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Alruwaili Y, Jacobs MB, Hasenkampf NR, Tardo AC, McDaniel CE, Embers ME. Superior efficacy of combination antibiotic therapy versus monotherapy in a mouse model of Lyme disease. Front Microbiol 2023; 14:1293300. [PMID: 38075920 PMCID: PMC10703379 DOI: 10.3389/fmicb.2023.1293300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/08/2023] [Indexed: 02/08/2024] Open
Abstract
Lyme disease (LD) results from the most prevalent tick-borne infection in North America, with over 476,000 estimated cases annually. The disease is caused by Borrelia burgdorferi (Bb) sensu lato which transmits through the bite of Ixodid ticks. Most cases treated soon after infection are resolved by a short course of oral antibiotics. However, 10-20% of patients experience chronic symptoms because of delayed or incomplete treatment, a condition called Post-Treatment Lyme Disease (PTLD). Some Bb persists in PTLD patients after the initial course of antibiotics and an effective treatment to eradicate the persistent Bb is needed. Other organisms that cause persistent infections, such as M. tuberculosis, are cleared using a combination of therapies rather than monotherapy. A group of Food and Drug Administration (FDA)-approved drugs previously shown to be efficacious against Bb in vitro were used in monotherapy or in combination in mice infected with Bb. Different methods of detection were used to assess the efficacy of the treatments in the infected mice including culture, xenodiagnosis, and molecular techniques. None of the monotherapies eradicated persistent Bb. However, 4 dual combinations (doxycycline + ceftriaxone, dapsone + rifampicin, dapsone + clofazimine, doxycycline + cefotaxime) and 3 triple combinations (doxycycline + ceftriaxone+ carbomycin, doxycycline + cefotaxime+ loratadine, dapsone+ rifampicin+ clofazimine) eradicated persistent Bb infections. These results suggest that combination therapy should be investigated in preclinical studies for treating human Lyme disease.
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Affiliation(s)
- Yasir Alruwaili
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Jouf University, Sakaka, Saudi Arabia
- Division of Immunology, Tulane National Primate Research Center, Tulane University, Covington, LA, United States
- Department of Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Mary B. Jacobs
- Division of Immunology, Tulane National Primate Research Center, Tulane University, Covington, LA, United States
| | - Nicole R. Hasenkampf
- Division of Immunology, Tulane National Primate Research Center, Tulane University, Covington, LA, United States
| | - Amanda C. Tardo
- Division of Immunology, Tulane National Primate Research Center, Tulane University, Covington, LA, United States
| | - Celine E. McDaniel
- Division of Immunology, Tulane National Primate Research Center, Tulane University, Covington, LA, United States
| | - Monica E. Embers
- Division of Immunology, Tulane National Primate Research Center, Tulane University, Covington, LA, United States
- Department of Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
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Horowitz RI, Fallon J, Freeman PR. Comparison of the Efficacy of Longer versus Shorter Pulsed High Dose Dapsone Combination Therapy in the Treatment of Chronic Lyme Disease/Post Treatment Lyme Disease Syndrome with Bartonellosis and Associated Coinfections. Microorganisms 2023; 11:2301. [PMID: 37764145 PMCID: PMC10537894 DOI: 10.3390/microorganisms11092301] [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: 08/08/2023] [Revised: 08/27/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Twenty-five patients with relapsing and remitting Borreliosis, Babesiosis, and bartonellosis despite extended anti-infective therapy were prescribed double-dose dapsone combination therapy (DDDCT), followed by one or several courses of High Dose Dapsone Combination Therapy (HDDCT). A retrospective chart review of these 25 patients undergoing DDDCT therapy and HDDCT demonstrated that 100% improved their tick-borne symptoms, and patients completing 6-7 day pulses of HDDCT had superior levels of improvement versus 4-day pulses if Bartonella was present. At the completion of treatment, 7/23 (30.5%) who completed 8 weeks of DDDCT followed by a 5-7 day pulse of HDDCT remained in remission for 3-9 months, and 3/23 patients (13%) who recently finished treatment were 1 ½ months in full remission. In conclusion, DDDCT followed by 6-7 day pulses of HDDCT could represent a novel, effective anti-infective strategy in chronic Lyme disease/Post Treatment Lyme Disease Syndrome (PTLDS) and associated co-infections, including Bartonella, especially in individuals who have failed standard antibiotic protocols.
