Shrestha M, Grodzicki R L, Steere A C
Am J Med. 1985 Feb;78(2):235-40. doi: 10.1016/0002-9343(85)90432-2.
The diagnostic value of clinical, culture, and serologic findings was studied prospectively in 41 patients with early Lyme disease. Fifteen patients had erythema chronicum migrans alone, and 26 had clinical evidence of disseminated infection, most commonly affecting the brain or meninges, other skin sites, lymph nodes, or joints. Of 40 blood cultures, only one, from a patient with disseminated infection, yielded spirochetes. One of 10 patients tested with localized infection had an elevated IgM response to the Lyme spirochete (200 units or greater) during acute disease. Two to three weeks after beginning antibiotic therapy, four of the 10 patients had elevated specific IgM or IgG responses (200 units or greater). Of the 22 patients tested with disseminated disease, 10 initially had elevated levels of specific IgM or IgG, and 12 had such responses by convalescence. Because of the low yield of cultures and the delay in the specific antibody response, recognition of the clinical picture remains very important in diagnosing early Lyme disease.
我们对41例早期莱姆病患者的临床、培养及血清学检查结果的诊断价值进行了前瞻性研究。15例患者仅有慢性游走性红斑，26例有播散性感染的临床证据，最常累及脑或脑膜、其他皮肤部位、淋巴结或关节。在40份血培养中，只有1份来自播散性感染患者的培养物培养出了螺旋体。10例局限性感染患者中，有1例在急性期对莱姆螺旋体的IgM反应升高（200单位或更高）。开始抗生素治疗2至3周后，10例患者中有4例特异性IgM或IgG反应升高（200单位或更高）。在22例播散性疾病患者中，10例最初特异性IgM或IgG水平升高，12例在恢复期出现此类反应。由于培养阳性率低以及特异性抗体反应出现延迟，临床症状的识别在早期莱姆病的诊断中仍然非常重要。
