Division of Infectious Diseases, Department of Internal Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam, The Netherlands.
J Infect Dis. 2024 Aug 14;230(Supplement_1):S62-S69. doi: 10.1093/infdis/jiae203.
Persistent symptoms after an infection have been described for a number of infectious diseases, including Lyme disease. Studies have confirmed a moderate but consistent increase in the prevalence of such symptoms after Lyme disease, though the risk increase varies dependent on study design and the definition of persistent symptoms. Various possible predictors have been proposed, including a dysregulation of the immune system, metabolic changes, increased sensitization to pain signals, cognitive-behavioral factors, or-controversially-the persistence of the causative Borrelia bacteria or remnants thereof. Research on the precise roles of any of these factors is still ongoing. The lack of biological underpinning also makes it difficult to assess with certainty which patients' (generally nonspecific) persistent symptoms are etiologically related to the previous Lyme disease episode and which are not, particularly as these symptoms occur in the general population relatively frequently. The diagnostic criteria for posttreatment Lyme disease syndrome have shown their usefulness in both clinical and research settings but leave out a number of patients whose symptoms may fall just outside said criteria. Though the relationship between these symptoms and the previous Lyme disease episode may be very uncertain, we would argue that a uniform description and classification of these patients will aid in future research and patient management, regardless of the eventual underlying cause. Thus, we argue for an inclusive classification system for all persistent symptoms attributed to Lyme disease in order to promote validation of patient experiences and perspectives, while also maintaining scientific nuance regarding the very uncertain etiology of these patients' symptoms.
许多传染病都有感染后持续存在症状的描述，包括莱姆病。研究证实，莱姆病后此类症状的患病率中等但持续增加，不过风险增加的幅度取决于研究设计和持续症状的定义。已经提出了各种可能的预测因素，包括免疫系统失调、代谢变化、对疼痛信号的敏感性增加、认知行为因素，或者——有争议的是——致病伯氏疏螺旋体细菌或其残余物的持续存在。关于这些因素中的任何一个的确切作用的研究仍在进行中。由于缺乏生物学基础，也很难确定哪些患者（通常是非特异性的）持续存在的症状与以前的莱姆病发作有病因学关系，哪些没有，特别是因为这些症状在普通人群中相对频繁发生。治疗后莱姆病综合征的诊断标准在临床和研究环境中都显示出了其有用性，但也遗漏了许多症状可能刚好超出这些标准的患者。尽管这些症状与以前的莱姆病发作之间的关系可能非常不确定，但我们认为，对这些患者的症状进行统一的描述和分类将有助于未来的研究和患者管理，而不管最终的潜在原因是什么。因此，我们主张对所有归因于莱姆病的持续症状采用包容性的分类系统，以促进对患者体验和观点的验证，同时保持对这些患者症状非常不确定的病因的科学细微差别。
