University Hospital "Dr. Jose Eleuterio Gonzalez", Department of Dermatology, Universidad Autonoma de Nuevo Leon, Av. Madero y Gonzalitos s/n, Colonia Mitras Centro, 64460, Monterrey, NL, Mexico.
Eur J Clin Microbiol Infect Dis. 2019 Feb;38(2):201-208. doi: 10.1007/s10096-018-3417-1. Epub 2018 Nov 19.
Lyme disease (borreliosis) is one of the most common vector-borne diseases worldwide. Its incidence and geographic expansion has been steadily increasing in the last decades. Lyme disease is caused by Borrelia burgdorferi sensu lato, a heterogeneous group of which three genospecies have been systematically associated to Lyme disease: B. burgdorferi sensu stricto Borrelia afzelii and Borrelia garinii. Geographical distribution and clinical manifestations vary according to the species involved. Lyme disease clinical manifestations may be divided into three stages. Early localized stage is characterized by erythema migrans in the tick bite site. Early disseminated stage may present multiple erythema migrans lesions, borrelial lymphocytoma, lyme neuroborreliosis, carditis, or arthritis. The late disseminated stage manifests with acordermatitis chronica atrophicans, lyme arthritis, and neurological symptoms. Diagnosis is challenging due to the varied clinical manifestations it may present and usually involves a two-step serological approach. In the current review, we present a thorough revision of the clinical manifestations Lyme disease may present. Additionally, history, microbiology, diagnosis, post-treatment Lyme disease syndrome, treatment, and prognosis are discussed.
莱姆病(波状热)是全球最常见的虫媒传染病之一。在过去几十年中,其发病率和地理分布范围一直在稳步扩大。莱姆病是由伯氏疏螺旋体(Borrelia burgdorferi sensu lato)引起的,该菌是一个具有异质性的群组,其中三种基因型已被系统地与莱姆病相关联:伯氏疏螺旋体(Borrelia burgdorferi sensu stricto)、阿氏疏螺旋体(Borrelia afzelii)和伽氏疏螺旋体(Borrelia garinii)。地理分布和临床表现因涉及的物种而异。莱姆病的临床表现可分为三个阶段。早期局部阶段的特征是蜱叮咬部位出现游走性红斑。早期播散阶段可能出现多个游走性红斑损害、伯氏疏螺旋体淋巴细胞瘤、莱姆神经伯氏疏螺旋体病、心肌炎或关节炎。晚期播散阶段表现为慢性萎缩性肢端皮炎、莱姆关节炎和神经系统症状。由于其可能出现的各种临床表现,诊断具有挑战性,通常涉及两步血清学方法。在本次综述中,我们对莱姆病可能出现的临床表现进行了全面的复习。此外,还讨论了病史、微生物学、诊断、治疗后莱姆病综合征、治疗和预后。