Chomel B
Rev Sci Tech. 2015 Aug;34(2):569-76. doi: 10.20506/rst.34.2.2380.
Lyme disease is among the most frequently diagnosed zoonotic tick-borne diseases worldwide. The number of human cases has been on the increase since the first recognition of its aetiological agent. Lyme disease is caused by spirochete bacteria belonging to the genus Borrelia, with B. burgdorferi sensu stricto (s.s.) found in the Americas, and B. afzelii and B. garinii, in addition to B. burgdorferi s.s., in Europe and Asia. Environmental factors, such as human encroachment onto habitats favourable to ticks and their hosts, reduced deforestation, increased human outdoor activities, and climatic factors favouring a wider distribution of tick vectors, have enhanced the impact of the disease on both humans and animals. Clinical manifestations in humans include, in the early phases, erythema migrans, followed several weeks later by neuro-borreliosis (meningo-radiculitis, meningitis or meningo-encephalitis), Lyme arthritis and/or Borrelia lymphocytoma. In dogs, acute signs include fever, general malaise, lameness, lymph node enlargement and polyarthritis, as well as neuro-borreliosis in the chronic form. Diagnosis is mainly serological in both humans and animals, based on either a two-tier approach (an immunoenzymatic test followed by a Western blot confirmatory test) in humans or C(6) peptide, only in dogs. Early treatment with antibiotics, such as doxycycline or amoxicillin, for three weeks usually reduces the risk of chronic disease. Tick control, including the use of tick repellents for both humans and animals, particularly dogs, is highly reliable in preventing transmission. Vaccines are not available to prevent human infection, whereas several vaccines are available to reduce transmission and the clinical manifestations of infection in dogs.
莱姆病是全球最常被诊断出的人兽共患蜱传疾病之一。自首次确认其病原体以来,人类病例数量一直在增加。莱姆病由属于疏螺旋体属的螺旋体细菌引起,在美洲发现的是狭义伯氏疏螺旋体(Borrelia burgdorferi sensu stricto,s.s.),在欧洲和亚洲除狭义伯氏疏螺旋体外,还有阿氏疏螺旋体(B. afzelii)和伽氏疏螺旋体(B. garinii)。环境因素,如人类侵占有利于蜱及其宿主生存的栖息地、森林砍伐减少、人类户外活动增加以及有利于蜱传播媒介更广泛分布的气候因素,都增强了该疾病对人类和动物的影响。人类的临床表现早期为游走性红斑,数周后会出现神经型疏螺旋体病(脑脊神经根炎、脑膜炎或脑膜脑炎)、莱姆关节炎和/或伯氏疏螺旋体淋巴细胞瘤。犬类的急性症状包括发热、全身不适、跛行、淋巴结肿大和多关节炎,以及慢性形式的神经型疏螺旋体病。人类和动物的诊断主要依靠血清学检测,人类采用两层检测法(免疫酶试验后进行免疫印迹确认试验),犬类仅检测C(6)肽。早期使用抗生素,如多西环素或阿莫西林,治疗三周通常可降低慢性病风险。蜱虫控制,包括对人类和动物,特别是犬类使用蜱虫驱避剂,在预防传播方面非常可靠。目前尚无预防人类感染的疫苗,而有几种疫苗可减少犬类感染的传播及临床表现。