated systematic review. Eur J Neurol 2023; 30:3780-3788. [PMID: 37565386 DOI: 10.1111/ene.16034] [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: 06/30/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Evidence-based recommendations for treatment of Lyme neuroborreliosis (LNB) should rely on the available literature. As new data emerges, close review and evaluation of the recent literature is needed to build evidence-based recommendations to inform clinical practice and management of LNB. We performed an update of a previous systematic review on treatment of LNB. METHODS A systematic literature search of Medline and CENTRAL was performed for published studies from 2015 to 2023 to update a previous systematic review. Randomized controlled trials (RCTs) and non-randomized studies (NRS) were evaluated. Risk of bias was assessed using the Cochrane risk of bias tools for RCTs; NRS were assessed using the ROBINS-I-tool. Quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Data were integrated into an existing meta-analysis of the available literature. RESULTS After screening 1530 records, two RCTs and five NRS with new and relevant data were additionally identified. Meta-analysis showed no statistically significant difference between doxycycline and beta-lactam antibiotics regarding residual neurological symptoms after 12 months. Meta-analysis showed no benefit of extended antibiotic treatment of LNB. Three NRS show no benefit for additional steroid use in LNB with facial palsy. DISCUSSION Additional incorporated recent research corroborates existing guideline recommendations for treatment of LNB. New RCTs add to the certainty of previous analysis showing similar efficacy for doxycycline and beta-lactam antibiotics in LNB. Available evidence shows no benefit for extended antibiotic treatment in LNB. NRS do not suggest a role for steroids in facial palsy due to LNB.
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Affiliation(s)
- Rick Dersch
- Clinic of Neurology and Neurophysiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sebastian Rauer
- Clinic of Neurology and Neurophysiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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8
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Chan PA, Le Brazidec DL, Becasen JS, Martin H, Kapadia J, Reno H, Bachmann L, Barbee LA. Safety of Longer-Term Doxycycline Use: A Systematic Review and Meta-Analysis With Implications for Bacterial Sexually Transmitted Infection Chemoprophylaxis. Sex Transm Dis 2023; 50:701-712. [PMID: 37732844 PMCID: PMC10592014 DOI: 10.1097/olq.0000000000001865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
BACKGROUND Sexually transmitted infections (STIs) such as syphilis, gonorrhea, and chlamydia have significantly increased over the past decade in the United States. Doxycycline as chemoprophylaxis (i.e., postexposure prophylaxis) offers promise for addressing bacterial STIs. The goal of the current study was to evaluate the safety of longer-term doxycycline use (defined as 8 or more weeks) in the context of potential use as STI chemoprophylaxis through a systematic literature review and meta-analysis. METHODS This review used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to search MEDLINE/PubMed for clinical studies published from August 2003 to January 2023 that reported on adverse events with doxycycline use with a focus on side effects and metabolic effects of long-term use. RESULTS A total of 67 studies were included in the systematic review. Overall, studies on longer-term doxycycline use reported 0% to greater than 50% adverse events ranging from mild to severe. Most common adverse events included gastrointestinal symptoms (i.e., nausea, vomiting, and abdominal pain), dermatologic (i.e., rash), and neurological (i.e., headache and dizziness) symptoms. Discontinuation of doxycycline due to adverse events was relatively uncommon in most studies. A meta-analysis of placebo controlled clinical trials (N = 18) revealed that gastrointestinal and dermatological adverse events were more likely to occur in the doxycycline group. CONCLUSIONS Longer-term (8+ weeks) doxycycline use is generally safe and may be associated with minor side effects. Further research is needed on the potential metabolic impact of longer-term doxycycline use.
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Affiliation(s)
- Philip A. Chan
- Department of Medicine, Brown University, Providence, Rhode Island, USA
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Jeffrey S. Becasen
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Harrison Martin
- Department of Medicine, Brown University, Providence, Rhode Island, USA
| | - Jhanavi Kapadia
- Department of Medicine, Brown University, Providence, Rhode Island, USA
| | - Hilary Reno
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Laura Bachmann
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lindley A. Barbee
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Gyura AN, Buser JM, Keesing H, Nelsen L, Marx GE, Hinckley AF, Seman C, Nelson CA. Lyme Disease Knowledge, Practices, and Vaccine Acceptability Among Nurse Practitioners in Pediatric Practice. J Pediatr Health Care 2023; 37:673-683. [PMID: 37702645 DOI: 10.1016/j.pedhc.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/17/2023] [Accepted: 08/17/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION Lyme disease (LD) is a major public health problem in the United States. Given its incidence and geographic expansion, nurse practitioners (NPs) will likely encounter patients with this condition. METHOD NPs were invited to participate in an electronic survey via email, newsletter, and social media posts. The 31-question survey collected information on provider characteristics, clinical scenario decisions, resources used, and vaccine sentiment for LD. RESULTS Survey participants (n = 606) were primarily cisgender female (75%) and aged 30-49 years (62%). Responding to six hypothetical clinical scenarios, only 31% of participants answered most questions correctly. If an LD vaccine becomes available, 39% said they would incorporate it into practice; 48% would seek further information before deciding. DISCUSSION Additional education on LD prevention, diagnosis, and treatment is needed for NPs. Increasing provider awareness of current guidelines and developing tailored resources for NPs may improve patient care.
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10
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Sébastien P, Jacques D, Catherine P, Xavier G. Diagnosis and treatment of "chronic Lyme": primum non nocere. BMC Infect Dis 2023; 23:642. [PMID: 37784031 PMCID: PMC10544220 DOI: 10.1186/s12879-023-08618-w] [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: 03/14/2023] [Accepted: 09/18/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Approximately 10% of patients experience prolonged symptoms after Lyme disease. PTLDS (post treatment Lyme disease syndrome) is a controversial topic. It has been described as a source of overdiagnosis and off-label treatment. This review aims to describe the diagnostic errors and adverse events associated with the diagnosis and treatment of PTLDS. METHODS systematic review of the literature in the Medline and Cochrane Library databases, according to PRISMA criteria, including randomized clinical trials (RCT), observational studies, and case reports addressing diagnostic errors and adverse events published between January 2010 and November 2020 in English or French. Selection used a quadruple reading process on the basis of the titles and abstracts of the different articles, followed by a full reading. RESULTS 17 studies were included: 1 RCT, 6 observational studies and 10 case reports. In the 6 observational studies, overdiagnosis rates were very high, ranging from 80 to 100%. The new diagnoses were often psychiatric, rheumatological and neurological. Disorders with somatic symptoms were often cited. Diagnostic delays were identified for cancers and frontoparietal dementia. In the RCT and observational studies, prolonged anti-infective treatments were also responsible for adverse events, with emergency room visits and/or hospitalization. The most common adverse events were diarrhea, sometimes with Clostridium difficile colitis, electrolyte abnormalities, sepsis, bacterial and fungal infections, and anaphylactic reactions. CONCLUSION This review highlights the risks of prolonged anti-infective treatments that have not been proven to be beneficial in PTLDS. It emphasizes the ethical imperative of the "primum non nocere" principle, which underscores the importance of not causing harm to patients. Physicians should exercise caution in diagnosing PTLDS and consider the potential risks associated with off-label treatments.
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Affiliation(s)
| | | | - Plotton Catherine
- Campus Santé Innovations, SAINT-PRIEST-EN-JAREZ, Jean-Monnet University, 10 RUE de la Marandière, 42270, Saint-Étienne, France
| | - Gocko Xavier
- Campus Santé Innovations, SAINT-PRIEST-EN-JAREZ, Jean-Monnet University, 10 RUE de la Marandière, 42270, Saint-Étienne, France.
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11
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Bai NA, Richardson CS. Posttreatment Lyme disease syndrome and myalgic encephalomyelitis/chronic fatigue syndrome: A systematic review and comparison of pathogenesis. Chronic Dis Transl Med 2023; 9:183-190. [PMID: 37711861 PMCID: PMC10497844 DOI: 10.1002/cdt3.74] [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: 02/01/2023] [Revised: 04/18/2023] [Accepted: 05/11/2023] [Indexed: 09/16/2023] Open
Abstract
Lyme disease is the most common vector-borne illness in the United States and has been causing significant morbidity since its discovery in 1977. It is well-documented that about 10% of patients properly treated with antibiotics never fully recover, but instead go on to develop a chronic illness dubbed, posttreatment Lyme disease syndrome (PTLDS) characterized by severe fatigue, cognitive slowing, chronic pain, and sleep difficulties. This review includes 18 studies that detail the symptoms of patients with PTLDS and uses qualitative analysis to compare them to myalgic encephalitis/chronic fatigue syndrome (ME/CFS), a strikingly similar syndrome. In the majority of the PTLDS studies, at least four of the six major symptoms of ME/CFS were also noted, including substantial impairment in activity level and fatigue for more than 6 months, post-exertional malaise, and unrefreshing sleep. In one of the included PTLDS articles, 26 of the 29 ME/CFS symptoms were noted. This study adds to the expanding literature on the post-active phase of infection syndromes, which suggests that chronic illnesses such as PTLDS and ME/CFS have similar pathogenesis despite different infectious origins.
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Affiliation(s)
- Natalie A. Bai
- Department of PsychiatryRowan‐Virtua School of Osteopathic MedicineMount LaurelNew JerseyUSA
| | - Christie S. Richardson
- Department of PsychiatryRowan‐Virtua School of Osteopathic MedicineMount LaurelNew JerseyUSA
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12
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Mack I, Kohns Vasconcelos M, Ritz N, Zimmermann P. A diagnostic algorithm for children presenting with peripheral facial nerve palsy and inconclusive diagnosis of neuroborreliosis. Acta Paediatr 2023; 112:1644-1647. [PMID: 37424283 DOI: 10.1111/apa.16841] [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: 03/28/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 07/11/2023]
Affiliation(s)
- Ines Mack
- Department of Paediatrics, University Children's Hospital, Regensburg, Germany
- Department for Infectious Diseases and Vaccinology, University of Basel Children's Hospital (UKBB), Basel, Switzerland
| | - Malte Kohns Vasconcelos
- Department for Infectious Diseases and Vaccinology, University of Basel Children's Hospital (UKBB), Basel, Switzerland
| | - Nicole Ritz
- Department for Infectious Diseases and Vaccinology, University of Basel Children's Hospital (UKBB), Basel, Switzerland
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics and Paediatric Infectious Diseases, Children's Hospital, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Petra Zimmermann
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
- Department of Paediatrics, Fribourg Hospital, Fribourg, Switzerland
- Infectious Diseases Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
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Trouillas P, Franck M. Complete Remission in Paralytic Late Tick-Borne Neurological Disease Comprising Mixed Involvement of Borrelia, Babesia, Anaplasma, and Bartonella: Use of Long-Term Treatments with Antibiotics and Antiparasitics in a Series of 10 Cases. Antibiotics (Basel) 2023; 12:1021. [PMID: 37370340 DOI: 10.3390/antibiotics12061021] [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: 03/30/2023] [Revised: 04/27/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
This study aimed to demonstrate that severe neurological motor deficits in the context of late tick-borne disease with mixed microorganism involvement are eligible for long-term combined antibiotic/antiparasitic treatments. The inclusion criteria were: 1. neurological limb paralysis with a disability score >4 according to the EDSS Kurtzke disability scale; 2. serological tests pointing to an involvement of the main tick-borne microorganisms Borrelia burgdorferi s.l., Babesia, Anaplasma, and Bartonella; 3. a general disease for more than 6 months with fatigue, pain and subjective cognitive deficit. The patients were administered long-term treatments with repeated cycles (at least three) of 35-day IV ceftriaxone and repeated oral regimens of azithromycin-doxycycline and azithromycin-doxycycline-rifampicin. For Babesia, repeated courses of atovaquone-azithromycin were administered. Ten patients had intractable or severe motor deficits before treatment in the context of Borrelia (two cases) Borrelia-Babesia (four cases), Borrelia-Babesia-Anaplasma (two cases), Borrelia-Babesia-Anaplasma-Bartonella (one case) and Babesia-Anaplasma (one case). For several months, five had been in wheelchairs, and four had been walking with sticks. Seven patients out of 10 (70%) showed complete remission after a mean active treatment duration of 20.1 + 6.6 months, with a mean number of 4 ceftriaxone cycles. Three patients showed an initial remission but suffered secondary antibiotic/antiparasitic-resistant motor recurrences. Among the nine patients with Borrelia serologic positivity, treatments obtained complete remission in seven cases (77%). The findings of this ten-case series suggest the usefulness of long-term antibiotic/antiparasitic treatments in patients with severe late tick-borne neurological deficits with highly significant elements of tick-borne involvement.
