Sanchez Edgar, Vannier Edouard, Wormser Gary P, Hu Linden T
Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts.
Division of Infectious Diseases, New York Medical College, Valhalla, New York.
JAMA. 2016 Apr 26;315(16):1767-77. doi: 10.1001/jama.2016.2884.
Lyme disease, human granulocytic anaplasmosis (HGA), and babesiosis are emerging tick-borne infections.
To provide an update on diagnosis, treatment, and prevention of tick-borne infections.
Search of PubMed and Scopus for articles on diagnosis, treatment, and prevention of tick-borne infections published in English from January 2005 through December 2015.
The search yielded 3550 articles for diagnosis and treatment and 752 articles for prevention. Of these articles, 361 were reviewed in depth. Evidence supports the use of US Food and Drug Administration-approved serologic tests, such as an enzyme immunoassay (EIA), followed by Western blot testing, to diagnose extracutaneous manifestations of Lyme disease. Microscopy and polymerase chain reaction assay of blood specimens are used to diagnose active HGA and babesiosis. The efficacy of oral doxycycline, amoxicillin, and cefuroxime axetil for treating Lyme disease has been established in multiple trials. Ceftriaxone is recommended when parenteral antibiotic therapy is recommended. Multiple trials have shown efficacy for a 10-day course of oral doxycycline for treatment of erythema migrans and for a 14-day course for treatment of early neurologic Lyme disease in ambulatory patients. Evidence indicates that a 10-day course of oral doxycycline is effective for HGA and that a 7- to 10-day course of azithromycin plus atovaquone is effective for mild babesiosis. Based on multiple case reports, a 7- to 10-day course of clindamycin plus quinine is often used to treat severe babesiosis. A recent study supports a minimum of 6 weeks of antibiotics for highly immunocompromised patients with babesiosis, with no parasites detected on blood smear for at least the final 2 weeks of treatment.
Evidence is evolving regarding the diagnosis, treatment, and prevention of Lyme disease, HGA, and babesiosis. Recent evidence supports treating patients with erythema migrans for no longer than 10 days when doxycycline is used and prescription of a 14-day course of oral doxycycline for early neurologic Lyme disease in ambulatory patients. The duration of antimicrobial therapy for babesiosis in severely immunocompromised patients should be extended to 6 weeks or longer.
莱姆病、人类粒细胞无形体病（HGA）和巴贝斯虫病是新出现的蜱传播感染。
提供蜱传播感染的诊断、治疗和预防方面的最新信息。
检索PubMed和Scopus数据库，查找2005年1月至2015年12月期间以英文发表的关于蜱传播感染的诊断、治疗和预防的文章。
检索得到3550篇关于诊断和治疗的文章以及752篇关于预防的文章。其中361篇文章得到深入综述。有证据支持使用美国食品药品监督管理局批准的血清学检测方法，如酶免疫测定（EIA），随后进行免疫印迹检测，以诊断莱姆病的皮肤外表现。血液标本的显微镜检查和聚合酶链反应检测用于诊断活动性HGA和巴贝斯虫病。口服多西环素、阿莫西林和头孢呋辛酯治疗莱姆病的疗效已在多项试验中得到证实。当推荐使用胃肠外抗生素治疗时，推荐使用头孢曲松。多项试验表明，口服多西环素10天疗程对游走性红斑有效，14天疗程对非卧床患者的早期神经型莱姆病有效。有证据表明，口服多西环素10天疗程对HGA有效，阿奇霉素加阿托伐醌7至10天疗程对轻度巴贝斯虫病有效。基于多个病例报告，克林霉素加奎宁7至10天疗程常用于治疗重度巴贝斯虫病。最近一项研究支持对高度免疫功能低下的巴贝斯虫病患者至少使用6周抗生素，且在治疗的最后2周至少血涂片未检测到寄生虫。
关于莱姆病、HGA和巴贝斯虫病的诊断、治疗和预防的证据不断发展。最近的证据支持，使用多西环素时，对游走性红斑患者的治疗时间不超过10天，对非卧床患者的早期神经型莱姆病开具口服多西环素14天疗程的处方。对严重免疫功能低下的巴贝斯虫病患者，抗菌治疗的持续时间应延长至6周或更长。
