在疑似莱姆病的患者中采用整体治疗方法，导致确诊比例低于 10%，抗生素治疗失败比例超过 80%。
Holistic Approach in Patients With Presumed Lyme Borreliosis Leads to Less Than 10% of Confirmation and More Than 80% of Antibiotic Failures.
机构信息
Sorbonne Université, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Service de Maladies infectieuses et Tropicales, Paris, France.
Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France.
出版信息
Clin Infect Dis. 2019 May 30;68(12):2060-2066. doi: 10.1093/cid/ciy799.
BACKGROUND
There is no precise idea whether patients with chronic symptoms attributed to Lyme borreliosis (LB) have LB or another disease.
METHODS
We evaluated patients consulting for a presumed LB with a holistic approach including presumptive treatment. We included symptomatic patients consulting for presumed LB. They were classified as confirmed LB when they met four criteria, and possible LB if three with a positive clinical response to presumptive treatment.
RESULTS
Amongst the 301 patients, 275 (91%) were exposed to tick bites, and 165 (54%) were bitten by a tick. At presentation, 151 patients (50.1%) had already been treated with a median of one (1-22) course of antimicrobials, during 34 (28-730) days. Median number of symptoms was three (1-12) with a median duration of 16 (1-68) months. Median number of signs was zero (0-2). ELISA was positive in 84/295 (28.4%) for IgM and 86/295 (29.1%) for IgG, and immunoblot was positive in 21/191 (10.9%) for IgM and 50/191 (26.1 %) for IgG. Presumptive treatment after presentation failed in 46/88 patients (52%). Diagnosis of LB was confirmed in 29 patients (9.6%), and possible in 9 (2.9%). Of the 243 patients with non-LB diagnosis, diseases were psychological, musculoskeletal, neurological or other origin in 76 (31.2%), 48 (19.7%), 37 (15.2%) and 82 (33.7%) patients respectively. Patients with other diseases were significantly younger, having more symptoms, longest duration of symptoms, less clinical signs and less frequent LB positive serologies.
CONCLUSIONS
Overdiagnosis and overtreatment of LB is worsening. Health authorities should investigate this phenomenon.
背景
目前尚不清楚患有慢性莱姆病（LB）相关症状的患者是否患有 LB 或其他疾病。
方法
我们采用整体方法评估疑似 LB 的患者，包括推测性治疗。我们纳入了因疑似 LB 而就诊的有症状患者。如果符合以下四项标准，则将其归类为确诊 LB，如果符合三项标准但对推测性治疗有阳性临床反应，则归类为可能 LB。
结果
在 301 名患者中，275 名（91%）有蜱叮咬史，165 名（54%）被蜱叮咬。就诊时，151 名患者（50.1%）已经接受过中位数为 1 个疗程（1-22 个疗程）的抗生素治疗，治疗时间为 34 天（28-730 天）。中位数症状数为 3 个（1-12 个），中位数持续时间为 16 个月（1-68 个月）。中位数体征数为 0 个（0-2 个）。295 例患者中，84 例（28.4%）IgM 酶联免疫吸附试验（ELISA）阳性，86 例（29.1%）IgG ELISA 阳性，191 例患者中 21 例（10.9%）IgM 免疫印迹阳性，50 例（26.1%）IgG 免疫印迹阳性。就诊后推测性治疗失败 46 例（52%）。确诊 LB 29 例（9.6%），可能 LB 9 例（2.9%）。243 例非 LB 诊断患者中，分别有 76 例（31.2%）、48 例（19.7%）、37 例（15.2%）和 82 例（33.7%）患者的疾病来源于心理、肌肉骨骼、神经或其他原因。患有其他疾病的患者明显更年轻，症状更多，症状持续时间更长，临床体征更少，LB 阳性血清学检查结果更少。
结论
LB 的过度诊断和过度治疗正在恶化。卫生当局应调查这一现象。
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