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[神经型莱姆病——诊断、治疗与病程]

[Neuroborreliosis - Diagnostics, treatment and course].

作者信息

Dersch R, Rauer S

机构信息

Abteilung für Neurologie und Neurophysiologie, Universitätsklinikum Freiburg, Breisacher Str. 64, 79106, Freiburg, Deutschland.

出版信息

Nervenarzt. 2017 Apr;88(4):419-431. doi: 10.1007/s00115-016-0263-1.

Abstract

Lyme neuroborreliosis is a tick-borne infectious disease caused by the spirochete bacterium Borrelia burgdorferi sensu lato. Clinical manifestations are classified as early and late Lyme neuroborreliosis. Early manifestations are much more common than late manifestations. Serological testing should only be performed when typical neurological symptoms are present because false positive results are common due to a high seroprevalence in the population. Cerebrospinal fluid (CSF) analysis should be performed if Lyme neuroborreliosis is suspected. A systematic review found similar effects of beta-lactam antibiotics and doxycycline regarding the outcome of neurological symptoms and adverse effects. The prognosis after antibiotic treatment is usually favorable and residual symptoms can rarely persist. Impairments in quality of life, fatigue, depression and cognitive impairment are not more frequent in patients after treatment of Lyme neuroborreliosis than in the normal healthy population.

摘要

莱姆病神经疏螺旋体病是一种由疏螺旋体伯氏疏螺旋体狭义亚种引起的蜱传感染性疾病。临床表现分为早期和晚期莱姆病神经疏螺旋体病。早期表现比晚期表现更为常见。仅当出现典型神经症状时才应进行血清学检测,因为人群中血清阳性率高,假阳性结果很常见。如果怀疑莱姆病神经疏螺旋体病,应进行脑脊液(CSF)分析。一项系统评价发现,β-内酰胺类抗生素和多西环素在神经症状结局和不良反应方面有相似的效果。抗生素治疗后的预后通常良好,残留症状很少持续存在。莱姆病神经疏螺旋体病治疗后的患者在生活质量、疲劳、抑郁和认知障碍方面的损害并不比正常健康人群更常见。

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