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Affiliation(s)
| | - Michel Franck
- ADNucleis Biological Laboratory, 69290 Grézieu la Varenne, France
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Raffetin A, Chahour A, Schemoul J, Paoletti G, He Z, Baux E, Patrat-Delon S, Nguala S, Caraux-Paz P, Puppo C, Arias P, Madec Y, Gallien S, Rivière J. Acceptance of diagnosis and management satisfaction of patients with "suspected Lyme borreliosis" after 12 months in a multidisciplinary reference center: a prospective cohort study. BMC Infect Dis 2023; 23:380. [PMID: 37280565 DOI: 10.1186/s12879-023-08352-3] [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: 11/21/2022] [Accepted: 05/26/2023] [Indexed: 06/08/2023] Open
Abstract
INTRODUCTION Because patients with a "suspicion of Lyme borreliosis (LB)" may experience medical wandering and difficult care paths, often due to misinformation, multidisciplinary care centers were started all over Europe a few years ago. The aim of our study was to prospectively identify the factors associated with the acceptance of diagnosis and management satisfaction of patients, and to assess the concordance of the medical health assessment between physicians and patients 12 months after their management at our multidisciplinary center. METHODS We included all adults who were admitted to the Tick-Borne Diseases Reference Center of Paris and the Northern Region (TBD-RC) (2017-2020). A telephone satisfaction survey was conducted 12 months after their first consultation. It consisted of 5 domains and 13 items rated between 0 (lowest) and 10 (highest grade): (1)Reception; (2)Care and quality of management; (3)Information/explanations given to the patients; (4)Current medical condition and acceptance of the final diagnosis; (5)Overall appreciation. Factors associated with diagnosis acceptance and management satisfaction at 12 months were identified using logistic regression models. The concordance of the health status as assessed by doctors and patients was calculated using a Cohen's kappa test. RESULTS Of the 569 patients who consulted, 349 (61.3%) answered the questionnaire. Overall appreciation had a median rating of 9 [8;10] and 280/349 (80.2%) accepted their diagnoses. Patients who were "very satisfied" with their care paths at TBD-RC (OR = 4.64;CI95%[1.52-14.16]) had higher odds of diagnosis acceptance. Well-delivered information was strongly associated with better satisfaction with the management (OR = 23.39;CI95%[3.52-155.54]). The concordance between patients and physicians to assess their health status 12 months after their management at TBD-RC was almost perfect in the groups of those with confirmed and possible LB (κ = 0.99), and moderate in the group with other diagnoses (κ = 0.43). CONCLUSION Patients seemed to approve of this multidisciplinary care organization for suspected LB. It helped them to accept their final diagnoses and enabled a high level of satisfaction with the information given by the doctors, confirming the importance of shared medical decisions, which may help to reduce health misinformation. This type of structure may be useful for any disease with a complex and controversial diagnosis.
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Affiliation(s)
- Alice Raffetin
- Department of Infectious Diseases, Tick-Borne Diseases Reference Center of Paris and the Northern Region, General Hospital of Villeneuve-Saint-Georges, Villeneuve-Saint-Georges, France.
- EpiMAI Research Unity, Laboratory of Animal Health, Ecole Nationale Vétérinaire d'Alfort, Anses-National Veterinaty School of Alfort, Maison-Alfort, France.
- DYNAMIC Research Unity, UPEC-Anses, Créteil, France.
| | - Amal Chahour
- Department of Infectious Diseases, Tick-Borne Diseases Reference Center of Paris and the Northern Region, General Hospital of Villeneuve-Saint-Georges, Villeneuve-Saint-Georges, France
| | - Julien Schemoul
- Department of Rheumatology, Tick-Borne Diseases Reference Center of Paris and the Northern Region, General Hospital of Villeneuve-Saint-Georges, Villeneuve-Saint-Georges, France
| | - Giulia Paoletti
- Department of Psychiatry, Tick-Borne Diseases Reference Center of Paris and the Northern Region, General Hospital of Villeneuve-Saint-Georges, Villeneuve-Saint-Georges, France
| | - Zhuoruo He
- Department of Infectious Diseases, Tick-Borne Diseases Reference Center of Paris and the Northern Region, General Hospital of Villeneuve-Saint-Georges, Villeneuve-Saint-Georges, France
- Department of Public Health, University of Paris Saclay, Saclay, France
| | - Elisabeth Baux
- Department of Infectious Diseases, Tick-Borne Diseases Reference Center of the Eastern Region, Brabois Hospital, University Hospital of Nancy, Nancy, France
| | - Solène Patrat-Delon
- Department of Infectious Diseases, Tick-Borne Diseases Reference Center of the Western Region, University Hospital of Rennes, Rennes, France
| | - Steve Nguala
- Department of Infectious Diseases, Tick-Borne Diseases Reference Center of Paris and the Northern Region, General Hospital of Villeneuve-Saint-Georges, Villeneuve-Saint-Georges, France
| | - Pauline Caraux-Paz
- Department of Infectious Diseases, Tick-Borne Diseases Reference Center of Paris and the Northern Region, General Hospital of Villeneuve-Saint-Georges, Villeneuve-Saint-Georges, France
| | - Costanza Puppo
- Department of Psychology, Lumière University Lyon II, UMR 1296, Lyon, France
| | - Pauline Arias
- Department of Infectious Diseases, Tick-Borne Diseases Reference Center of Paris and the Northern Region, General Hospital of Villeneuve-Saint-Georges, Villeneuve-Saint-Georges, France
| | - Yoann Madec
- Epidemiology of Emerging Diseases Unit, Institut Pasteur, University of Paris, Paris, France
| | - Sébastien Gallien
- Department of Infectious Diseases, Tick-Borne Diseases Reference Center of Paris and the Northern Region, General Hospital of Villeneuve-Saint-Georges, Villeneuve-Saint-Georges, France
- DYNAMIC Research Unity, UPEC-Anses, Créteil, France
- Department of Infectious Diseases, UH Henri Mondor, Créteil, France
| | - Julie Rivière
- EpiMAI Research Unity, Laboratory of Animal Health, Ecole Nationale Vétérinaire d'Alfort, Anses-National Veterinaty School of Alfort, Maison-Alfort, France
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Hernández SA, Ogrinc K, Korva M, Kastrin A, Bogovič P, Rojko T, Kelley KW, Weis JJ, Strle F, Strle K. Association of Persistent Symptoms after Lyme Neuroborreliosis and Increased Levels of Interferon-α in Blood. Emerg Infect Dis 2023; 29:1091-1101. [PMID: 37209716 PMCID: PMC10202885 DOI: 10.3201/eid2906.221685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023] Open
Abstract
Patients who have Lyme neuroborreliosis (LNB) might experience lingering symptoms that persist despite antibiotic drug therapy. We tested whether those symptoms are caused by maladaptive immune responses by measuring 20 immune mediators in serum and cerebrospinal fluid (CSF) in 79 LNB patients followed for 1 year. At study entry, most mediators were highly concentrated in CSF, the site of the infection. Those responses resolved with antibiotic therapy, and associations between CSF cytokines and signs and symptoms of LNB were no longer observed. In contrast, subjective symptoms that persisted after use of antibiotics were associated with increased levels of serum interferon-α (IFN-α), which were already observed at study entry, and remained increased at each subsequent timepoint. Highest IFN-α levels corresponded with severe disease. Although the infection serves as the initial trigger, sequelae after antibiotic therapy are associated with unremitting systemic IFN-α levels, consistent with the pathogenic role of this cytokine in interferonopathies in other conditions.
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Stelma FF, Berende A, Ter Hofstede H, Vrijmoeth HD, Vos F, Kullberg BJ. Classical Borrelia Serology Does Not Aid in the Diagnosis of Persistent Symptoms Attributed to Lyme Borreliosis: A Retrospective Cohort Study. Life (Basel) 2023; 13:life13051134. [PMID: 37240779 DOI: 10.3390/life13051134] [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: 03/27/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE The diagnosis of Lyme borreliosis is based on two-tier testing using an ELISA and Western blot. About 5-10% of patients report persistent symptoms of unknown etiology after treatment, resulting in substantial difficulties in further diagnostic workup. This paper presents a study aimed at determining whether serology can differentiate between patients with persistent symptoms attributed to Lyme and other patients with Lyme borreliosis. METHODS A retrospective cohort study included 162 samples from four subgroups: patients with persistent symptoms of Lyme (PSL), early Lyme borreliosis with erythema migrans (EM), patients tested in a general practitioner setting (GP), and healthy controls (HC). ELISA, Western blots, and multiplex assays from different manufacturers were used to determine inter-test variations in PSL and to compare reactivity against Borrelia-specific antigens among the groups. RESULTS In comparing the IgG and IgM reactivity by Western blot, IgG was more often positive in the PSL group than in the GP group. The individual antigen reactivity was similar between the PSL and EM or GP groups. Inter-test agreement among the manufacturers was variable, and agreement was higher for IgG testing compared to IgM. CONCLUSIONS Serological testing is unable to define the subgroup of patients with persistent symptoms attributed to Lyme borreliosis. Additionally, the current two-tier testing protocol shows a large variance among different manufacturers in these patients.
