Zafar Kashaf, Azuama Onyedikachi C, Parveen Nikhat
Department of Microbiology, Biochemistry and Molecular Genetics, Rutgers New Jersey Medical School, Newark, NJ, United States.
Front Microbiol. 2024 Sep 13;15:1459202. doi: 10.3389/fmicb.2024.1459202. eCollection 2024.
Lyme disease is the most prevalent tick-borne infection caused by bacteria in North America. Other Borrelia species are predominately the cause of this disease in Eurasia with some distinct and various overlapping manifestations. Consequently, caution must be exercised when comparing the disease and its manifestations and treatment regimens in North America and Europe. Diagnosis of the early Lyme disease remains difficult using the currently FDA approved serological tests in the absence of a reported tick bite or of erythema migrans in many individuals, non-specific initial symptoms, and the absence of detectable anti-Borrelia antibodies in the prepatent period of infection. Furthermore, it is difficult to distinguish persistence of infection and disease versus reinfection in the endemic regions of Lyme disease by serological assays. If early infection remains untreated, spirochetes can disseminate and could affect various organs in the body with a variety of disease manifestations including arthralgias and musculoskeletal pain, neurologic symptoms and anomalies, and acrodermatitis chronicum atrophicans (ACA) in Europe. Although most patients recover after antibiotic treatment, an estimated ∼10-20% patients in the United States show persistence of symptoms known as post-treatment Lyme disease syndrome (PTLDS). The causes and biomarkers of PTLDS are not well-defined; however, several contributing factors with inconsistent degree of supporting evidence have been suggested. These include antigenic debris, dysregulation of immunological response, bacterial persisters, or combination of these features. This review highlights currently employed treatment approaches describing different antimicrobials used, and vaccine candidates tried to prevent infection.
莱姆病是北美由细菌引起的最常见的蜱传播感染。在欧亚大陆，其他疏螺旋体物种是这种疾病的主要病因，有一些独特且多样的重叠表现。因此，在比较北美和欧洲的这种疾病及其表现和治疗方案时必须谨慎。在许多个体没有报告蜱叮咬或游走性红斑、存在非特异性初始症状以及在感染的潜伏期没有可检测到的抗疏螺旋体抗体的情况下，使用目前美国食品药品监督管理局（FDA）批准的血清学检测方法诊断早期莱姆病仍然困难。此外，通过血清学检测很难区分莱姆病流行地区感染和疾病的持续存在与再感染。如果早期感染未得到治疗，螺旋体可以播散并可能影响身体的各个器官，出现各种疾病表现，包括关节痛和肌肉骨骼疼痛、神经症状和异常，以及在欧洲出现的慢性萎缩性肢端皮炎（ACA）。虽然大多数患者在抗生素治疗后康复，但在美国估计有10% - 20%的患者会出现称为治疗后莱姆病综合征（PTLDS）的症状持续存在。PTLDS的病因和生物标志物尚未明确；然而，已经提出了几个支持证据程度不一致的促成因素。这些因素包括抗原碎片、免疫反应失调、细菌持留菌或这些特征的组合。这篇综述重点介绍了目前采用的治疗方法，描述了所使用的不同抗菌药物，以及尝试预防感染的候选疫苗。