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Affiliation(s)
- Richard I. Horowitz
- Lyme and Tick-Borne Diseases Working Group, New York State Department of Health, Albany, NY 12224, USA
- Hudson Valley Healing Arts Center, Hyde Park, NY 12538, USA; (J.F.); (P.R.F.)
| | - John Fallon
- Hudson Valley Healing Arts Center, Hyde Park, NY 12538, USA; (J.F.); (P.R.F.)
| | - Phyllis R. Freeman
- Hudson Valley Healing Arts Center, Hyde Park, NY 12538, USA; (J.F.); (P.R.F.)
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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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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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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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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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Abstract
Lyme borreliosis is the most common vectorborne disease in the northern hemisphere. It usually begins with erythema migrans; early disseminated infection particularly causes multiple erythema migrans or neurologic disease, and late manifestations predominantly include arthritis in North America, and acrodermatitis chronica atrophicans (ACA) in Europe. Diagnosis of Lyme borreliosis is based on characteristic clinical signs and symptoms, complemented by serological confirmation of infection once an antibody response has been mounted. Manifestations usually respond to appropriate antibiotic regimens, but the disease can be followed by sequelae, such as immune arthritis or residual damage to affected tissues. A subset of individuals reports persistent symptoms, including fatigue, pain, arthralgia, and neurocognitive symptoms, which in some people are severe enough to fulfil the criteria for post-treatment Lyme disease syndrome. The reported prevalence of such persistent symptoms following antimicrobial treatment varies considerably, and its pathophysiology is unclear. Persistent active infection in humans has not been identified as a cause of this syndrome, and randomized treatment trials have invariably failed to show any benefit of prolonged antibiotic treatment. For prevention of Lyme borreliosis, post-exposure prophylaxis may be indicated in specific cases, and novel vaccine strategies are under development.
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Affiliation(s)
- Bart Jan Kullberg
- Department of Medicine and Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Hedwig D Vrijmoeth
- Department of Medicine and Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Freek van de Schoor
- Department of Medicine and Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Joppe W Hovius
- Amsterdam University Medical Centers, location AMC, Department of Medicine, Division of Infectious Diseases, and Amsterdam Multidisciplinary Lyme borreliosis Center, Amsterdam, Netherlands
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Berende A, Ter Hofstede HJM, Vos FJ, Vogelaar ML, van Middendorp H, Evers AWM, Kessels RPC, Kullberg BJ. Effect of prolonged antibiotic treatment on cognition in patients with Lyme borreliosis. Neurology 2019; 92:e1447-e1455. [PMID: 30796143 PMCID: PMC6453770 DOI: 10.1212/wnl.0000000000007186] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 11/21/2018] [Indexed: 11/24/2022] Open
Abstract
Objective To investigate whether longer-term antibiotic treatment improves cognitive performance in patients with persistent symptoms attributed to Lyme borreliosis. Methods Data were collected during the Persistent Lyme Empiric Antibiotic Study Europe (PLEASE) trial, a randomized, placebo-controlled study. Study participants passed performance-validity testing (measure for detecting suboptimal effort) and had persistent symptoms attributed to Lyme borreliosis. All patients received a 2-week open-label regimen of intravenous ceftriaxone before the 12-week blinded oral regimen (doxycycline, clarithromycin/hydroxychloroquine, or placebo). Cognitive performance was assessed at baseline and after 14, 26, and 40 weeks with neuropsychological tests covering the cognitive domains of episodic memory, attention/working memory, verbal fluency, speed of information processing, and executive function. Results Baseline characteristics of patients enrolled (n = 239) were comparable in all treatment groups. After 14 weeks, performance on none of the cognitive domains differed significantly between the treatment arms (p = 0.49–0.82). At follow-up, no additional treatment effect (p = 0.35–0.98) or difference between groups (p = 0.37–0.93) was found at any time point. Patients performed significantly better in several cognitive domains at weeks 14, 26, and 40 compared to baseline, but this was not specific to a treatment group. Conclusions A 2-week treatment with ceftriaxone followed by a 12-week regimen of doxycycline or clarithromycin/hydroxychloroquine did not lead to better cognitive performance compared to a 2-week regimen of ceftriaxone in patients with Lyme disease–attributed persistent symptoms. ClinicalTrials.gov identifier NCT01207739. Classification of evidence This study provides Class II evidence that longer-term antibiotics in patients with borreliosis-attributed persistent symptoms does not increase cognitive performance compared to shorter-term antibiotics.