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Affiliation(s)
- Foekje F Stelma
- Department of Medical Microbiology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Radboud Center for Infectious Diseases, 6525 GA Nijmegen, The Netherlands
| | - Anneleen Berende
- Radboud Center for Infectious Diseases, 6525 GA Nijmegen, The Netherlands
- Department of Internal Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Hadewych Ter Hofstede
- Radboud Center for Infectious Diseases, 6525 GA Nijmegen, The Netherlands
- Department of Internal Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Hedwig D Vrijmoeth
- Radboud Center for Infectious Diseases, 6525 GA Nijmegen, The Netherlands
- Department of Internal Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Fidel Vos
- Department of Internal Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Bart-Jan Kullberg
- Radboud Center for Infectious Diseases, 6525 GA Nijmegen, The Netherlands
- Department of Internal Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
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17
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Santos-Lobato BL, Brito MMCM, Pimentel ÂV, Cavalcanti RTO, Del-Bel E, Tumas V. Doxycycline to treat levodopa-induced dyskinesias in Parkinson's disease: a preliminary study. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:460-468. [PMID: 37257466 DOI: 10.1055/s-0043-1768668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Levodopa-induced dyskinesia (LID) is a common motor complication of levodopa therapy in patients with Parkinson's disease (PD). Doxycycline is a widely used and inexpensive tetracycline with anti-inflammatory properties. OBJECTIVE To evaluate the efficacy and safety of doxycycline in patients with PD and LID. METHODS This was an open-label, uncontrolled, single-arm, single-center, phase 2 proof-of-concept study in patients with PD with functional impact of dyskinesia, which used levodopa three times daily, in a movement disorders clinic in Brazil. Participants were treated with doxycycline 200 mg/day for 12 weeks, with evaluations at baseline, week 4, and week 12 of treatment. The primary outcome measure was the change from baseline in the Unified Dyskinesia Rating Scale (UDysRS) total score at week 12, evaluated by two blinded raters. Key secondary outcomes measures were OFF time and ON time with troublesome dyskinesia in the PD home diary. RESULTS Eight patients with PD were treated and evaluated. Doxycycline 200 mg/day reduced the UDysRS total score at week 12, compared with baseline (Friedman χ2 = 9.6; p = 0.008). Further, doxycycline reduced the ON time with troublesome dyskinesia (Friedman χ2 = 10.8; p = 0.004) without worsening parkinsonism. There were no severe adverse events, and dyspepsia was the commonest event. CONCLUSION In this preliminary, open-label and uncontrolled trial, doxycycline was effective in reducing LID and safe after a 12-week treatment. Further well-designed placebo-controlled clinical trials with a longer duration and a larger number of participants are needed. CLINICAL TRIAL REGISTRATION https://ensaiosclinicos.gov.br, identifier: RBR-1047fwbf.
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Affiliation(s)
- Bruno Lopes Santos-Lobato
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil
- Universidade Federal do Pará, Faculdade de Medicina, Laboratório de Neuropatologia Experimental, Belém PA, Brazil
| | | | - Ângela Vieira Pimentel
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil
| | - Rômulo Torres Oliveira Cavalcanti
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil
| | - Elaine Del-Bel
- Universidade de São Paulo, Faculdade de Odontologia de Ribeirão Preto, Ribeirão Preto SP, Brazil
| | - Vitor Tumas
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil
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Bruinsma RA, Zomer TP, Skogman BH, van Hensbroek MB, Hovius JW. Clinical manifestations of Lyme neuroborreliosis in children: a review. Eur J Pediatr 2023; 182:1965-1976. [PMID: 36856886 DOI: 10.1007/s00431-023-04811-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 03/02/2023]
Abstract
Lyme neuroborreliosis (LNB) is a manifestation of Lyme disease involving the central and peripheral nervous system. It is caused by the spirochete Borrelia burgdorferi, transmitted by tick bites to a human host. Clinical signs of LNB develop after the dissemination of the pathogen to the nervous system. The infection occurs in children and adults, but the clinical manifestations differ. In adults, painful meningoradicultis is the most common manifestation of LNB, while children often present with facial nerve palsy and/or subacute meningitis. Subacute headache can be the only manifestation of LNB in children, especially during the summer months in Lyme disease-endemic regions. Non-specific symptoms, such as loss of appetite, fatigue or mood changes, may also occur, especially in young children. A high level of suspicion and early recognition of the various clinical manifestations presented by children with LNB is essential to minimize delay in diagnosis and optimize management. This review provides an overview of the spectrum of clinical manifestations, and discusses diagnosis, antibiotic treatment, and clinical outcome of LNB in children.
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Affiliation(s)
- R A Bruinsma
- Lyme Center Apeldoorn, Gelre Hospital, Apeldoorn, P.O. Box 9014, 7300 DS, the Netherlands.,Department of Pediatrics, Gelre Hospital, Apeldoorn, the Netherlands
| | - T P Zomer
- Lyme Center Apeldoorn, Gelre Hospital, Apeldoorn, P.O. Box 9014, 7300 DS, the Netherlands.
| | - B H Skogman
- Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden.,Department of Medical Sciences, Örebro University, Örebro, Sweden
| | - M Boele van Hensbroek
- Department of Pediatrics, Amsterdam Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - J W Hovius
- Amsterdam UMC Multidisciplinary Lyme borreliosis Center, Amsterdam UMC Medical Centers, location AMC, University of Amsterdam, Amsterdam, the Netherlands
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19
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Zhang X, Jiang Y, Chen Y, Yang J, Zhang X, Xing L, Liu A, Bao F. Efficacy and safety of antibiotic therapy for post-Lyme disease? A systematic review and network meta-analysis. BMC Infect Dis 2023; 23:22. [PMID: 36635681 PMCID: PMC9838005 DOI: 10.1186/s12879-023-07989-4] [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: 07/25/2022] [Accepted: 01/06/2023] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND At present, the pathogenesis of post-treatment Lyme disease (PTLDS) is not clear, so the treatment scheme of PTLDS, especially antibiotic treatment, is still controversial. This study aims to evaluate the efficacy of antibiotics in the treatment of PTLDS using network meta-analysis (NMA). METHODS Following PRISMA guidelines, a systematic literature search was conducted on randomized controlled trials in PubMed, EMBASE, Web of Science and Cochrane Library (the literature was published from database inception through December 16, 2022). Using random effect model and fixed effect model. STATA17.0 software was used to evaluate the quality and heterogeneity of the included research literature. RESULTS The system included 4 randomized controlled trials (485 subjects). The network meta-analysis showed that ceftriaxone had better results than placebo [Mean = 0.87, 95% CI (0.02, 1.71)] and doxycycline [Mean = 1.01, 95% CI (0.03, 1.98)] in FSS scale scores. There was no statistical difference in FSS scale scores of other drugs after treatment. In terms of FSS score results, Ceftriaxone was the best intervention according to the SUCRA value of each treatment (97.7). The analysis of outcome indicators such as Beck Depression Inventory (BDI), Mental-health Scale and Physical-functioning scale showed that there was no statistically significant difference between the antibiotic group and placebo group. CONCLUSION Ceftriaxone treatment may be the best choice for antibiotic treatment of PTLD, which provides useful guidance for antibiotic treatment of PTLD in the future.
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Affiliation(s)
- Xiaoqian Zhang
- grid.285847.40000 0000 9588 0960Department of Stomatology, Haiyuan College of Kunming Medical University, Kunming, 650000 China
| | - Yuwei Jiang
- grid.285847.40000 0000 9588 0960Medical Microbiology and Immunology Teaching and Research Section, Haiyuan College of Kunming Medical University, Kunming, 650000 China
| | - Yihan Chen
- grid.285847.40000 0000 9588 0960Department of Stomatology, Haiyuan College of Kunming Medical University, Kunming, 650000 China
| | - Jiaru Yang
- grid.285847.40000 0000 9588 0960The Institute for Tropical Medicine, Faculty of Basic Medical Science, Kunming Medical University, Kunming, China
| | - Xiaoqi Zhang
- grid.13291.380000 0001 0807 1581Department of Orthodontics, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases, National Clinical Research Center of Oral Diseases, Sichuan University, Chengdu, China
| | - Lu Xing
- grid.13291.380000 0001 0807 1581Department of Orthodontics, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases, National Clinical Research Center of Oral Diseases, Sichuan University, Chengdu, China
| | - Aihua Liu
- grid.285847.40000 0000 9588 0960The Institute for Tropical Medicine, Faculty of Basic Medical Science, Kunming Medical University, Kunming, China ,grid.285847.40000 0000 9588 0960Yunnan Province Key Laboratory of Children’s Major Diseases Research, The Affiliated Children’s Hospital, Kunming Medical University, Kunming, China
| | - Fukai Bao
- grid.285847.40000 0000 9588 0960The Institute for Tropical Medicine, Faculty of Basic Medical Science, Kunming Medical University, Kunming, China ,grid.285847.40000 0000 9588 0960Yunnan Province Key Laboratory of Children’s Major Diseases Research, The Affiliated Children’s Hospital, Kunming Medical University, Kunming, China
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20
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Verschoor YL, Vrijlandt A, Spijker R, van Hest RM, ter Hofstede H, van Kempen K, Henningsson AJ, Hovius JW. Persistent Borrelia burgdorferi Sensu Lato Infection after Antibiotic Treatment: Systematic Overview and Appraisal of the Current Evidence from Experimental Animal Models. Clin Microbiol Rev 2022; 35:e0007422. [PMID: 36222707 PMCID: PMC9769629 DOI: 10.1128/cmr.00074-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Lyme borreliosis is caused by spirochetes belonging to the Borrelia burgdorferi sensu lato group, which are transmitted by Ixodes tick species living in the temperate climate zones of the Northern Hemisphere. The clinical manifestations of Lyme borreliosis are diverse and treated with oral or intravenous antibiotics. In some patients, long-lasting and debilitating symptoms can persist after the recommended antibiotic treatment. The etiology of such persisting symptoms is under debate, and one hypothesis entails persistent infection by a subset of spirochetes after antibiotic therapy. Here, we review and appraise the experimental evidence from in vivo animal studies on the persistence of B. burgdorferi sensu lato infection after antibiotic treatment, focusing on the antimicrobial agents doxycycline and ceftriaxone. Our review indicates that some in vivo animal studies found sporadic positive cultures after antibiotic treatment. However, this culture positivity often seemed to be related to inadequate antibiotic treatment, and the few positive cultures in some studies could not be reproduced in other studies. Overall, current results from animal studies provide insufficient evidence for the persistence of viable and infectious spirochetes after adequate antibiotic treatment. Borrelial nucleic acids, on the contrary, were frequently detected in these animal studies and may thus persist after antibiotic treatment. We put forward that research into the pathogenesis of persisting complaints after antibiotic treatment for Lyme borreliosis in humans should be a top priority, but future studies should most definitely also focus on explanations other than persistent B. burgdorferi sensu lato infection after antibiotic treatment.
