Update on persistent symptoms associated with Lyme disease.
Update on persistent symptoms associated with Lyme disease.
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DOI：
10.1097/mop.0000000000000167
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发表时间：
2015-02
影响因子：
3.6
通讯作者：
Shapiro ED
中科院分区：
文献类型：
--
作者：
Oliveira CR;Shapiro ED
莱姆病是由伯氏疏螺旋体引起的，是美国最常见的媒介传播疾病。莱姆病的发病机制、生态学和流行病学已被很好地描述，抗菌治疗是非常有效的。尽管接受了抗菌药的治疗，但感染是否会持续并导致慢性症状，一直存在争议。这篇综述总结了最近针对这一问题的研究。接受莱姆病治疗的患者中持续性非特异性症状的发病机制尚不清楚，而且试图证明持续感染伯氏杆菌的结果的有效性尚未建立。一项研究试图使用异种诊断来检测曾接受莱姆病治疗的患者中的伯氏杆菌。另一项研究评估了移行性红斑的反复发作是由相同还是不同的伯氏杆菌菌株引起的。在一些接受治疗的患者中，持续关节炎的一个可能原因是对不能存活的微生物清除缓慢，这可能会导致长期的炎症。所有这些研究的结果继续提供证据，证明在接受莱姆病常规抗菌治疗的患者中，存活的伯氏杆菌不会持续存在。可能与莱姆病相关的持续性症状的患者经常给临床医生带来挑战。最近的研究提供了更多的证据表明，在使用抗菌剂进行常规治疗后，活的伯氏杆菌不会持续存在，这表明接受常规治疗莱姆病的患者的持续症状不应归因于持续的活动性感染。Http://links.lww.com/MOP/A23
Lyme disease, caused by Borrelia burgdorferi, is the most common vector-borne illness in the United States. The pathogenesis, ecology, and epidemiology of Lyme disease have been well described, and antimicrobial treatment is very effective. There has been controversy about whether infection can persist and cause chronic symptoms despite treatment with antimicrobials. This review summarizes recent studies that have addressed this issue. The pathogenesis of persistent nonspecific symptoms in patients who were treated for Lyme disease is poorly understood, and the validity of results of attempts to demonstrate persistent infection with B. burgdorferi has not been established. One study attempted to use xenodiagnosis to detect B. burgdorferi in patients who have been treated for Lyme disease. Another study assessed whether repeated episodes of erythema migrans were due to the same or different strains of B. burgdorferi. A possible cause of persistent arthritis in some treated patients is slow clearance of nonviable organisms that may lead to prolonged inflammation. The results of all of these studies continue to provide evidence that viable B. burgdorferi do not persist in patients who receive conventional antimicrobial treatment for Lyme disease. Patients with persistent symptoms possibly associated with Lyme disease often provide a challenge for clinicians. Recent studies have provided additional evidence that viable B. burgdorferi do not persist after conventional treatment with antimicrobials, indicating that ongoing symptoms in patients who received conventional treatment for Lyme disease should not be attributed to persistent active infection. http://links.lww.com/MOP/A23