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Affiliation(s)
- Anneleen Berende
- From the Department of Medicine (A.B., H.J.M.t.H., F.J.V., B.J.K.), Radboud Center for Infectious Diseases (A.B., H.J.M.t.H., F.J.V., B.J.K.), and Department of Medical Psychology (M.L.V., H.v.M., A.W.M.E., R.P.C.K.), Radboud University Medical Center; Department of Medicine (F.J.V.), Sint Maartenskliniek, Nijmegen; Institute of Psychology (H.v.M., A.W.M.E.), Health, Medical, and Neuropsychology Unit, Leiden University; and Donders Institute for Brain, Cognition and Behaviour (R.P.C.K.), Radboud University, Nijmegen, the Netherlands.
| | - Hadewych J M Ter Hofstede
- From the Department of Medicine (A.B., H.J.M.t.H., F.J.V., B.J.K.), Radboud Center for Infectious Diseases (A.B., H.J.M.t.H., F.J.V., B.J.K.), and Department of Medical Psychology (M.L.V., H.v.M., A.W.M.E., R.P.C.K.), Radboud University Medical Center; Department of Medicine (F.J.V.), Sint Maartenskliniek, Nijmegen; Institute of Psychology (H.v.M., A.W.M.E.), Health, Medical, and Neuropsychology Unit, Leiden University; and Donders Institute for Brain, Cognition and Behaviour (R.P.C.K.), Radboud University, Nijmegen, the Netherlands
| | - Fidel J Vos
- From the Department of Medicine (A.B., H.J.M.t.H., F.J.V., B.J.K.), Radboud Center for Infectious Diseases (A.B., H.J.M.t.H., F.J.V., B.J.K.), and Department of Medical Psychology (M.L.V., H.v.M., A.W.M.E., R.P.C.K.), Radboud University Medical Center; Department of Medicine (F.J.V.), Sint Maartenskliniek, Nijmegen; Institute of Psychology (H.v.M., A.W.M.E.), Health, Medical, and Neuropsychology Unit, Leiden University; and Donders Institute for Brain, Cognition and Behaviour (R.P.C.K.), Radboud University, Nijmegen, the Netherlands
| | - Michiel L Vogelaar
- From the Department of Medicine (A.B., H.J.M.t.H., F.J.V., B.J.K.), Radboud Center for Infectious Diseases (A.B., H.J.M.t.H., F.J.V., B.J.K.), and Department of Medical Psychology (M.L.V., H.v.M., A.W.M.E., R.P.C.K.), Radboud University Medical Center; Department of Medicine (F.J.V.), Sint Maartenskliniek, Nijmegen; Institute of Psychology (H.v.M., A.W.M.E.), Health, Medical, and Neuropsychology Unit, Leiden University; and Donders Institute for Brain, Cognition and Behaviour (R.P.C.K.), Radboud University, Nijmegen, the Netherlands
| | - Henriët van Middendorp
- From the Department of Medicine (A.B., H.J.M.t.H., F.J.V., B.J.K.), Radboud Center for Infectious Diseases (A.B., H.J.M.t.H., F.J.V., B.J.K.), and Department of Medical Psychology (M.L.V., H.v.M., A.W.M.E., R.P.C.K.), Radboud University Medical Center; Department of Medicine (F.J.V.), Sint Maartenskliniek, Nijmegen; Institute of Psychology (H.v.M., A.W.M.E.), Health, Medical, and Neuropsychology Unit, Leiden University; and Donders Institute for Brain, Cognition and Behaviour (R.P.C.K.), Radboud University, Nijmegen, the Netherlands
| | - Andrea W M Evers
- From the Department of Medicine (A.B., H.J.M.t.H., F.J.V., B.J.K.), Radboud Center for Infectious Diseases (A.B., H.J.M.t.H., F.J.V., B.J.K.), and Department of Medical Psychology (M.L.V., H.v.M., A.W.M.E., R.P.C.K.), Radboud University Medical Center; Department of Medicine (F.J.V.), Sint Maartenskliniek, Nijmegen; Institute of Psychology (H.v.M., A.W.M.E.), Health, Medical, and Neuropsychology Unit, Leiden University; and Donders Institute for Brain, Cognition and Behaviour (R.P.C.K.), Radboud University, Nijmegen, the Netherlands
| | - Roy P C Kessels
- From the Department of Medicine (A.B., H.J.M.t.H., F.J.V., B.J.K.), Radboud Center for Infectious Diseases (A.B., H.J.M.t.H., F.J.V., B.J.K.), and Department of Medical Psychology (M.L.V., H.v.M., A.W.M.E., R.P.C.K.), Radboud University Medical Center; Department of Medicine (F.J.V.), Sint Maartenskliniek, Nijmegen; Institute of Psychology (H.v.M., A.W.M.E.), Health, Medical, and Neuropsychology Unit, Leiden University; and Donders Institute for Brain, Cognition and Behaviour (R.P.C.K.), Radboud University, Nijmegen, the Netherlands