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Affiliation(s)
- Y. L. Verschoor
- Amsterdam UMC, Location University of Amsterdam, Department of Internal Medicine, Section of Infectious Diseases, Amsterdam UMC Multidisciplinary Lyme Borreliosis Center, Amsterdam, The Netherlands
- Amsterdam UMC, Location University of Amsterdam, Center for Experimental and Molecular Medicine, Amsterdam, The Netherlands
| | - A. Vrijlandt
- Amsterdam UMC, Location University of Amsterdam, Department of Internal Medicine, Section of Infectious Diseases, Amsterdam UMC Multidisciplinary Lyme Borreliosis Center, Amsterdam, The Netherlands
- Amsterdam UMC, Location University of Amsterdam, Center for Experimental and Molecular Medicine, Amsterdam, The Netherlands
| | - R. Spijker
- Amsterdam UMC, Location University of Amsterdam, Amsterdam Public Health, Medical Library, Amsterdam, The Netherlands
| | - R. M. van Hest
- Amsterdam UMC, Location University of Amsterdam, Department of Hospital Pharmacy and Clinical Pharmacology, Amsterdam, The Netherlands
| | - H. ter Hofstede
- Department of Internal Medicine, Section of Infectious Diseases, Lyme Borreliosis Outpatient Clinic, Radboudumc, Nijmegen, The Netherlands
| | | | - A. J. Henningsson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Microbiology in Jönköping, Region Jönköping County, Linköping University, Linköping, Sweden
| | - J. W. Hovius
- Amsterdam UMC, Location University of Amsterdam, Department of Internal Medicine, Section of Infectious Diseases, Amsterdam UMC Multidisciplinary Lyme Borreliosis Center, Amsterdam, The Netherlands
- Amsterdam UMC, Location University of Amsterdam, Center for Experimental and Molecular Medicine, Amsterdam, The Netherlands
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Non-specific symptoms and post-treatment Lyme disease syndrome in patients with Lyme borreliosis: a prospective cohort study in Belgium (2016-2020). BMC Infect Dis 2022; 22:756. [PMID: 36171561 PMCID: PMC9518937 DOI: 10.1186/s12879-022-07686-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 08/05/2022] [Indexed: 11/24/2022] Open
Abstract
Background Patients with Lyme borreliosis (LB) may report persisting non-specific symptoms such as fatigue, widespread musculoskeletal pain or cognitive difficulties. When present for more than 6 months and causing a reduction in daily activities, this is often referred to as post-treatment Lyme disease syndrome (PTLDS). This study aimed to compare the occurrence of symptoms between LB patients and controls, to estimate the proportion of LB patients developing PTLDS and to identify risk factors. Methods A prospective cohort study was set up including three subpopulations: patients with an erythema migrans (EM) (i) or disseminated/late LB (ii) and a non-LB control group (iii). At 6- and 12-months follow-up, the occurrence of several symptoms, including six symptoms used to define PTLDS, i.e. muscle pain, joint pain, fatigue, memory problems, difficulties concentrating and problems finding words, and impact on daily activities, was compared between LB patients and controls. Finally, the proportion of LB patients developing PTLDS as defined by the Infectious Disease Society of America was estimated, including a time frame for symptoms to be present. Results Although the risk of presenting PTLDS-related symptoms was significantly higher in EM patients (n = 120) compared to controls (n = 128) at 6 months follow-up, the risk of presenting at least one of these symptoms combined with impact on daily activities was not significantly higher in EM patients, at either 6- or 12-months follow-up. A significant association was found between disseminated/late LB (n = 15) and the occurrence of any PTLDS-symptom with an impact on daily activities at both time points. The proportion of patients with PTLDS was estimated at 5.9% (95% CI 2.7–12.9) in EM patients and 20.9% (95% CI 6.8–64.4) in patients with disseminated/late LB (RR = 3.53, 95% CI 0.98–12.68, p = 0.053). No significant risk factors were identified, which may be explained by small sample sizes. Conclusions In our study, PTLDS was present in both LB cohorts, yet with a higher percentage in disseminated/late LB patients. Additional research is needed into risk factors for and causes of this syndrome. In addition, development and validation of standardized methods to assess the PTLDS case definition, easily applicable in practice, is of great importance.
Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07686-8.
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22
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The Role of the Infectious Disease Consultation in Lyme Disease. Infect Dis Clin North Am 2022; 36:703-718. [PMID: 36116844 DOI: 10.1016/j.idc.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A consultation regarding Lyme disease can be challenging for the infectious disease physician when the referral question centers on the use of prolonged or empirical antibiotic treatment of Lyme disease and associated tick-borne infections. Patients who have been infected with Borrelia burgdorferi, and many who have been misdiagnosed, are confronted with a seemingly endless array of misinformation that is not in keeping with the current understanding of the clinical spectrum of Lyme disease and its response to evidence-based treatment. Preparing for these conversations with a good grasp of the public beliefs regarding Lyme disease and its treatment can be beneficial.
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Abstract
Most patients with Lyme disease will fully recover with recommended antibiotic therapy. However, some patients report persisting nonspecific symptoms after treatment, referred to as posttreatment Lyme disease symptoms (PTLDs) or syndrome (PTLDS), depending on the degree to which the individual's symptoms impact their quality of life. PTLDs occur in a portion of patients diagnosed with chronic Lyme disease (CLD), a controversial term describing different patient populations, diagnosed based on unvalidated tests and criteria. Practitioners should review the evidence for the Lyme disease diagnosis and not overlook unrelated conditions. Current evidence shows that prolonged antibiotic therapy provides little benefit and carries significant risk. Further research to elucidate the mechanisms underlying persistent symptoms after Lyme disease and to understand CLD is needed.
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Affiliation(s)
- Adriana Marques
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, BG 10 RM 12C118 MSC 1888 10 Center, Bethesda, MD 20892-1888, USA.
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Solheim AM, Lorentzen ÅR, Dahlberg AO, Flemmen HØ, Brune S, Forselv KJN, Pripp AH, Bø MH, Eikeland R, Reiso H, Mygland Å, Ljøstad U. Six versus 2 weeks treatment with doxycycline in European Lyme neuroborreliosis: a multicentre, non-inferiority, double-blinded, randomised and placebo-controlled trial. J Neurol Neurosurg Psychiatry 2022; 93:jnnp-2022-329724. [PMID: 35896378 PMCID: PMC9606522 DOI: 10.1136/jnnp-2022-329724] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/12/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND There is limited evidence regarding optimal duration of antibiotic treatment in neuroborreliosis. We aimed to compare efficacy and safety of oral doxycycline for 2 and 6 weeks in European Lyme neuroborreliosis (LNB). METHODS The trial had a randomised, double-blinded, placebo-controlled, non-inferiority design. Patients with LNB were recruited from eight Norwegian hospitals and randomised to doxycycline 200 mg once daily for 2 weeks, followed by 4 weeks of placebo, or doxycycline 200 mg once daily for 6 weeks. The primary endpoint was clinical improvement as measured by difference in a Composite Clinical Score (0-64 points) from baseline to 6 months. The non-inferiority margin was predetermined to 0.5 points. RESULTS One hundred and twenty-one patients were included. Fifty-two treated for 2 weeks and 53 for 6 weeks were included in the intention-to-treat analyses, and 52 and 51 in per-protocol analysis. Mean difference in clinical improvement between the groups was 0.06, 95% CI -1.2 to 1.2, p=0.99 in the intention-to-treat population, and -0.4, 95% CI -1.4 to 0.7, p=0.51 in the per-protocol population and non-inferiority could not be established. There were no treatment failures and no serious adverse events. The groups did not differ in secondary outcomes including clinical scores at 10 weeks and 12 months, cerebrospinal fluid data and patient-reported outcome measures. Patients receiving 6 weeks doxycycline reported slightly more side effects in week 5. CONCLUSION Our results strongly indicate that there are no benefits of doxycycline treatment beyond 2 weeks in European LNB. TRIAL REGISTRATION NUMBER 2015-001481-25.
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Affiliation(s)
- Anne Marit Solheim
- Department of Neurology, Sørlandet sykehus HF Kristiansand, Kristiansand, Norway
- Institute of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Åslaug Rudjord Lorentzen
- Department of Neurology, Sørlandet sykehus HF Kristiansand, Kristiansand, Norway
- The Norwegian National Advisory Unit on Tick-borne diseases, Sørlandet sykehus HF Arendal, Arendal, Norway
| | - Audun Olav Dahlberg
- Department of Neurology, Møre og Romsdal Hospital Trust, Molde, Norway
- Department of Neurology and Clinical Neurophysiology, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Synne Brune
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | | | - Are Hugo Pripp
- Biostatistics and Epidemiology Unit, Oslo University Hospital, Oslo, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | | | - Randi Eikeland
- The Norwegian National Advisory Unit on Tick-borne diseases, Sørlandet sykehus HF Arendal, Arendal, Norway
- Institute of Health and Nursing Science, University of Agder, Kristiansand, Norway
| | - Harald Reiso
- The Norwegian National Advisory Unit on Tick-borne diseases, Sørlandet sykehus HF Arendal, Arendal, Norway
| | - Åse Mygland
- Department of Neurology, Sørlandet sykehus HF Kristiansand, Kristiansand, Norway
- Institute of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Unn Ljøstad
- Department of Neurology, Sørlandet sykehus HF Kristiansand, Kristiansand, Norway
- Institute of Clinical Medicine, University of Bergen, Bergen, Norway
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25
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Halperin JJ, Eikeland R, Branda JA, Dersch R. Lyme neuroborreliosis: known knowns, known unknowns. Brain 2022; 145:2635-2647. [PMID: 35848861 DOI: 10.1093/brain/awac206] [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: 02/26/2022] [Revised: 05/12/2022] [Accepted: 05/17/2022] [Indexed: 11/14/2022] Open
Abstract
Lyme borreliosis affects the nervous system in three principal ways-mononuclear cell meningitis, cranial neuropathies and radiculoneuropathies-the last a broad term encompassing painful radiculopathy, unifocal and multifocal peripheral nerve involvement. Diagnostic tools have been significantly refined-including improved peripheral blood and CSF serodiagnostics-and much has been learned about the interactions between the causative pathogen and the nervous system. Despite these advances in our understanding of this disease, a broad range of other disorders continue to be misattributed to nervous system Lyme borreliosis, supported by, at best, limited evidence. These misattributions often reflect limited understanding not only of Lyme neuroborreliosis but also of what constitutes nervous system disease generally. Fortunately, a large body of evidence now exists to clarify many of these issues, establishing a clear basis for diagnosing nervous system involvement in this infection and, based on well performed studies, clarifying which clinical disorders are associated with Lyme neuroborreliosis, which with non-neurologic Lyme borreliosis, and which with neither.
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Affiliation(s)
- John J Halperin
- Department of Neurosciences, Overlook Medical Center, 99 Beauvoir Ave., Summit, NJ 07901, USA.,Department of Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA 19107, USA.,Department of Neurology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Randi Eikeland
- National Advisory on Tick-borne Diseases, Sørlandet Hospital Trust, Egvsveien 100, 4615 Kristiansand, Norway.,Faculty of Health and Sport Sciences, University of Agder, 4879 Grimstad, Norway
| | - John A Branda
- Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA.,Department of Pathology, Harvard Medical School, Boston, MA 02114, USA
| | - Rick Dersch
- Clinic of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
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26
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Sur ML, Moldovan BS, Mocanu D, Samasca G, Lupan I, Armat I, Harabagiu M, Sur G, Lazar C. Immune Responses to Some Viral Infections That Have a High Evolutionary Potential-A Case Report with Literature Review. LIFE (BASEL, SWITZERLAND) 2022; 12:life12070940. [PMID: 35888030 PMCID: PMC9324372 DOI: 10.3390/life12070940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/03/2022] [Accepted: 06/13/2022] [Indexed: 12/03/2022]
Abstract
Viral infections are a key issue in modern medicine. SARS-CoV-2 infection confirms that we are not sufficiently prepared for these unforeseen infections. The COVID-19 pandemic has cultivated a great sense of fear and distrust in patients. If viral infections, in this case, SARS-CoV-2, overlap with another infection, the symptoms are prolonged and worsened, and complications may occur. Starting from an objective clinical finding of a patient they had in follow-up and treatment, the authors present the problems of the diseases the patient suffered from. These are described as reviews so that readers can get an idea of the clinical methods of expression and the therapeutic possibilities. Therefore, this article describes Lyme disease and post-treatment Lyme disease syndrome, SARS-CoV-2 infection, and multisystem inflammatory syndrome in children (MISC-C), as the patient suffered from an incomplete form of Kawasaki disease. During the treatment for Lyme disease, the patient also contracted the influenza type A virus. Although any of these diseases could have the potential for serious evolution, our patient still went through these infections relatively well. This can be explained by the fact that the patient had a slow immune response to the aforementioned infections, which allowed him to survive these diseases relatively easily, unlike other individuals who have an exaggerated immune response or who suffer from serious immune involvement, e.g., hepatitis B with a fulminant response. The case was presented chronologically, but at the same time, all particular infection manifestations were accurately described. For these reasons, the article is presented in the form of a review, exemplified by the case itself. Of the 52 cases of MISC-C found in the Pediatrics Clinic II of Cluj-Napoca, we present the case of a male patient who presented with Lyme disease, post-treatment Lyme disease syndrome, Kawasaki disease, and MISC-C incomplete form.
