Adkison Heather, Embers Monica E
Division of Immunology, Tulane National Primate Research Center, Tulane University Health Sciences, Covington, LA, United States.
Front Med (Lausanne). 2023 May 24;10:1183344. doi: 10.3389/fmed.2023.1183344. eCollection 2023.
Lyme disease, caused by the spirochete , is the most common vector-borne illness in the United States. Many aspects of the disease are still topics of controversy within the scientific and medical communities. One particular point of debate is the etiology behind antibiotic treatment failure of a significant portion (10-30%) of Lyme disease patients. The condition in which patients with Lyme disease continue to experience a variety of symptoms months to years after the recommended antibiotic treatment is most recently referred to in the literature as post treatment Lyme disease syndrome (PTLDS) or just simply post treatment Lyme disease (PTLD). The most commonly proposed mechanisms behind treatment failure include host autoimmune responses, long-term sequelae from the initial infection, and persistence of the spirochete. The aims of this review will focus on the , and clinical evidence that either validates or challenges these mechanisms, particularly with regard to the role of the immune response in disease and resolution of the infection. Next generation treatments and research into identifying biomarkers to predict treatment responses and outcomes for Lyme disease patients are also discussed. It is essential that definitions and guidelines for Lyme disease evolve with the research to translate diagnostic and therapeutic advances to patient care.
莱姆病由螺旋体引起，是美国最常见的媒介传播疾病。该病的许多方面仍是科学界和医学界争论的话题。一个特别有争议的点是相当一部分（10%-30%）莱姆病患者抗生素治疗失败背后的病因。莱姆病患者在接受推荐的抗生素治疗数月至数年之后仍持续出现各种症状，这种情况最近在文献中被称为治疗后莱姆病综合征（PTLDS）或简称为治疗后莱姆病（PTLD）。治疗失败背后最常被提出的机制包括宿主自身免疫反应、初始感染的长期后遗症以及螺旋体的持续存在。本综述的目的将聚焦于支持或质疑这些机制的免疫反应、临床证据，特别是关于免疫反应在疾病和感染消退中的作用。还讨论了针对莱姆病患者的下一代治疗方法以及识别预测治疗反应和结果的生物标志物的研究。随着研究进展，莱姆病的定义和指南不断演变，以便将诊断和治疗进展转化为患者护理，这一点至关重要。