| | - Bart Jan Kullberg
- From the Department of Medicine (A.B., H.J.M.t.H., F.J.V., B.J.K.), Radboud Center for Infectious Diseases (A.B., H.J.M.t.H., F.J.V., B.J.K.), and Department of Medical Psychology (M.L.V., H.v.M., A.W.M.E., R.P.C.K.), Radboud University Medical Center; Department of Medicine (F.J.V.), Sint Maartenskliniek, Nijmegen; Institute of Psychology (H.v.M., A.W.M.E.), Health, Medical, and Neuropsychology Unit, Leiden University; and Donders Institute for Brain, Cognition and Behaviour (R.P.C.K.), Radboud University, Nijmegen, the Netherlands
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Berende A, Nieuwenhuis L, ter Hofstede HJM, Vos FJ, Vogelaar ML, Tromp M, van Middendorp H, Donders ART, Evers AWM, Kullberg BJ, Adang EMM. Cost-effectiveness of longer-term versus shorter-term provision of antibiotics in patients with persistent symptoms attributed to Lyme disease. PLoS One 2018; 13:e0195260. [PMID: 29608590 PMCID: PMC5880374 DOI: 10.1371/journal.pone.0195260] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 03/17/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The treatment of persistent symptoms attributed to Lyme disease remains controversial. Recently, the PLEASE study did not demonstrate any additional clinical benefit of longer-term versus shorter-term antibiotic treatment. However, the economic impact of the antibiotic strategies has not been investigated. METHODS This prospective economic evaluation, adhering a societal perspective, was performed alongside the PLEASE study, a multicenter, placebo-controlled, double-blind 1:1:1 randomized clinical trial in which all patients received open-label intravenous ceftriaxone for two weeks before the 12-week randomized blinded oral antibiotic regimen (doxycycline, clarithromycin plus hydroxychloroquine, or placebo). Between 2010 and 2013, patients (n = 271) with borreliosis-attributed persistent symptoms were enrolled and followed for one year. Main outcomes were costs, quality-adjusted life years, and incremental net monetary benefit of longer-term versus shorter-term antibiotic therapy. RESULTS Mean quality-adjusted life years (95% CI) were not significantly different (p = 0.96): 0.82 (0.77-0.88) for ceftriaxone/doxycycline (n = 82), 0.81 (0.76-0.88) for ceftriaxone/clarithromycin-hydroxychloroquine (n = 93), and 0.81 (0.76-0.86) for ceftriaxone/placebo (n = 96). Total societal costs per patient (95% CI) were not significantly different either (p = 0.35): €11,995 (€8,823-€15,670) for ceftriaxone/doxycycline, €12,202 (€9,572-€15,253) for ceftriaxone/clarithromycin-hydroxychloroquine, and €15,249 (€11,294-€19,781) for ceftriaxone/placebo. Incremental net monetary benefit (95% CI) for ceftriaxone/doxycycline compared to ceftriaxone/placebo varied from €3,317 (-€2,199-€8,998) to €4,285 (-€6,085-€14,524) over the willingness-to-pay range, and that of ceftriaxone/clarithromycin-hydroxychloroquine compared to ceftriaxone/placebo from €3,098 (-€888-€7,172) to €3,710 (-€4,254-€11,651). For every willingness-to-pay threshold, the incremental net monetary benefits did not significantly differ from zero. CONCLUSION The longer-term treatments were similar with regard to costs, effectiveness and cost-effectiveness compared to shorter-term treatment in patients with borreliosis-attributed persistent symptoms after one year of follow-up. Given the results of this study, and taking into account the external costs associated with antibiotic resistance, the shorter-term treatment is the antibiotic regimen of first choice.