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Affiliation(s)
- Maria Lucia Sur
- Department of Pediatric I, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (M.L.S.); (M.H.); (C.L.)
| | - Bogdan-Stefan Moldovan
- Children’s Emergency Clinical Hospital, 400370 Cluj-Napoca, Romania; (B.-S.M.); (D.M.); (I.A.); (G.S.)
| | - Diana Mocanu
- Children’s Emergency Clinical Hospital, 400370 Cluj-Napoca, Romania; (B.-S.M.); (D.M.); (I.A.); (G.S.)
| | - Gabriel Samasca
- Children’s Emergency Clinical Hospital, 400370 Cluj-Napoca, Romania; (B.-S.M.); (D.M.); (I.A.); (G.S.)
- Department of Immunology, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
- Correspondence:
| | - Iulia Lupan
- Molecular Biology Department, Babes Bolyai University, 400084 Cluj-Napoca, Romania;
| | - Ionel Armat
- Children’s Emergency Clinical Hospital, 400370 Cluj-Napoca, Romania; (B.-S.M.); (D.M.); (I.A.); (G.S.)
| | - Marin Harabagiu
- Department of Pediatric I, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (M.L.S.); (M.H.); (C.L.)
- Clinical Hospital of Infectious Diseases, 400000 Cluj-Napoca, Romania
| | - Genel Sur
- Children’s Emergency Clinical Hospital, 400370 Cluj-Napoca, Romania; (B.-S.M.); (D.M.); (I.A.); (G.S.)
| | - Calin Lazar
- Department of Pediatric I, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (M.L.S.); (M.H.); (C.L.)
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27
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Bares A, Chirouze C, Bouiller K. Perception and knowledge of pharmacists on Lyme borreliosis. Ticks Tick Borne Dis 2022; 13:101956. [DOI: 10.1016/j.ttbdis.2022.101956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/06/2022] [Accepted: 04/10/2022] [Indexed: 10/18/2022]
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28
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Sevestre J, Benichou A, Rio V, Delaunay P, Gonfrier G, Martaresche C, Carlo V, Nakam S, Mondain V, Carles M, Jeandel PY, Durant J. Emergence of Lyme Disease on the French Riviera, a Retrospective Survey. Front Med (Lausanne) 2022; 9:737854. [PMID: 35391881 PMCID: PMC8981725 DOI: 10.3389/fmed.2022.737854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 02/23/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe French Riviera has been declared free of Lyme Borreliosis (LB) for years. Many patients are referred for presumed LB, sometimes with atypical clinical signs and/or doubtful serology, calling the diagnosis into question.MethodsPatients were assessed for LB diagnosis, depending on clinical presentation, laboratory findings, and further examination by other medical professionals.ResultsAmong 255 patients, 45 (18%) were classified as confirmed LB cases [including 28 ongoing LB (10%) and 17 past LB (8%)], and for 210 (82%) a Lyme borreliosis diagnosis was ruled out. Among ongoing LB, 56% had been exposed to or bitten by ticks, exclusively in rural locations of the Alpes-Maritimes. As a result of the diagnostic procedure, 132 (52%) patients had been treated. An alternative diagnosis was established for 134 (52%) patients, covering a wide range of conditions, including mainly psychological (28%) and neurological conditions (25%) or inflammatory and systemic diseases (22%).ConclusionsOur results strongly suggest the endemicity of LB in the Alpes-Maritimes region. Confirmed LB accounted for 18% of patients while 52% were diagnosed with other conditions.
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Affiliation(s)
- Jacques Sevestre
- Laboratory of Parasitology, Nice University Hospital, Nice, France
- IHU Méditerranée Infection, Marseille, France
| | - Antoine Benichou
- Department of Internal Medicine, Nice University Hospital, Nice, France
| | - Vanessa Rio
- Department of Infectious Diseases, Nice University Hospital, Nice, France
| | - Pascal Delaunay
- Laboratory of Parasitology, Nice University Hospital, Nice, France
| | | | | | - Virginie Carlo
- Department of Infectious Diseases, Nice University Hospital, Nice, France
| | - Sarah Nakam
- Department of Infectious Diseases, Nice University Hospital, Nice, France
| | - Véronique Mondain
- Department of Infectious Diseases, Nice University Hospital, Nice, France
| | - Michel Carles
- Department of Infectious Diseases, Nice University Hospital, Nice, France
| | | | - Jacques Durant
- Department of Infectious Diseases, Nice University Hospital, Nice, France
- *Correspondence: Jacques Durant
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29
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Multidisciplinary Management of Suspected Lyme Borreliosis: Clinical Features of 569 Patients, and Factors Associated with Recovery at 3 and 12 Months, a Prospective Cohort Study. Microorganisms 2022; 10:microorganisms10030607. [PMID: 35336182 PMCID: PMC8955660 DOI: 10.3390/microorganisms10030607] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/07/2022] [Accepted: 03/09/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction. Because patients with a suspicion of Lyme borreliosis (LB) may have experienced difficult care paths, the Tick-Borne Diseases Reference Center (TBD-RC) was started in 2017. The aim of our study was to compare the clinical features of patients according to their final diagnoses, and to determine the factors associated with recovery in the context of multidisciplinary management for suspected LB. Methods. We included all adult patients who were seen at the TBD-RC (2017–2020). Four groups were defined: (i) confirmed LB, (ii) possible LB, (iii) Post-Treatment Lyme Disease Syndrome (PTLDS) or sequelae, and (iv) other diagnoses. Their clinical evolution at 3, 6, and 9–12 months after care was compared. Factors associated with recovery at 3 and at 9–12 months were identified using logistic regression models. Results. Among the 569 patients who consulted, 72 (12.6%) had confirmed LB, 43 (7.6%) possible LB, 58 (10.2%) PTLDS/sequelae, and 396 (69.2%) another diagnosis. A favorable evolution was observed in 389/569 (68.4%) at three months and in 459/569 (80.7%) at 12 months, independent of the final diagnosis. A longer delay between the first symptoms and the first consultation at the TBD-RC (p = 0.001), the multiplicity of the diagnoses (p = 0.004), and the inappropriate prescription of long-term antibiotic therapy (p = 0.023) were negatively associated with recovery, reflecting serial misdiagnoses. Conclusions. A multidisciplinary team dedicated to suspicion of LB may achieve a more precise diagnosis and better patient-centered medical support in the adapted clinical sector with a shorter delay, enabling clinical improvement and avoiding inappropriate antimicrobial prescription.
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30
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Borrelia burgdorferi inhibits NADPH-mediated reactive oxygen species production through the mTOR pathway. Ticks Tick Borne Dis 2022; 13:101943. [DOI: 10.1016/j.ttbdis.2022.101943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 03/14/2022] [Accepted: 03/18/2022] [Indexed: 11/21/2022]
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31
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Huiberts AJ, Vermeeren YM, van Bemmel T, Wieberdink RG, van Jaarsveld CHM, Zomer TP. Coping strategies and quality of life in patients with chronic symptoms visiting a Lyme Center in a Dutch teaching hospital. Qual Life Res 2022; 31:2423-2434. [PMID: 35122610 DOI: 10.1007/s11136-022-03094-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Little is known on coping strategies in patients with chronic symptoms suspected of Lyme borreliosis (LB). Different coping strategies might influence quality of life (QoL). We assessed coping strategies and QoL in patients with chronic symptoms suspected of LB. METHODS Adult patients referred to the Lyme Center Apeldoorn were included (November 2019-April 2021). Participants completed the RAND-36 to assess QoL and the Utrecht Coping List to assess coping strategies. Patient data were extracted from medical records. Patients were categorized based on clinical LB and serology. Linear regression analyses were conducted to examine an association between coping strategies and QoL subscales. RESULTS Included were 201 patients. Patients suspected of LB had a different coping profile and lower QoL compared to the reference population. Patients with negative serology and no clinical LB scored lowest on all QoL subscales. In multivariate analyses, correcting for age, gender, comorbidity, and patient category, a negative association was found between passive coping and the QoL subscales physical functioning (β(SE) = - 1.1(0.5)), social functioning (β(SE) = - 3.3(0.5)), role limitations (emotional) (β(SE) = - 5.5(0.8)), mental health (β(SE) = - 3.7(0.3)), vitality (β(SE) = - 2.3(0.3)), pain (β(SE) = - 2.3(0.5)), and general health (β(SE) = - 2.7(0.3)). A negative association was also found between palliative coping and the QoL subscale role limitations (physical) (β(SE) = - 1.8(0.6)) and between expressing emotions and mental health (β(SE) = - 1.3(0.6)). A positive association was found between active coping and the QoL subscales mental health (β(SE) = 1.0(0.3)) and role limitations (emotional) (β(SE) = 1.9(0.8)). CONCLUSION In patients suspected of LB, dysfunctional coping strategies were associated with worse quality of life. There is a need for interventions that can guide patients with chronic symptoms suspected of LB towards more active coping and increase QoL.
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Affiliation(s)
- Anne J Huiberts
- Lyme Center Apeldoorn, Gelre Hospital, P.O. Box 9014, 7300 DS, Apeldoorn, The Netherlands
| | - Yolande M Vermeeren
- Lyme Center Apeldoorn, Gelre Hospital, P.O. Box 9014, 7300 DS, Apeldoorn, The Netherlands.,Department of Internal Medicine, Gelre Hospital, Apeldoorn, The Netherlands
| | - Thomas van Bemmel
- Lyme Center Apeldoorn, Gelre Hospital, P.O. Box 9014, 7300 DS, Apeldoorn, The Netherlands.,Department of Internal Medicine, Gelre Hospital, Apeldoorn, The Netherlands
| | - Renske G Wieberdink
- Lyme Center Apeldoorn, Gelre Hospital, P.O. Box 9014, 7300 DS, Apeldoorn, The Netherlands.,Department of Neurology, Gelre Hospital, Apeldoorn, The Netherlands
| | - Cornelia H M van Jaarsveld
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Tizza P Zomer
- Lyme Center Apeldoorn, Gelre Hospital, P.O. Box 9014, 7300 DS, Apeldoorn, The Netherlands.
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32
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Donta ST. What We Know and Don't Know About Lyme Disease. Front Public Health 2022; 9:819541. [PMID: 35127630 PMCID: PMC8813852 DOI: 10.3389/fpubh.2021.819541] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 12/20/2021] [Indexed: 11/18/2022] Open
Abstract
We know the cause of Lyme disease. We know that the bacteria can be found in the initial rash, and occasionally in the blood in the subsequent 2–3 months, but after then, its subsequent location is unknown. Whereas diagnosis and treatment of early Lyme disease is generally straightforward, the etiology of relapsing or persisting symptoms is yet to be defined, and presents clinical challenges. There are no current tests to determine if the infection is still present or absent, thus complicating diagnosis and treatment. Presented here are approaches to the diagnosis and treatment of persisting Lyme disease, based on available published information, and the experience of the author.
