Division of Clinical Microbiology, Laboratory Medicine, Region Jönköping County, Jönköping, Sweden.
Division of Clinical Microbiology, Region Östergötland, Linköping, Sweden.
Front Public Health. 2021 Sep 20;9:580102. doi: 10.3389/fpubh.2021.580102. eCollection 2021.
For the most important and well-known infections spread by ticks, Lyme borreliosis (LB) and tick-borne encephalitis (TBE), there are recommendations for diagnosis and management available from several health authorities and professional medical networks. However, other tick-borne microorganisms with potential to cause human disease are less known and clear recommendations on diagnosis and management are scarce. Therefore, we performed a systematic review of published studies and reviews focusing on evaluation of laboratory methods for clinical diagnosis of human tick-borne diseases (TBDs), other than acute LB and TBE. The specific aim was to evaluate the scientific support for laboratory diagnosis of human granulocytic anaplasmosis, rickettsiosis, neoehrlichiosis, babesiosis, hard tick relapsing fever, tularemia and bartonellosis, as well as tick-borne co-infections and persistent LB in spite of recommended standard antibiotic treatment. We performed a systematic literature search in 11 databases for research published from 2007 through 2017, and categorized potentially relevant references according to the predefined infections and study design. An expert group assessed the relevance and eligibility and reviewed the articles according to the QUADAS (diagnostic studies) or AMSTAR (systematic reviews) protocols, respectively. Clinical evaluations of one or several diagnostic tests and systematic reviews were included. Case reports, non-human studies and articles published in other languages than English were excluded. A total of 48 studies fulfilled the inclusion criteria for evaluation. The majority of these studies were based on small sample sizes. There were no eligible studies for evaluation of tick-borne co-infections or for persistent LB after antibiotic treatment. Our findings highlight the need for larger evaluations of laboratory tests using clinical samples from well-defined cases taken at different time-points during the course of the diseases. Since the diseases occur at a relatively low frequency, single-center cross-sectional studies are practically not feasible, but multi-center case control studies could be a way forward.
对于最主要和广为人知的由蜱传播的感染，莱姆病（LB）和蜱传脑炎（TBE），有几个卫生当局和专业医疗网络提供的诊断和管理建议。然而，其他具有引起人类疾病潜力的蜱传微生物则知之甚少，并且缺乏明确的诊断和管理建议。因此，我们对已发表的研究和综述进行了系统评价，重点是评估用于临床诊断人类蜱传疾病（TBD）的实验室方法，除了急性 LB 和 TBE 以外。具体目标是评估实验室诊断人类粒细胞无形体病、立克次体病、新立克次体病、巴贝斯虫病、硬蜱复发性发热、野兔热和巴尔通体病以及蜱传合并感染和尽管推荐了标准抗生素治疗但仍持续存在 LB 的科学依据。我们在 11 个数据库中进行了系统的文献搜索，以检索 2007 年至 2017 年期间发表的研究，并根据预先确定的感染和研究设计对潜在相关参考文献进行分类。专家组评估了相关性和合格性，并根据 QUADAS（诊断研究）或 AMSTAR（系统评价）协议分别对文章进行了审查。包括对一项或多项诊断测试的临床评估和系统评价。排除病例报告、非人类研究和以英文以外其他语言发表的文章。共有 48 项研究符合评估的纳入标准。这些研究大多数基于小样本量。没有关于蜱传合并感染或抗生素治疗后持续 LB 的评估研究。我们的研究结果强调需要对使用来自疾病不同病程时间点的明确病例的临床样本进行更大规模的实验室测试评估。由于这些疾病的发生频率相对较低，单中心横断面研究实际上是不可行的，但多中心病例对照研究可能是一种方法。