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Affiliation(s)
- Anneleen Berende
- Department of Internal Medicine, and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
- * E-mail:
| | - Lisette Nieuwenhuis
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Epidemiology, CAPHRI—School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
| | - Hadewych J. M. ter Hofstede
- Department of Internal Medicine, and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Fidel J. Vos
- Department of Internal Medicine, and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
- Sint Maartenskliniek, Nijmegen, Netherlands
| | - Michiel L. Vogelaar
- Department of Internal Medicine, and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Mirjam Tromp
- Department of Internal Medicine, and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Henriët van Middendorp
- Institute of Psychology; Health, Medical, and Neuropsychology Unit, Leiden University, Leiden, Netherlands
| | - A. Rogier T. Donders
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
| | - Andrea W. M. Evers
- Institute of Psychology; Health, Medical, and Neuropsychology Unit, Leiden University, Leiden, Netherlands
| | - Bart Jan Kullberg
- Department of Internal Medicine, and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Eddy M. M. Adang
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
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van den Wijngaard CC, Hofhuis A, Simões M, Rood E, van Pelt W, Zeller H, Van Bortel W. Surveillance perspective on Lyme borreliosis across the European Union and European Economic Area. ACTA ACUST UNITED AC 2017; 22. [PMID: 28703098 PMCID: PMC5508331 DOI: 10.2807/1560-7917.es.2017.22.27.30569] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 05/05/2017] [Indexed: 11/20/2022]
Abstract
Lyme borreliosis (LB) is the most prevalent tick-borne disease in Europe. Erythema migrans (EM), an early, localised skin rash, is its most common presentation. Dissemination of the bacteria can lead to more severe manifestations including skin, neurological, cardiac, musculoskeletal and ocular manifestations. Comparison of LB incidence rates in the European Union (EU)/European Economic Area (EEA) and Balkan countries are difficult in the absence of standardised surveillance and reporting procedures. We explored six surveillance scenarios for LB surveillance in the EU/EEA, based on the following key indicators: (i) erythema migrans, (ii) neuroborreliosis, (iii) all human LB manifestations, (iv) seroprevalence, (v) tick bites, and (vi) infected ticks and reservoir hosts. In our opinion, neuroborreliosis seems most feasible and useful as the standard key indicator, being one of the most frequent severe LB manifestations, with the possibility of a specific case definition. Additional surveillance with erythema migrans as key indicator would add value to the surveillance of neuroborreliosis and lead to a more complete picture of LB epidemiology in the EU/EEA. The other scenarios have less value as a basis for EU-level surveillance, but can be considered periodically and locally, as they could supply complementary insights.
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Affiliation(s)
- Cees C van den Wijngaard
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Agnetha Hofhuis
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Mariana Simões
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Ente Rood
- Epidemiology Unit, KIT (Royal Tropical Institute) Health, Amsterdam, the Netherlands
| | - Wilfrid van Pelt
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Herve Zeller
- Office of the Chief Scientist, European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Wim Van Bortel
- Surveillance and Response Support Unit, European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden (affiliation when the work was performed).,Institute of Tropical Medicine, Antwerp, Belgium (current affiliation)
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Hofmann H, Fingerle V, Hunfeld KP, Huppertz HI, Krause A, Rauer S, Ruf B. Cutaneous Lyme borreliosis: Guideline of the German Dermatology Society. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2017; 15:Doc14. [PMID: 28943834 PMCID: PMC5588623 DOI: 10.3205/000255] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Indexed: 02/07/2023]
Abstract
This guideline of the German Dermatology Society primarily focuses on the diagnosis and treatment of cutaneous manifestations of Lyme borreliosis. It has received consensus from 22 German medical societies and 2 German patient organisations. It is the first part of an AWMF (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V.) interdisciplinary guideline: “Lyme Borreliosis – Diagnosis and Treatment, development stage S3”. The guideline is directed at physicians in private practices and clinics who treat Lyme borreliosis. Objectives of this guideline are recommendations for confirming a clinical diagnosis, recommendations for a stage-related laboratory diagnosis (serological detection of IgM and IgG Borrelia antibodies using the 2-tiered ELISA/immunoblot process, sensible use of molecular diagnostic and culture procedures) and recommendations for the treatment of the localised, early-stage infection (erythema migrans, erythema chronicum migrans, and borrelial lymphocytoma), the disseminated early-stage infection (multiple erythemata migrantia, flu-like symptoms) and treatment of the late-stage infection (acrodermatitis chronica atrophicans with and without neurological manifestations). In addition, an information sheet for patients containing recommendations for the prevention of Lyme borreliosis is attached to the guideline.