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33
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Luciano CA, Caraballo-Cartagena S. Treatment and Management of Infectious, Granulomatous, and Toxic Neuromuscular Disorders. Neuromuscul Disord 2022. [DOI: 10.1016/b978-0-323-71317-7.00016-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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34
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A Review of Post-treatment Lyme Disease Syndrome and Chronic Lyme Disease for the Practicing Immunologist. Clin Rev Allergy Immunol 2021; 62:264-271. [PMID: 34687445 DOI: 10.1007/s12016-021-08906-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 12/22/2022]
Abstract
Lyme disease is an infection caused by Borrelia burgdorferi sensu lato, which is transmitted to humans through the bite of an infected Ixodes tick. The majority of patients recover without complications with antibiotic therapy. However, for a minority of patients, accompanying non-specific symptoms can persist for months following completion of therapy. The constellation of symptoms such as fatigue, cognitive dysfunction, and musculoskeletal pain that persist beyond 6 months and are associated with disability have been termed post-treatment Lyme disease syndrome (PTLDS), a subset of a broader term "chronic Lyme disease." Chronic Lyme disease is a broad, vaguely defined term that is used to describe patients with non-specific symptoms that are attributed to a presumed persistent Borrelia burgdorferi infection in patients who may or may not have evidence of either previous or current Lyme disease. The diagnoses of chronic Lyme disease and of PTLDS have become increasingly relevant to the practice of immunologists due to referrals for consultation or for intravenous immunoglobulin (IVIG) treatment. This review aims to explore the relationship between chronic Lyme disease, post-treatment Lyme disease syndrome, and the immune system. Here, we review the current literature on (1) issues in conventional and alternative diagnostic testing for Lyme disease, (2) the hypothesis that B. burgdorferi infection can persist despite appropriate use of recommended antibiotics, (3) current theories regarding B. burgdorferi's role in causing both immune dysregulation and protracted symptoms, and (4) the use of IVIG for the treatment of Lyme disease.
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35
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Markowicz M, Kundi M, Stanek G, Stockinger H. Nonspecific symptoms following infection with Borrelia burgdorferi sensu lato: A retrospective cohort study. Ticks Tick Borne Dis 2021; 13:101851. [PMID: 34662801 DOI: 10.1016/j.ttbdis.2021.101851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/26/2021] [Accepted: 09/07/2021] [Indexed: 10/20/2022]
Abstract
Whether infection with Borrelia burgdorferi sensu lato (sl) can cause nonspecific symptoms is a matter of controversy. We investigated whether individuals infected with B. burgdorferi sl develop unspecific symptoms more frequently than non-infected controls. Eighty-nine persons having presented with B. burgdorferi sl infection between 2015 and 2019 were asked to participate. The infection was defined as erythema migrans diagnosed either in the course of a previous study, during medical visits in the outpatient department, or as seroconversion in asymptomatic subjects. The control group consisted of 85 seronegative individuals without erythema migrans in the past. About two and a half years later, participants were asked to fill out a questionnaire with a list of nonspecific symptoms. The data of 37 persons with previous Borrelia infection and 49 uninfected controls were available for analysis. Muscle pain was significantly (P = 0.040) more frequent in the control group. Fatigue occurred more often in the infected group, but this was not statistically significant (P = 0.109). Likewise, the distribution of other symptoms did not differ considerably. The analysis revealed no difference in the frequency of symptoms of persons who had EM or asymptomatic Borrelia infection 2 years prior assessment in comparison to persons without Borrelia infection.
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Affiliation(s)
- Mateusz Markowicz
- Institute for Hygiene and Applied Immunology; Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Kinderspitalgasse 15, A-1090 Vienna, Austria.
| | - Michael Kundi
- Department of Environmental Health, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15, A-1090 Vienna, Austria.
| | - Gerold Stanek
- Institute for Hygiene and Applied Immunology; Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Kinderspitalgasse 15, A-1090 Vienna, Austria.
| | - Hannes Stockinger
- Institute for Hygiene and Applied Immunology; Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Kinderspitalgasse 15, A-1090 Vienna, Austria.
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Trautmann A. [Mechanisms underlying chronic fatigue, a symptom too often overlooked]. Med Sci (Paris) 2021; 37:910-919. [PMID: 34647880 DOI: 10.1051/medsci/2021143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Acute fatigue after exertion, like acute inflammation after injury, is useful for our body. On the contrary, both chronic fatigue and chronic inflammation are deleterious, and they are associated in many diseases. In this first part, we will analyze different immune phenomena (bystander activation, memory of the innate immune system, link with the intestinal microbiota) involved in triggering chronic inflammation. This review aims at looking for links between different signs and symptoms associated with chronic fatigue, as well as between different diseases in which severe chronic fatigue can manifest. Possible underlying mechanisms for these phenomena are discussed. This is a proposal made by a researcher, with no clinical experience, to doctors confronted with an entity that is still largely mysterious. The link between chronic inflammation, neuroinflammation and fatigue will be examined in a second part.
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Affiliation(s)
- Alain Trautmann
- UMR CNRS 8104, Inserm 1016, université Paris Descartes, Institut Cochin, rue Méchain, 75014 Paris, France
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Maksimyan S, Syed MS, Soti V. Post-Treatment Lyme Disease Syndrome: Need for Diagnosis and Treatment. Cureus 2021; 13:e18703. [PMID: 34659931 PMCID: PMC8507427 DOI: 10.7759/cureus.18703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 01/19/2023] Open
Abstract
With the continued surge in Lyme disease cases, post-treatment Lyme disease syndrome (PTLDS) is becoming a more pressing health concern. The aim of this review is to identify comprehensive treatment strategies for PTLDS patients. Unfortunately, universal guidelines for diagnosing and treating PTLDS do not currently exist. Consequently, physicians cannot adequately address concerns of possible PTLDS patients. Patients are left suffering and searching for answers, and their activities of daily living and quality of life are adversely impacted. This review highlights that PTLDS clinical trials have focused mainly on treatment with antibiotics, yielding challenging results that lack consistency in inclusion criteria across trials. It will remain exceedingly difficult to extrapolate the outcomes of such studies if a standard for PTLDS diagnosis is not well-established. By focusing on treatment trials rather than establishing diagnostic criteria, research in this field ignores a critical step in investigating PTLDS. The first significant step is to create comprehensive guidelines for the diagnosis of PTLDS, which can generate uniformity and validate PTLDS treatment trials.
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Affiliation(s)
- Simona Maksimyan
- Infectious Disease, Lake Erie College of Osteopathic Medicine, Elmira, USA
| | - Munir S Syed
- Pathology and Histology, Lake Erie College of Osteopathic Medicine, Elmira, USA
| | - Varun Soti
- Pharmacology and Therapeutics, Lake Erie College of Osteopathic Medicine, Elmira, USA
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Bobe JR, Jutras BL, Horn EJ, Embers ME, Bailey A, Moritz RL, Zhang Y, Soloski MJ, Ostfeld RS, Marconi RT, Aucott J, Ma'ayan A, Keesing F, Lewis K, Ben Mamoun C, Rebman AW, McClune ME, Breitschwerdt EB, Reddy PJ, Maggi R, Yang F, Nemser B, Ozcan A, Garner O, Di Carlo D, Ballard Z, Joung HA, Garcia-Romeu A, Griffiths RR, Baumgarth N, Fallon BA. Recent Progress in Lyme Disease and Remaining Challenges. Front Med (Lausanne) 2021; 8:666554. [PMID: 34485323 PMCID: PMC8416313 DOI: 10.3389/fmed.2021.666554] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 07/12/2021] [Indexed: 12/14/2022] Open
Abstract
Lyme disease (also known as Lyme borreliosis) is the most common vector-borne disease in the United States with an estimated 476,000 cases per year. While historically, the long-term impact of Lyme disease on patients has been controversial, mounting evidence supports the idea that a substantial number of patients experience persistent symptoms following treatment. The research community has largely lacked the necessary funding to properly advance the scientific and clinical understanding of the disease, or to develop and evaluate innovative approaches for prevention, diagnosis, and treatment. Given the many outstanding questions raised into the diagnosis, clinical presentation and treatment of Lyme disease, and the underlying molecular mechanisms that trigger persistent disease, there is an urgent need for more support. This review article summarizes progress over the past 5 years in our understanding of Lyme and tick-borne diseases in the United States and highlights remaining challenges.
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Affiliation(s)
- Jason R. Bobe
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Brandon L. Jutras
- Department of Biochemistry, Fralin Life Sciences Institute, Virginia Tech, Blacksburg, VA, United States
| | | | - Monica E. Embers
- Tulane University Health Sciences, New Orleans, LA, United States
| | - Allison Bailey
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Ying Zhang
- State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mark J. Soloski
- Division of Rheumatology, Department of Medicine, Lyme Disease Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | - Richard T. Marconi
- Department of Microbiology and Immunology, Virginia Commonwealth University Medical Center, Richmond, VA, United States
| | - John Aucott
- Division of Rheumatology, Department of Medicine, Lyme Disease Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Avi Ma'ayan
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Kim Lewis
- Department of Biology, Northeastern University, Boston, MA, United States
| | | | - Alison W. Rebman
- Division of Rheumatology, Department of Medicine, Lyme Disease Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Mecaila E. McClune
- Department of Biochemistry, Fralin Life Sciences Institute, Virginia Tech, Blacksburg, VA, United States
| | - Edward B. Breitschwerdt
- Department of Clinical Sciences, Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
| | | | - Ricardo Maggi
- Department of Clinical Sciences, Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
| | - Frank Yang
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Bennett Nemser
- Steven & Alexandra Cohen Foundation, Stamford, CT, United States
| | - Aydogan Ozcan
- University of California, Los Angeles, Los Angeles, CA, United States
| | - Omai Garner
- University of California, Los Angeles, Los Angeles, CA, United States
| | - Dino Di Carlo
- University of California, Los Angeles, Los Angeles, CA, United States
| | - Zachary Ballard
- University of California, Los Angeles, Los Angeles, CA, United States
| | - Hyou-Arm Joung
- University of California, Los Angeles, Los Angeles, CA, United States
| | - Albert Garcia-Romeu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Roland R. Griffiths
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Nicole Baumgarth
- Center for Immunology and Infectious Diseases and the Department of Pathology, Microbiology & Immunology, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Brian A. Fallon
- Columbia University Irving Medical Center, New York, NY, United States
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Borreliosi di Lyme e neuroborreliosi. Neurologia 2021. [DOI: 10.1016/s1634-7072(21)45319-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Abstract
PURPOSE OF REVIEW This article reviews the symptomatology, diagnosis, and treatment of neuroborreliosis. RECENT FINDINGS The most recent guidelines for the diagnosis and treatment of Lyme disease were published in 2020 by the Infectious Diseases Society of America, the American Academy of Neurology, and the American College of Rheumatology. SUMMARY The most common neurologic complications of Lyme disease are cranial neuritis (most often a unilateral or bilateral facial nerve palsy), meningitis, and radiculoneuritis/mononeuropathy multiplex. Testing for Lyme disease begins with an enzyme-linked immunosorbent assay (ELISA). If the ELISA is positive or borderline, Western blots should be performed for both IgM and IgG antibodies. As a general rule, in infectious diseases, an IgM antibody response is followed by an IgG antibody response. A central nervous system infection has either a CSF pleocytosis or pathogen-specific intrathecal antibody production. Lyme meningitis, cranial neuropathy, radiculoneuropathy, or other peripheral nervous system manifestations are treated with oral doxycycline or IV ceftriaxone, cefotaxime, or penicillin G. No additional antibiotic therapy is indicated for patients with posttreatment Lyme disease syndrome or patients with concern for chronic Lyme disease with no evidence of previous or current Lyme infection.
