Eppes Stephen C
Division of Infectious Diseases, Department of Pediatrics, A.I. duPont Hospital for Children, Wilmington, Delaware 19899, USA.
Paediatr Drugs. 2003;5(6):363-72. doi: 10.2165/00128072-200305060-00002.
The approaches to diagnosing and treating Lyme disease (LD) have been improved and refined as a result of basic and clinical research, and considerable practical experience. In addition, there have been recent studies that have allowed improvements in the ability to prevent infection with Borrelia burgdorferi. This paper will review the relevant literature and address recent developments in the diagnosis, treatment, and prevention of LD. Issues specifically related to the management of children will be identified. Controversies regarding treatment approaches will be examined in some detail. Understanding the clinical manifestations, or stage, of LD is crucial when approaching both diagnosis and treatment. Early localized disease is best diagnosed by recognizing the characteristic skin lesion, erythema migrans. Early disease will frequently, but not always, be accompanied by a detectable antibody response, particularly IgM antibody to the spirochete. Late disease, chiefly arthritis, is generally associated with high levels of IgG antibody. Western blot technology allows confirmation of enzyme immunoassay results and is especially useful when the latter is in the low or equivocal range. Early localized disease responds well to oral antibacterial therapy. Early disseminated disease, often associated with neurologic findings, may require parenteral therapy. The arthritis associated with LD frequently responds to oral antibacterials, but some refractory cases may require intravenous therapy, and occasionally surgery. Doxycycline is the oral antibacterial of choice, while amoxicillin and cefuroxime axetil are alternatives that may be preferred in young children. Owing to its long half-life and once daily dose administration, intravenous ceftriaxone has become the accepted standard for parenteral therapy. Tick avoidance has long been the mainstay for preventing LD. Antibacterial prophylaxis, using doxycycline, for tick bites has been shown to be an effective approach to prevention, but its relevance to pediatrics is uncertain. Vaccines designed to prevent infection have also been developed.
由于基础和临床研究以及丰富的实践经验，莱姆病（LD）的诊断和治疗方法得到了改进和完善。此外，最近的研究使得预防伯氏疏螺旋体感染的能力有所提高。本文将回顾相关文献，并阐述莱姆病诊断、治疗和预防方面的最新进展。将确定与儿童管理特别相关的问题。将详细探讨治疗方法方面的争议。在进行诊断和治疗时，了解莱姆病的临床表现或阶段至关重要。早期局限性疾病最好通过识别特征性皮肤病变——游走性红斑来诊断。早期疾病通常但并非总是伴有可检测到的抗体反应，特别是针对螺旋体的IgM抗体。晚期疾病主要是关节炎，通常与高水平的IgG抗体相关。免疫印迹技术可用于确认酶免疫测定结果，当后者处于低水平或不确定范围时尤其有用。早期局限性疾病对口服抗菌治疗反应良好。早期播散性疾病常伴有神经系统表现，可能需要胃肠外治疗。与莱姆病相关的关节炎通常对口服抗菌药物有反应，但一些难治性病例可能需要静脉治疗，偶尔还需要手术。多西环素是首选的口服抗菌药物，而阿莫西林和头孢呋辛酯是替代品，可能更适合幼儿。由于其半衰期长且每日给药一次，静脉注射头孢曲松已成为胃肠外治疗的公认标准。长期以来，避免蜱叮咬一直是预防莱姆病的主要方法。使用多西环素进行蜱叮咬后的抗菌预防已被证明是一种有效的预防方法，但其在儿科中的相关性尚不确定。旨在预防感染的疫苗也已研发出来。