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Affiliation(s)
- Heidelore Hofmann
- Klinik für Dermatologie und Allergologie der TU München, München, Germany
| | - Volker Fingerle
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit (LGL) Oberschleißheim, Germany
| | - Klaus-Peter Hunfeld
- Zentralinstitut für Labormedizin, Mikrobiologie & Krankenhaushygiene, Krankenhaus Nordwest, Frankfurt, Germany
| | | | | | | | - Bernhard Ruf
- Klinik für Infektiologie Klinik St Georg, Leipzig, Germany
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Berende A, ter Hofstede HJM, Vos FJ, van Middendorp H, Vogelaar ML, Tromp M, van den Hoogen FH, Donders ART, Evers AWM, Kullberg BJ. Randomized Trial of Longer-Term Therapy for Symptoms Attributed to Lyme Disease. N Engl J Med 2016; 374:1209-20. [PMID: 27028911 DOI: 10.1056/nejmoa1505425] [Citation(s) in RCA: 146] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The treatment of persistent symptoms attributed to Lyme disease remains controversial. We assessed whether longer-term antibiotic treatment of persistent symptoms attributed to Lyme disease leads to better outcomes than does shorter-term treatment. METHODS In a randomized, double-blind, placebo-controlled trial conducted in Europe, we assigned patients with persistent symptoms attributed to Lyme disease--either related temporally to proven Lyme disease or accompanied by a positive IgG or IgM immunoblot assay for Borrelia burgdorferi--to receive a 12-week oral course of doxycycline, clarithromycin plus hydroxychloroquine, or placebo. All study groups received open-label intravenous ceftriaxone for 2 weeks before initiating the randomized regimen. The primary outcome measure was health-related quality of life, as assessed by the physical-component summary score of the RAND-36 Health Status Inventory (RAND SF-36) (range, 15 to 61, with higher scores indicating better quality of life), at the end of the treatment period at week 14, after the 2-week course of ceftriaxone and the 12-week course of the randomized study drug or placebo had been completed. RESULTS Of the 281 patients who underwent randomization, 280 were included in the modified intention-to-treat analysis (86 patients in the doxycycline group, 96 in the clarithromycin-hydroxychloroquine group, and 98 in the placebo group). The SF-36 physical-component summary score did not differ significantly among the three study groups at the end of the treatment period, with mean scores of 35.0 (95% confidence interval [CI], 33.5 to 36.5) in the doxycycline group, 35.6 (95% CI, 34.2 to 37.1) in the clarithromycin-hydroxychloroquine group, and 34.8 (95% CI, 33.4 to 36.2) in the placebo group (P=0.69; a difference of 0.2 [95% CI, -2.4 to 2.8] in the doxycycline group vs. the placebo group and a difference of 0.9 [95% CI, -1.6 to 3.3] in the clarithromycin-hydroxychloroquine group vs. the placebo group); the score also did not differ significantly among the groups at subsequent study visits (P=0.35). In all study groups, the SF-36 physical-component summary score increased significantly from baseline to the end of the treatment period (P<0.001). The rates of adverse events were similar among the study groups. Four serious adverse events thought to be related to drug use occurred during the 2-week open-label ceftriaxone phase, and no serious drug-related adverse event occurred during the 12-week randomized phase. CONCLUSIONS In patients with persistent symptoms attributed to Lyme disease, longer-term antibiotic treatment did not have additional beneficial effects on health-related quality of life beyond those with shorter-term treatment. (Funded by the Netherlands Organization for Health Research and Development ZonMw; PLEASE ClinicalTrials.gov number, NCT01207739.).