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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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Raffetin A, Barquin A, Nguala S, Paoletti G, Rabaud C, Chassany O, Caraux-Paz P, Covasso S, Partouche H. Perceptions, Representations, and Experiences of Patients Presenting Nonspecific Symptoms in the Context of Suspected Lyme Borreliosis. Microorganisms 2021; 9:microorganisms9071515. [PMID: 34361950 PMCID: PMC8304161 DOI: 10.3390/microorganisms9071515] [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: 06/10/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Some subjective symptoms may be reported at all stages of Lyme borreliosis (LB) and may persist for several months after treatment. Nonspecific symptoms without any objective manifestation of LB are sometimes attributed by patients to a possible tick bite. The aim of our study was to explore the perceptions, representations, and experiences that these patients had of their disease and care paths. METHODS We performed a qualitative study through individual interviews (October 2017-May 2018), based on grounded theory, following the COREQ checklist. A balanced sample of patients with diverse profiles was recruited at consultations with general practitioners and infectious disease physicians. RESULTS Twelve patients were interviewed. Data saturation was reached at the twelfth interview. For codes, 293 were identified, and classified into 5 themes: (1) the experience of disabling nonspecific symptoms, especially pain, causing confusion and fear, (2) long and difficult care paths for the majority of the patients, experienced as an obstacle course, (3) a break with the previous state of health, causing a negative impact on every sphere of the patient's life, (4) empowerment of the patients and the self-management of their disease, and (5) the strong expression of a desire for change, with better listening, greater recognition of the symptoms, and simpler care paths. CONCLUSIONS This study allows for the understanding of a patient's behaviours and the obstacles encountered, the way they are perceived, and the necessary solutions. The patients' expectations identified here could help physicians better understand the doctor-patient relationship in these complex management situations, which would reduce the burden of the disease. The current development of specialised reference centres could help meet the patients' demands and those of family physicians.
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Affiliation(s)
- Alice Raffetin
- Department of Infectious Diseases, Tick-Borne Diseases Reference Centre, North Region, CH Villeneuve Saint Georges, 40 Allée de la Source, 94190 Villeneuve-Saint-Georges, France; (S.N.); (P.C.-P.); (S.C.)
- European Study Group for Lyme Borreliosis ESGBOR, ESCMID, Gerbergasse 14 3rd Floor, 4001 Basel, Switzerland
- Correspondence: ; Tel.: +33-143862068
| | - Aude Barquin
- Département de Médecine Générale, Paris University, Site Cochin 27, Rue du Fbg Saint-Jacques, CEDEX 14, 75679 Paris, France; (A.B.); (H.P.)
| | - Steve Nguala
- Department of Infectious Diseases, Tick-Borne Diseases Reference Centre, North Region, CH Villeneuve Saint Georges, 40 Allée de la Source, 94190 Villeneuve-Saint-Georges, France; (S.N.); (P.C.-P.); (S.C.)
| | - Giulia Paoletti
- Department of Psychiatry, Tick-Borne Diseases Reference Centre, Île-de-France/Hauts-de-France, CH Villeneuve Saint Georges, 40 Allée de la Source, 94190 Villeneuve-Saint-Georges, France;
| | - Christian Rabaud
- Department of Infectious Diseases, Tick-Borne Diseases Reference Centre, East Region, CHRU Nancy, Bâtiment Philippe Canton, Hôpitaux de Brabois, Allée du Morvan, 54500 Vandoeuvre les Nancy, France;
| | - Olivier Chassany
- Health Economics Clinical Trial Unit (URC-ECO), Hôpital Hotel-Dieu, AP-HP, 1 Place du Parvis Notre Dame, 75004 Paris, France;
| | - Pauline Caraux-Paz
- Department of Infectious Diseases, Tick-Borne Diseases Reference Centre, North Region, CH Villeneuve Saint Georges, 40 Allée de la Source, 94190 Villeneuve-Saint-Georges, France; (S.N.); (P.C.-P.); (S.C.)
| | - Sarah Covasso
- Department of Infectious Diseases, Tick-Borne Diseases Reference Centre, North Region, CH Villeneuve Saint Georges, 40 Allée de la Source, 94190 Villeneuve-Saint-Georges, France; (S.N.); (P.C.-P.); (S.C.)
- Department of Anthropology, University Lyon II, UFR Anthropologie, Sociologie et Science Politique, Université Lumière Lyon 2, 5 Avenue Pierre Mendès France, 69676 Bron, France
| | - Henri Partouche
- Département de Médecine Générale, Paris University, Site Cochin 27, Rue du Fbg Saint-Jacques, CEDEX 14, 75679 Paris, France; (A.B.); (H.P.)
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Ursinus J, Vrijmoeth HD, Harms MG, Tulen AD, Knoop H, Gauw SA, Zomer TP, Wong A, Friesema IH, Vermeeren YM, Joosten LA, Hovius JW, Kullberg BJ, van den Wijngaard CC. Prevalence of persistent symptoms after treatment for lyme borreliosis: A prospective observational cohort study. THE LANCET REGIONAL HEALTH. EUROPE 2021; 6:100142. [PMID: 34557833 PMCID: PMC8454881 DOI: 10.1016/j.lanepe.2021.100142] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Concerns about long-lasting symptoms attributed to Lyme borreliosis (LB) are widespread in the Western world, while such symptoms are highly prevalent in the general population. METHODS In the largest prospective study to date, adults with physician-confirmed LB were included at the start of antibiotic treatment. Primary outcomes, prevalence of persistent symptoms and symptom severity, were assessed using three-monthly standardised questionnaires during one year. Persistent symptoms were defined as impaired scores for fatigue (CIS, subscale fatigue), cognitive impairment (CFQ) or pain (SF-36, subscale bodily pain) ≥6 months, with onset <6 months. Outcomes were compared with a longitudinal general population and a tick-bite cohort without LB as a reference. FINDINGS Of 1135 LB patients (94•8% erythema migrans, 5•2% disseminated LB), 1084 fulfilled primary analysis criteria, as well as 1942 population and 1887 tick-bite controls. Overall prevalence of persistent symptoms in LB patients was 27•2% (95%CI, 24•7%-29•7%); 6•0% and 3•9% higher than in population (21•2%, 95%CI, 19•3%-23•1%; p < 0•0001) and tick-bite (23•3%, 95%CI 21•3%-25•3%; p = 0•016) cohorts, respectively. At 12 months, fatigue, cognitive impairment, and pain were significantly more severe in erythema migrans patients than in reference cohorts, while in disseminated LB patients, only pain was more severe. INTERPRETATION In treated LB patients, persistent symptoms were significantly more prevalent and symptoms were more severe than in individuals without LB, although the background prevalence was substantial. This suggests an association, either direct or indirect, between persistent symptoms and LB in a relatively small subset of patients. FUNDING ZonMw; Dutch Ministry of Health, Welfare and Sport.
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Key Words
- ACA, Acrodermatitis chronica atrophicans
- CFQ, Cognitive Failure Questionnaire
- CIS, Checklist Individual Strength
- EM, Erythema migrans
- LB, Lyme borreliosis
- PCR, Polymerase Chain Reaction
- PHQ-15, Patient Health Questionnaire
- PTLDS, Post-treatment Lyme Disease Syndrome
- SF-36, SF-36 item Health Survey
- TiC-P, Treatment Inventory of Costs in Patients with psychiatric disorders
- s.l., sensu lato
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Affiliation(s)
- Jeanine Ursinus
- Department of Internal Medicine, Division of Infectious Diseases & Center for Experimental and Molecular Medicine, Amsterdam UMC, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, Netherlands
| | - Hedwig D. Vrijmoeth
- Department of Internal Medicine and Radboudumc Center for Infectious Diseases (RCI), Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, Netherlands
| | - Margriet G. Harms
- National Institute for Public Health and the Environment (RIVM), Center for Infectious Disease Control, P.O. Box 1, 3720 BA, Bilthoven, Netherlands
| | - Anna D. Tulen
- National Institute for Public Health and the Environment (RIVM), Center for Infectious Disease Control, P.O. Box 1, 3720 BA, Bilthoven, Netherlands
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, P.O. Box 22660, 1100 DD, Amsterdam, Netherlands
| | - Stefanie A. Gauw
- Department of Internal Medicine, Division of Infectious Diseases & Center for Experimental and Molecular Medicine, Amsterdam UMC, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, Netherlands
| | - Tizza P. Zomer
- Lyme Center Apeldoorn, Gelre Hospital, P.O. Box 9014, 7300 DS, Apeldoorn, Netherlands
| | - Albert Wong
- National Institute for Public Health and the Environment (RIVM), Department for Statistics, Informatics and Modeling, P.O. Box 1, 3720 BA, Bilthoven, Netherlands
| | - Ingrid H.M. Friesema
- National Institute for Public Health and the Environment (RIVM), Center for Infectious Disease Control, P.O. Box 1, 3720 BA, Bilthoven, Netherlands
| | - Yolande M. Vermeeren
- Lyme Center Apeldoorn, Gelre Hospital, P.O. Box 9014, 7300 DS, Apeldoorn, Netherlands
| | - Leo A.B. Joosten
- Department of Internal Medicine and Radboudumc Center for Infectious Diseases (RCI), Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, Netherlands
| | - Joppe W. Hovius
- Department of Internal Medicine, Division of Infectious Diseases & Center for Experimental and Molecular Medicine, Amsterdam UMC, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, Netherlands
| | - Bart Jan Kullberg
- Department of Internal Medicine and Radboudumc Center for Infectious Diseases (RCI), Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, Netherlands
| | - Cees C. van den Wijngaard
- National Institute for Public Health and the Environment (RIVM), Center for Infectious Disease Control, P.O. Box 1, 3720 BA, Bilthoven, Netherlands
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Frankl S, Hadar PN, Yakhkind A, Lang AE, Sandsmark DK. Devastating Neurological Injury as a Result of Treatment of "Chronic Lyme Disease". Mayo Clin Proc 2021; 96:2005-2007. [PMID: 34218872 DOI: 10.1016/j.mayocp.2021.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/05/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Sarah Frankl
- University of Pennsylvania Health System, Philadelphia, PA
| | - Peter N Hadar
- University of Pennsylvania Health System, Philadelphia, PA
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Pascal C, Arquembourg J, Vorilhon P, Lesens O. Emergence of Lyme disease as a social problem: analysis of discourse using the media content. Eur J Public Health 2021; 30:504-510. [PMID: 31688903 DOI: 10.1093/eurpub/ckz198] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Chronic Lyme disease (LD) is a matter of debate worldwide and has emerged as a social problem. We aim to analyze the media content and describe the transformation process of a collective pain into a social problem in France. METHODS Using social science methodology, a corpus of articles from 20 newspapers and videos from seven major TV stations from 1987 to 2017 were analyzed for discourse content. The speaking times and the frequency of interventions between doctors supporting the official guidelines and those against them were compared using the Mann-Whitney test and the Chi-square test, respectively. RESULTS In France, the media discourse is carried through testimonials from patient organizations and a professor of infectiology who acted as a whistleblower (WB). We showed that the emergence of the LD alert in the media corresponds to the process described by social sciences as 'naming, blaming, claiming'. Since his first article in 2014, the WB has featured in 24% (22/89) of newspaper articles compared with 20% (18/89) for doctors defending the official guidelines (P = 0.52). Since his first appearance on a TV newscast in 2014, the WB has appeared in 45% (22/49) of news reports on LD with 24% of the speaking time compared with 22% (11/49) for doctors defending the official guidelines (P = 0.018). CONCLUSIONS Media coverage of LD has been unbalanced since 2014 and promotes associations as well as the WB, who seems to be better identified than any of the different doctors defending the official guidelines.
