Raffetin Alice, Schemoul Julien, Chahour Amal, Nguala Steve, Caraux-Paz Pauline, Paoletti Giulia, Belkacem Anna, Medina Fernanda, Fabre Catherine, Gallien Sébastien, Vignier Nicolas, Madec Yoann
Department of Infectious Diseases, Tick-Borne Diseases Reference Center-Paris and Northern Region, General Hospital Lucie et Raymond Aubrac, 94190 Villeneuve-Saint-Georges, France.
European Study Group for Lyme Borreliosis (ESGBOR), ESCMID, Gerbergasse 14 3rd Floor, 4001 Basel, Switzerland.
Microorganisms. 2022 Mar 12;10(3):607. doi: 10.3390/microorganisms10030607.
. Because patients with a suspicion of Lyme borreliosis (LB) may have experienced difficult care paths, the Tick-Borne Diseases Reference Center (TBD-RC) was started in 2017. The aim of our study was to compare the clinical features of patients according to their final diagnoses, and to determine the factors associated with recovery in the context of multidisciplinary management for suspected LB. . We included all adult patients who were seen at the TBD-RC (2017-2020). Four groups were defined: (i) confirmed LB, (ii) possible LB, (iii) Post-Treatment Lyme Disease Syndrome (PTLDS) or sequelae, and (iv) other diagnoses. Their clinical evolution at 3, 6, and 9-12 months after care was compared. Factors associated with recovery at 3 and at 9-12 months were identified using logistic regression models. . Among the 569 patients who consulted, 72 (12.6%) had confirmed LB, 43 (7.6%) possible LB, 58 (10.2%) PTLDS/sequelae, and 396 (69.2%) another diagnosis. A favorable evolution was observed in 389/569 (68.4%) at three months and in 459/569 (80.7%) at 12 months, independent of the final diagnosis. A longer delay between the first symptoms and the first consultation at the TBD-RC ( = 0.001), the multiplicity of the diagnoses ( = 0.004), and the inappropriate prescription of long-term antibiotic therapy ( = 0.023) were negatively associated with recovery, reflecting serial misdiagnoses. . A multidisciplinary team dedicated to suspicion of LB may achieve a more precise diagnosis and better patient-centered medical support in the adapted clinical sector with a shorter delay, enabling clinical improvement and avoiding inappropriate antimicrobial prescription.
由于疑似莱姆病（LB）的患者可能经历过复杂的治疗过程，蜱传疾病参考中心（TBD-RC）于2017年成立。我们研究的目的是根据患者的最终诊断比较其临床特征，并确定在疑似LB的多学科管理背景下与康复相关的因素。我们纳入了在TBD-RC就诊的所有成年患者（2017年至2020年）。定义了四组：（i）确诊的LB，（ii）可能的LB，（iii）治疗后莱姆病综合征（PTLDS）或后遗症，以及（iv）其他诊断。比较了他们在治疗后3个月、6个月和9至12个月的临床进展。使用逻辑回归模型确定在3个月和9至12个月时与康复相关的因素。在569名咨询患者中，72名（12.6%）确诊为LB，43名（7.6%）可能为LB，58名（10.2%）为PTLDS/后遗症，396名（69.2%）为其他诊断。无论最终诊断如何，在3个月时观察到389/569（68.4%）的患者病情好转，在12个月时观察到459/569（80.7%）的患者病情好转。首次症状与在TBD-RC首次咨询之间的间隔时间更长（P = 0.001）、诊断的多样性（P = 0.004）以及长期抗生素治疗的不适当处方（P = 0.023）与康复呈负相关，反映了一系列误诊。一个致力于疑似LB诊断的多学科团队可以在合适的临床领域以更短的延迟实现更精确的诊断和更好的以患者为中心的医疗支持，从而实现临床改善并避免不适当的抗菌药物处方。
