Wong Katelyn H, Shapiro Eugene D, Soffer Gary K
Department of Pediatrics, Yale School of Medicine, 330 Cedar Street, LMP 5039, New Haven, CT, 06520, USA.
Clin Rev Allergy Immunol. 2022 Feb;62(1):264-271. doi: 10.1007/s12016-021-08906-w. Epub 2021 Oct 23.
Lyme disease is an infection caused by Borrelia burgdorferi sensu lato, which is transmitted to humans through the bite of an infected Ixodes tick. The majority of patients recover without complications with antibiotic therapy. However, for a minority of patients, accompanying non-specific symptoms can persist for months following completion of therapy. The constellation of symptoms such as fatigue, cognitive dysfunction, and musculoskeletal pain that persist beyond 6 months and are associated with disability have been termed post-treatment Lyme disease syndrome (PTLDS), a subset of a broader term "chronic Lyme disease." Chronic Lyme disease is a broad, vaguely defined term that is used to describe patients with non-specific symptoms that are attributed to a presumed persistent Borrelia burgdorferi infection in patients who may or may not have evidence of either previous or current Lyme disease. The diagnoses of chronic Lyme disease and of PTLDS have become increasingly relevant to the practice of immunologists due to referrals for consultation or for intravenous immunoglobulin (IVIG) treatment. This review aims to explore the relationship between chronic Lyme disease, post-treatment Lyme disease syndrome, and the immune system. Here, we review the current literature on (1) issues in conventional and alternative diagnostic testing for Lyme disease, (2) the hypothesis that B. burgdorferi infection can persist despite appropriate use of recommended antibiotics, (3) current theories regarding B. burgdorferi's role in causing both immune dysregulation and protracted symptoms, and (4) the use of IVIG for the treatment of Lyme disease.
莱姆病是一种由伯氏疏螺旋体复合群引起的感染，通过感染的硬蜱叮咬传播给人类。大多数患者通过抗生素治疗可康复且无并发症。然而，少数患者在治疗结束后，伴随的非特异性症状可能会持续数月。那些持续超过6个月且与残疾相关的疲劳、认知功能障碍和肌肉骨骼疼痛等症状群被称为治疗后莱姆病综合征（PTLDS），它是更广泛术语“慢性莱姆病”的一个子集。慢性莱姆病是一个宽泛且定义模糊的术语，用于描述那些有非特异性症状的患者，这些症状被认为是由假定的伯氏疏螺旋体持续感染所致，而这些患者可能有或可能没有既往或当前莱姆病的证据。由于会诊转诊或静脉注射免疫球蛋白（IVIG）治疗的原因，慢性莱姆病和PTLDS的诊断在免疫学家的实践中变得越来越重要。本综述旨在探讨慢性莱姆病、治疗后莱姆病综合征与免疫系统之间的关系。在此，我们综述了关于以下方面的当前文献：（1）莱姆病传统和替代诊断检测中的问题；（2）尽管适当使用了推荐抗生素，伯氏疏螺旋体感染仍可能持续的假说；（3）关于伯氏疏螺旋体在导致免疫失调和长期症状中作用的当前理论；（4）IVIG在莱姆病治疗中的应用。