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Affiliation(s)
- Clélia Pascal
- Infectious and Tropical Diseases Department, CRIOA, CHU Clermont-Ferrand, Clermont-Ferrand, France.,UMR CNRS 6023, Laboratoire Microorganismes: Génome Environnement (LMGE), Université Clermont Auvergne, Clermont-Ferrand, France
| | - Jocelyne Arquembourg
- Sciences de l'Information et de la Communication, Université Sorbonne Nouvelle - Paris3, Paris, France
| | - Philippe Vorilhon
- Department of General Practice, Institut Pascal, CNRS, SIGMA Clermont, Clermont Auvergne University, Clermont-Ferrand, France
| | - Olivier Lesens
- Infectious and Tropical Diseases Department, CRIOA, CHU Clermont-Ferrand, Clermont-Ferrand, France.,UMR CNRS 6023, Laboratoire Microorganismes: Génome Environnement (LMGE), Université Clermont Auvergne, Clermont-Ferrand, France
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Thomas HS, Lee AW, Nabavizadeh B, Namiri NK, Hakam N, Martin-Tuite P, Rios N, Enriquez A, Mmonu NA, Cohen AJ, Breyer BN. Characterizing online crowdfunding campaigns for patients with kidney cancer. Cancer Med 2021; 10:4564-4574. [PMID: 34102000 PMCID: PMC8267118 DOI: 10.1002/cam4.3974] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/16/2021] [Accepted: 05/03/2021] [Indexed: 11/13/2022] Open
Abstract
Background Cancer patients incur high care costs; however, there is a paucity of literature characterizing unmet financial obligations for patients with urologic cancers. Kidney cancer patients are particularly burdened by costs associated with novel systemic treatments. This study aimed to ascertain the characteristics of GoFundMe® crowdfunding campaigns for patients with kidney cancer, in order to better understand the financial needs of this population. Methods We performed a cross‐sectional, quantitative, and qualitative analysis of all kidney cancer GoFundMe® campaigns since 2010. Fundraising metrics such as goal funds and amount raised, were extracted. Eight independent investigators collected patient, disease and campaign‐level variables from campaign stories (κ = 0.72). In addition, we performed a content analysis of campaign narratives spotlighting the primary appeal of the patient's life story. Results A total of 486 GoFundMe® kidney cancer campaigns were reviewed. The median goal funds were 10,000USD [IQR = 5000, 20,000] and the median amount raised was 1450USD [IQR = 578, 4050]. Most campaigns were for adult males (53%) and 62% of adults had children. A minority were for pediatric patients (17%). Thirty‐seven percent of adult patients were primary wage earners and 43% reported losing their job or substantially reducing hours due to illness. Twenty‐nine percent reported no insurance or insufficient coverage. Campaigns most frequently sought funds for medical bills (60%), nonmedical bills (27%), and medical travel (23%). Qualitative campaign narratives mostly emphasized patients’ hardship (46.3%) or high moral character (35.2%). Only 8% of campaigns achieved their target funds. Conclusions Despite fundraising efforts, patients with kidney cancer face persistent financial barriers, incurring both medical and nonmedical cost burdens. This may be compounded by limited or no insurance. Cancer care providers should be aware of financial constraints placed on kidney cancer patients, and consider how these may impact treatment regimens.
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Affiliation(s)
- Hannah S Thomas
- University of Edinburgh School of Medicine, Edinburgh, UK.,Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Austin W Lee
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Behnam Nabavizadeh
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Nikan K Namiri
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Nizar Hakam
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Patrick Martin-Tuite
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Natalie Rios
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Anthony Enriquez
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Nnenaya A Mmonu
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Andrew J Cohen
- The Brady Urological Institute at Johns Hopkins, Baltimore, MD, USA
| | - Benjamin N Breyer
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA.,Department of Biostatistics and Epidemiology, University of California-San Francisco, San Francisco, CA, USA
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47
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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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48
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van Middendorp H, Berende A, Vos FJ, Ter Hofstede HHM, Kullberg BJ, Evers AWM. Expectancies as predictors of symptom improvement after antimicrobial therapy for persistent symptoms attributed to Lyme disease. Clin Rheumatol 2021; 40:4295-4308. [PMID: 34031759 PMCID: PMC8463383 DOI: 10.1007/s10067-021-05760-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 04/29/2021] [Accepted: 05/02/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION/OBJECTIVE Expectancies about symptom improvement or deterioration are reliable predictors of symptom progression and treatment outcomes (symptom resolution or symptomatic improvement) in many (non-)pharmacological studies and treatments. This study examined predictors of symptom improvement after antimicrobial therapy for persistent symptoms attributed to Lyme disease, hypothesizing particularly pre-treatment expectancies regarding symptom improvement to be predictive. METHODS A predictive study was performed on pre-treatment and post-treatment individual characteristics, including expectancies, and physical and mental health-related quality of life (HRQoL) from the PLEASE-trial comparing randomized 12-weeks of doxycycline, clarithromycin-hydroxychloroquine, or placebo following 2 weeks of intravenous ceftriaxone. At end-of-treatment (14 weeks after trial start) and follow-up (52 weeks), complete data of 231 and 170 (of initial 280) patients with persistent symptoms temporally related to a history of erythema migrans or otherwise confirmed symptomatic Lyme disease, or accompanied by B. burgdorferi IgG or IgM antibodies, were examined through hierarchical regression analyses. RESULTS In addition to pre-treatment HRQoL, pre-treatment expectancies regarding symptom improvement were consistently associated with stronger physical and mental HRQoL improvements at both end-of-treatment and follow-up (95% CI range: .09;.54, p < .01 to .27;.92, p < .001). Post-treatment expectancies regarding having received antibiotics vs. placebo was associated with more HRQoL improvement at end-of-treatment, but not at follow-up (95% CI-range 1.00;4.75, p = .003 to -7.34; -2.22, p < .001). CONCLUSIONS The present study shows that, next to pre-treatment functioning, patients' pre-treatment and post-treatment expectancies regarding improvement of persistent symptoms attributed to Lyme disease relate to a more beneficial symptom course. Expectancies of patients may be relevant to explain and potentially improve patient outcomes (e.g., by optimized communication about treatment success). TRIAL REGISTRATION ClinicalTrials.gov, NCT01207739 (Registration date: 23-09-2010) Key Points • As there is currently no sufficient symptom resolution or symptomatic improvement for many patients with persistent symptoms attributed to Lyme disease, it is relevant to know which factors determine symptom progression and predict heterogeneity in treatment response. • Next to pre-treatment functioning, expectancies regarding symptom improvement and having received antimicrobial study medication are associated with a more beneficial symptom course after both shorter-term and longer-term antimicrobial treatment. • Expectancies are relevant to consider in treatment studies and may be useful in clinical settings to improve symptom course and treatment outcome (e.g., by optimized communication about treatment success).
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Affiliation(s)
- Henriët van Middendorp
- Health, Medical and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Institute of Psychology, Leiden University, PO Box 9555, 2300 RB, Leiden, The Netherlands.
| | - Anneleen Berende
- Department of Medicine, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.,Gelre Ziekenhuizen, Apeldoorn, The Netherlands
| | - Fidel J Vos
- Department of Medicine, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.,Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Hadewych H M Ter Hofstede
- Department of Medicine, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bart Jan Kullberg
- Department of Medicine, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Institute of Psychology, Leiden University, PO Box 9555, 2300 RB, Leiden, The Netherlands.,Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
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Kortela E, Kanerva MJ, Puustinen J, Hurme S, Airas L, Lauhio A, Hohenthal U, Jalava-Karvinen P, Nieminen T, Finnilä T, Häggblom T, Pietikäinen A, Koivisto M, Vilhonen J, Marttila-Vaara M, Hytönen J, Oksi J. Oral Doxycycline Compared to Intravenous Ceftriaxone in the Treatment of Lyme Neuroborreliosis: A Multicenter, Equivalence, Randomized, Open-label Trial. Clin Infect Dis 2021; 72:1323-1331. [PMID: 32133487 DOI: 10.1093/cid/ciaa217] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/01/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Lyme neuroborreliosis (LNB) is often treated with intravenous ceftriaxone even if doxycycline is suggested to be noninferior to ceftriaxone. We evaluated the efficacy of oral doxycycline in comparison to ceftriaxone in the treatment of LNB. METHODS Patients with neurological symptoms suggestive of LNB without other obvious reasons were recruited. The inclusion criteria were (1) production of Borrelia burgdorferi-specific antibodies in cerebrospinal fluid (CSF) or serum; (2) B. burgdorferi DNA in the CSF; or (3) an erythema migrans during the past 3 months. Participants were randomized in a 1:1 ratio to receive either oral doxycycline 100 mg twice daily for 4 weeks, or intravenous ceftriaxone 2 g daily for 3 weeks. The participants described their subjective condition with a visual analogue scale (VAS) from 0 to 10 (0 = normal; 10 = worst) before the treatment, and 4 and 12 months after the treatment. The primary outcome was the change in the VAS score at 12 months. RESULTS Between 14 September 2012 and 28 December 2017, 210 adults with suspected LNB were assigned to receive doxycycline (n = 104) or ceftriaxone (n = 106). The per-protocol analysis comprised 82 patients with doxycycline and 84 patients with ceftriaxone. The mean change in the VAS score was -3.9 in the doxycycline group and -3.8 in the ceftriaxone group (mean difference, 0.17 [95% confidence interval, -.59 to .92], which is within the prespecified equivalence margins of -1 to 1 units). Participants in both groups improved equally. CONCLUSIONS Oral doxycycline is equally effective as intravenous ceftriaxone in the treatment of LNB. CLINICAL TRIALS REGISTRATION NCT01635530 and EudraCT 2012-000313-37.
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Affiliation(s)
- Elisa Kortela
- Department of Clinical Medicine, University of Turku, Turku, Finland.,Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mari J Kanerva
- Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Juha Puustinen
- Unit of Neurology, Satakunta Central Hospital, Pori, Finland.,Department of Neurology, University of Turku, Turku, Finland.,Division of Pharmacology and Pharmacotherapy, University of Helsinki, Helsinki, Finland
| | - Saija Hurme
- Department of Biostatistics, University of Turku, Turku, Finland
| | - Laura Airas
- Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland
| | | | - Ulla Hohenthal
- Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland
| | - Päivi Jalava-Karvinen
- Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland
| | - Tuomas Nieminen
- Infectious Diseases Unit, Satakunta Central Hospital, Pori, Finland
| | - Taru Finnilä
- Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland
| | - Tony Häggblom
- Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Mari Koivisto
- Department of Biostatistics, University of Turku, Turku, Finland
| | - Johanna Vilhonen
- Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland
| | - Minna Marttila-Vaara
- Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland
| | - Jukka Hytönen
- Institute of Biomedicine, University of Turku, Turku, Finland.,Clinical Microbiology, Turku University Hospital, Turku, Finland
| | - Jarmo Oksi
- Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland
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50
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Abstract
Lyme disease is a multisystem disease caused by Borrelia burgdorferi infection and accounts for well-defined manifestations, appearing either at an early or late stage. Appropriate antibiotic therapy generally leads to a favorable outcome. Still, unspecific persisting symptoms such as fatigue, myalgia, arthralgia or cognitive dysfunction are reported by several patients months to years after adequate treatment. Their underlying pathophysiologic mechanism is unclear. However, there is no evidence for microbiological persistence in these cases and attempts to resolve the symptoms by repeated or prolonged antibiotic treatment have not been convincingly successful, but they may rather be harmful. To narrow down the controversially handled entity of posttreatment Lyme disease syndrome (PTLDS) and to avoid overdiagnosis and overtreatment, case definitions have been proposed, acknowledging PTLDS as a complex of nonspecific, subjective symptoms, which are neither caused by ongoing infection nor by any other identifiable disease. PTLDS is mainly a diagnosis of exclusion and requires careful evaluation of differential diagnosis followed by counseling about optimal management in light of missing specific therapeutic options.
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Affiliation(s)
- Hanna Schmid
- From the University of Basel Children's Hospital, Paediatric Infectious Diseases and Vaccinology, Basel, Switzerland
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