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Affiliation(s)
- Anneleen Berende
- From the Departments of Medicine (A.B., H.J.M.H., F.J.V., M.L.V., M.T., B.J.K.), Medical Psychology (H.M., M.L.V., A.W.M.E.), Rheumatology (F.H.), and Health Evidence (A.R.T.D.) and the Radboud Center for Infectious Diseases (A.B., H.J.M.H., F.J.V., M.L.V., M.T., B.J.K.), Radboud University Medical Center, and Sint Maartenskliniek (F.J.V., F.H.), - both in Nijmegen, and the Health, Medical, and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden (H.M., A.W.M.E.) - all in the Netherlands
| | - Hadewych J M ter Hofstede
- From the Departments of Medicine (A.B., H.J.M.H., F.J.V., M.L.V., M.T., B.J.K.), Medical Psychology (H.M., M.L.V., A.W.M.E.), Rheumatology (F.H.), and Health Evidence (A.R.T.D.) and the Radboud Center for Infectious Diseases (A.B., H.J.M.H., F.J.V., M.L.V., M.T., B.J.K.), Radboud University Medical Center, and Sint Maartenskliniek (F.J.V., F.H.), - both in Nijmegen, and the Health, Medical, and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden (H.M., A.W.M.E.) - all in the Netherlands
| | - Fidel J Vos
- From the Departments of Medicine (A.B., H.J.M.H., F.J.V., M.L.V., M.T., B.J.K.), Medical Psychology (H.M., M.L.V., A.W.M.E.), Rheumatology (F.H.), and Health Evidence (A.R.T.D.) and the Radboud Center for Infectious Diseases (A.B., H.J.M.H., F.J.V., M.L.V., M.T., B.J.K.), Radboud University Medical Center, and Sint Maartenskliniek (F.J.V., F.H.), - both in Nijmegen, and the Health, Medical, and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden (H.M., A.W.M.E.) - all in the Netherlands
| | - Henriët van Middendorp
- From the Departments of Medicine (A.B., H.J.M.H., F.J.V., M.L.V., M.T., B.J.K.), Medical Psychology (H.M., M.L.V., A.W.M.E.), Rheumatology (F.H.), and Health Evidence (A.R.T.D.) and the Radboud Center for Infectious Diseases (A.B., H.J.M.H., F.J.V., M.L.V., M.T., B.J.K.), Radboud University Medical Center, and Sint Maartenskliniek (F.J.V., F.H.), - both in Nijmegen, and the Health, Medical, and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden (H.M., A.W.M.E.) - all in the Netherlands
| | - Michiel L Vogelaar
- From the Departments of Medicine (A.B., H.J.M.H., F.J.V., M.L.V., M.T., B.J.K.), Medical Psychology (H.M., M.L.V., A.W.M.E.), Rheumatology (F.H.), and Health Evidence (A.R.T.D.) and the Radboud Center for Infectious Diseases (A.B., H.J.M.H., F.J.V., M.L.V., M.T., B.J.K.), Radboud University Medical Center, and Sint Maartenskliniek (F.J.V., F.H.), - both in Nijmegen, and the Health, Medical, and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden (H.M., A.W.M.E.) - all in the Netherlands
| | - Mirjam Tromp
- From the Departments of Medicine (A.B., H.J.M.H., F.J.V., M.L.V., M.T., B.J.K.), Medical Psychology (H.M., M.L.V., A.W.M.E.), Rheumatology (F.H.), and Health Evidence (A.R.T.D.) and the Radboud Center for Infectious Diseases (A.B., H.J.M.H., F.J.V., M.L.V., M.T., B.J.K.), Radboud University Medical Center, and Sint Maartenskliniek (F.J.V., F.H.), - both in Nijmegen, and the Health, Medical, and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden (H.M., A.W.M.E.) - all in the Netherlands
| | - Frank H van den Hoogen
- From the Departments of Medicine (A.B., H.J.M.H., F.J.V., M.L.V., M.T., B.J.K.), Medical Psychology (H.M., M.L.V., A.W.M.E.), Rheumatology (F.H.), and Health Evidence (A.R.T.D.) and the Radboud Center for Infectious Diseases (A.B., H.J.M.H., F.J.V., M.L.V., M.T., B.J.K.), Radboud University Medical Center, and Sint Maartenskliniek (F.J.V., F.H.), - both in Nijmegen, and the Health, Medical, and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden (H.M., A.W.M.E.) - all in the Netherlands
