抗生素治疗后持续的伯氏疏螺旋体感染:来自实验动物模型的系统综述和当前证据评估。

Persistent Borrelia burgdorferi Infection after Antibiotic Treatment: Systematic Overview and Appraisal of the Current Evidence from Experimental Animal Models.

机构信息

Amsterdam UMC, Location University of Amsterdam, Department of Internal Medicine, Section of Infectious Diseases, Amsterdam UMC Multidisciplinary Lyme Borreliosis Center, Amsterdam, The Netherlands.

Amsterdam UMC, Location University of Amsterdam, Center for Experimental and Molecular Medicine, Amsterdam, The Netherlands.

出版信息

Clin Microbiol Rev. 2022 Dec 21;35(4):e0007422. doi: 10.1128/cmr.00074-22. Epub 2022 Oct 12.

Abstract

Lyme borreliosis is caused by spirochetes belonging to the Borrelia burgdorferi group, which are transmitted by tick species living in the temperate climate zones of the Northern Hemisphere. The clinical manifestations of Lyme borreliosis are diverse and treated with oral or intravenous antibiotics. In some patients, long-lasting and debilitating symptoms can persist after the recommended antibiotic treatment. The etiology of such persisting symptoms is under debate, and one hypothesis entails persistent infection by a subset of spirochetes after antibiotic therapy. Here, we review and appraise the experimental evidence from animal studies on the persistence of B. burgdorferi sensu lato infection after antibiotic treatment, focusing on the antimicrobial agents doxycycline and ceftriaxone. Our review indicates that some animal studies found sporadic positive cultures after antibiotic treatment. However, this culture positivity often seemed to be related to inadequate antibiotic treatment, and the few positive cultures in some studies could not be reproduced in other studies. Overall, current results from animal studies provide insufficient evidence for the persistence of viable and infectious spirochetes after adequate antibiotic treatment. Borrelial nucleic acids, on the contrary, were frequently detected in these animal studies and may thus persist after antibiotic treatment. We put forward that research into the pathogenesis of persisting complaints after antibiotic treatment for Lyme borreliosis in humans should be a top priority, but future studies should most definitely also focus on explanations other than persistent B. burgdorferi sensu lato infection after antibiotic treatment.

摘要

莱姆病是由属于伯氏疏螺旋体的螺旋体引起的,这些螺旋体通过生活在北半球温带气候带的蜱传播。莱姆病的临床表现多种多样,采用口服或静脉内抗生素治疗。在一些患者中,在推荐的抗生素治疗后,长期和虚弱的症状可能持续存在。这种持续症状的病因存在争议,一种假说认为在抗生素治疗后,亚群螺旋体持续存在感染。在这里,我们回顾和评估了来自动物研究的关于抗生素治疗后伯氏疏螺旋体感染持续存在的实验证据,重点关注抗生素多西环素和头孢曲松。我们的综述表明,一些动物研究在抗生素治疗后发现了散在的阳性培养物。然而,这种培养阳性似乎往往与抗生素治疗不充分有关,并且一些研究中的少数阳性培养物在其他研究中无法重现。总的来说,目前来自动物研究的结果提供的证据不足以证明在充分的抗生素治疗后,仍有存活和感染的螺旋体存在。相反,在这些动物研究中经常检测到伯氏疏螺旋体的核酸,因此在抗生素治疗后可能持续存在。我们提出,研究人类莱姆病抗生素治疗后持续存在的投诉的发病机制应是重中之重,但未来的研究肯定也应关注除抗生素治疗后伯氏疏螺旋体持续感染以外的其他解释。

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