IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Aix Marseille Université, 13005 Marseille, France.
Laboratoire de bactériologie, Centre national de référence des Borrelia, faculté de médecine de Strasbourg, hôpitaux universitaires de Strasbourg, 67091 Strasbourg, France.
Med Mal Infect. 2019 Mar;49(2):102-111. doi: 10.1016/j.medmal.2019.01.009. Epub 2019 Feb 11.
Bacteria of the Borrelia burgdorferi sensu lato complex, responsible for Lyme disease, are members of the spirochetes phylum. Diagnostic difficulties of Lyme disease are partly due to the characteristics of spirochetes as their culture is tedious or even impossible for some of them. We performed a literature review to assess the value of the various diagnostic tests of spirochetes infections of medical interest such as Lyme borreliosis, relapsing fever borreliae, syphilis, and leptospirosis. We were able to draw similarities between these four infections. Real-time PCR now plays an important role in the direct diagnosis of these infections. However, direct diagnosis remains difficult because of a persistent lack of sensitivity. Serological testing is therefore crucial in the diagnostic process. All currently available diagnostic tools are imperfect, with a potential risk of false positive and false negative results depending on the clinical context. Physicians should always take into consideration the clinical and epidemiological context when Lyme disease, relapsing fever borreliae, syphilis, and leptospirosis are suspected.
伯氏疏螺旋体复合群细菌是导致莱姆病的病原体，属于螺旋体门的成员。由于螺旋体的某些特征，如培养繁琐甚至对某些螺旋体来说是不可能的，导致莱姆病的诊断存在困难。我们进行了文献回顾，以评估各种与医学相关的螺旋体感染的诊断试验的价值，如莱姆病、回归热螺旋体、梅毒和钩端螺旋体病。我们能够发现这四种感染之间的相似之处。实时 PCR 现在在这些感染的直接诊断中起着重要作用。然而，由于持续缺乏敏感性，直接诊断仍然很困难。因此，血清学检测在诊断过程中至关重要。目前所有可用的诊断工具都不完善，由于临床背景的不同，存在假阳性和假阴性结果的潜在风险。当怀疑患有莱姆病、回归热螺旋体、梅毒和钩端螺旋体病时，医生应始终考虑临床和流行病学背景。