| | - A Rogier T Donders
- From the Departments of Medicine (A.B., H.J.M.H., F.J.V., M.L.V., M.T., B.J.K.), Medical Psychology (H.M., M.L.V., A.W.M.E.), Rheumatology (F.H.), and Health Evidence (A.R.T.D.) and the Radboud Center for Infectious Diseases (A.B., H.J.M.H., F.J.V., M.L.V., M.T., B.J.K.), Radboud University Medical Center, and Sint Maartenskliniek (F.J.V., F.H.), - both in Nijmegen, and the Health, Medical, and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden (H.M., A.W.M.E.) - all in the Netherlands
| | - Andrea W M Evers
- From the Departments of Medicine (A.B., H.J.M.H., F.J.V., M.L.V., M.T., B.J.K.), Medical Psychology (H.M., M.L.V., A.W.M.E.), Rheumatology (F.H.), and Health Evidence (A.R.T.D.) and the Radboud Center for Infectious Diseases (A.B., H.J.M.H., F.J.V., M.L.V., M.T., B.J.K.), Radboud University Medical Center, and Sint Maartenskliniek (F.J.V., F.H.), - both in Nijmegen, and the Health, Medical, and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden (H.M., A.W.M.E.) - all in the Netherlands
| | - Bart Jan Kullberg
- From the Departments of Medicine (A.B., H.J.M.H., F.J.V., M.L.V., M.T., B.J.K.), Medical Psychology (H.M., M.L.V., A.W.M.E.), Rheumatology (F.H.), and Health Evidence (A.R.T.D.) and the Radboud Center for Infectious Diseases (A.B., H.J.M.H., F.J.V., M.L.V., M.T., B.J.K.), Radboud University Medical Center, and Sint Maartenskliniek (F.J.V., F.H.), - both in Nijmegen, and the Health, Medical, and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden (H.M., A.W.M.E.) - all in the Netherlands
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Vayssier-Taussat M, Cosson JF, Degeilh B, Eloit M, Fontanet A, Moutailler S, Raoult D, Sellal E, Ungeheuer MN, Zylbermann P. How a multidisciplinary 'One Health' approach can combat the tick-borne pathogen threat in Europe. Future Microbiol 2016; 10:809-18. [PMID: 26000651 DOI: 10.2217/fmb.15.15] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
In Europe, ticks are the major arthropod vectors of disease agents to humans and domestic animals. They are capable of transmitting many pathogens most of which have been discovered or identified as tick-borne pathogens in the last 20 years. In recent years, unexplained syndromes occurring after a tick bite have become an increasingly important issue in public and animal health. Ticks and wildlife (the main reservoir of tick-borne pathogens) are highly susceptible to global environmental and socio-economic changes, which in turn may lead to an increased burden of tick-borne diseases. In this review, we explain the importance of a 'One Health' approach to better combat tick-borne diseases.
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Affiliation(s)
| | | | | | - Marc Eloit
- 4Biology of Infection Unit, Inserm U1117, Pathogen discovery Laboratory, Institut Pasteur, Paris Cedex 15, France
| | - Arnaud Fontanet
- 5Unité d'Epidémiologie des Maladies Emergentes, Institut Pasteur, CNAM, Paris, France
| | - Sara Moutailler
- 1INRA, UMR Bipar, Anses, ENVA, USC INRA, 94700 Maisons-Alfort, France
| | - Didier Raoult
- 6URMITE, UM63, CNRS 7278, IRD 198, INSERM 1095, Aix Marseille Université, Marseille, France
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Bjark PH. Re: Ikke langvarig antibiotikabehandling ved sykdom tilskrevet borreliose. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2016; 136:1327. [DOI: 10.4045/tidsskr.16.0691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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