Klopfenstein Timothée, Jaulhac Benoît, Blanchon Thierry, Hansmann Yves, Chirouze Catherine
Sante Publique. 2019 May 13;S1(HS):51-63. doi: 10.3917/spub.190.0051.
Epidemiological evidence for tick-borne infections, particularly those related to Lyme borreliosis, is heterogeneous. Lyme borreliosis is a tick-born zoonosis transmitted by ticks of the genus Ixodes ricinus. After tick bite, the risk of transmission of an infectious agent remains low, most often represented by Borrelia burgdorferi sensu lato; co-infections in Humans by several different infectious agents (bacterial, viral or parasitic) are possible but a priori rare. In addition, besides well-known tick-borne pathogens, new species or gender of micro-organisms are regularly described in ticks but their pathogenicity in human pathology is not described or not yet established. The clinical presentation of Lyme borreliosis is varied, with localized and disseminated forms occurring long ago after tick bite, making diagnosis sometimes difficult. The natural course of Lyme borreliosis is insufficiently known because of recommendations of antibiotherapy in case of illness; however, some historical studies seem reassuring with possible spontaneous healing and seemingly minor sequelae. The diagnosis of disseminated forms requires paraclinical examinations, in first place serology, whose sensitivity increases with time of evolution of borreliosis; this is all the more interesting as the disseminated forms are of more difficult clinical diagnosis. After antibiotherapy, the clinical course is good, the sequelae remain possible especially in case of late diagnosis or late disseminated form; however, their frequency remains unknown.
蜱传感染，尤其是与莱姆病相关的感染的流行病学证据并不一致。莱姆病是一种由蓖麻硬蜱传播的蜱传人畜共患病。蜱叮咬后，感染病原体的传播风险仍然较低，最常见的是狭义伯氏疏螺旋体；人类可能会被几种不同的感染因子（细菌、病毒或寄生虫）共同感染，但从先验角度来看较为罕见。此外，除了众所周知的蜱传病原体外，蜱中还经常发现新的微生物物种或种类，但它们在人类病理学中的致病性尚未得到描述或确定。莱姆病的临床表现多种多样，蜱叮咬后很长时间才会出现局部和播散性形式，这有时会使诊断变得困难。由于患病时使用抗生素治疗的建议，莱姆病的自然病程尚不清楚；然而，一些历史研究似乎令人放心，因为可能会自发痊愈且后遗症似乎较轻。播散性形式的诊断需要进行临床检查，首先是血清学检查，其敏感性会随着莱姆病病程的延长而增加；这一点尤其重要，因为播散性形式的临床诊断更为困难。抗生素治疗后，临床病程良好，后遗症仍有可能出现，尤其是在诊断较晚或播散较晚的情况下；然而，其后遗症的发生率仍然未知。
