From the University of Basel Children's Hospital, Paediatric Infectious Diseases and Vaccinology, Basel, Switzerland.
Pediatr Infect Dis J. 2021 May 1;40(5S):S31-S34. doi: 10.1097/INF.0000000000002772.
Lyme disease is a multisystem disease caused by Borrelia burgdorferi infection and accounts for well-defined manifestations, appearing either at an early or late stage. Appropriate antibiotic therapy generally leads to a favorable outcome. Still, unspecific persisting symptoms such as fatigue, myalgia, arthralgia or cognitive dysfunction are reported by several patients months to years after adequate treatment. Their underlying pathophysiologic mechanism is unclear. However, there is no evidence for microbiological persistence in these cases and attempts to resolve the symptoms by repeated or prolonged antibiotic treatment have not been convincingly successful, but they may rather be harmful. To narrow down the controversially handled entity of posttreatment Lyme disease syndrome (PTLDS) and to avoid overdiagnosis and overtreatment, case definitions have been proposed, acknowledging PTLDS as a complex of nonspecific, subjective symptoms, which are neither caused by ongoing infection nor by any other identifiable disease. PTLDS is mainly a diagnosis of exclusion and requires careful evaluation of differential diagnosis followed by counseling about optimal management in light of missing specific therapeutic options.
莱姆病是一种由伯氏疏螺旋体感染引起的多系统疾病，具有明确的表现，可分为早期或晚期。适当的抗生素治疗通常会带来良好的结果。然而，一些患者在充分治疗后数月至数年仍会出现疲劳、肌痛、关节痛或认知功能障碍等非特异性持续症状。其潜在的病理生理机制尚不清楚。然而，这些情况下没有微生物持续存在的证据，并且通过重复或延长抗生素治疗来缓解症状的尝试并没有令人信服的成功，反而可能有害。为了缩小治疗后莱姆病综合征（PTLDS）这一备受争议的实体的范围，并避免过度诊断和过度治疗，已经提出了病例定义，将 PTLDS 视为一组非特异性、主观症状的综合征，这些症状既不是由持续感染引起的，也不是由任何其他可识别的疾病引起的。PTLDS 主要是一种排除性诊断，需要仔细评估鉴别诊断，然后根据缺乏特定治疗选择的情况，就最佳管理进行咨询。
