Diagnosis, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis: A Review.
Diagnosis, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis: A Review.
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DOI：
10.1001/jama.2016.2884
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发表时间：
2016-04-26
期刊：
影响因子：
--
通讯作者：
Hu LT
中科院分区：
文献类型：
--
作者：
Sanchez E;Vannier E;Wormser GP;Hu LT
莱姆病、人粒细胞无形体病（HGA）和巴贝虫病是新出现的蜱传感染。提供关于这些感染的诊断、治疗和预防的最新信息。我们检索PUBMED和SCOPUS，查找2005年1月至2015年12月期间以英语发表的关于这些感染的诊断、治疗和预防的文章。我们的检索产生了3550篇诊断和治疗的文章和752篇预防的文章。在这些文章中，对361篇进行了深入审查。证据支持使用FDA批准的血清学试验，如酶免疫测定（EIA），然后进行蛋白质印迹试验，以诊断莱姆病的皮外表现。显微镜检查和聚合酶链反应对血液标本用于诊断活动性HGA和巴贝虫病。口服强力霉素、阿莫西林和头孢呋辛酯治疗莱姆病的疗效已在多项试验中得到证实。当需要肠外抗生素治疗时，推荐使用头孢曲松。多项试验显示，口服多西环素10天疗程治疗游走性红斑和口服多西环素14天疗程治疗门诊患者早期神经系统莱姆病的疗效。有证据表明，口服强力霉素10天疗程对HGA有效，阿奇霉素加阿托伐醌7-10天疗程对轻度巴贝斯虫病有效。根据多个病例报告，克林霉素加奎宁7-10天的疗程通常用于治疗严重的巴贝虫病。最近的一项研究支持高度免疫功能低下的巴贝斯虫病患者至少使用6周的抗生素，至少在治疗的最后两周内，血涂片上没有检测到寄生虫。关于莱姆病、HGA和巴贝虫病的诊断、治疗和预防的证据正在不断发展。新的证据支持使用强力霉素治疗游走性红斑患者不超过10天，并为门诊患者的早期神经性莱姆病开具14天的口服强力霉素疗程。在免疫功能高度低下的患者中，巴贝斯虫病的抗菌治疗持续时间应延长至16周。
Lyme disease, human granulocytic anaplasmosis (HGA) and babesiosis are emerging tick-borne infections. To provide an update on diagnosis, treatment, and prevention of these infections. We searched PUBMED and SCOPUS for articles on diagnosis, treatment and prevention of these infections published in English from January 2005 through December 2015. Our search yielded 3550 articles for diagnosis and treatment and 752 articles for prevention. Of these articles, 361 were reviewed in depth. Evidence supports the use of FDA-approved serologic tests, such as an enzyme immunoassay (EIA), followed by western blot test(s), to diagnose extracutaneous manifestations of Lyme disease. Microscopy and polymerase chain reaction on blood specimens are used to diagnose active HGA and babesiosis. The efficacy of oral doxycycline, amoxicillin and cefuroxime axetil for treating Lyme disease has been established in multiple trials. Ceftriaxone is recommended when parenteral antibiotic therapy is warranted. Multiple trials have shown efficacy of a 10-day course of oral doxycycline for treatment of erythema migrans and of a 14-day course of oral doxycycline for treatment of early neurologic Lyme disease in ambulatory patients. Evidence indicates that a 10-day course of oral doxycycline is effective for HGA and that a 7-10 day course of azithromycin plus atovaquone is effective for mild babesiosis. Based on multiple case reports, a 7-10 day course of clindamycin plus quinine is often used to treat severe babesiosis. A recent study supports a minimum of 6 weeks of antibiotics for highly immunocompromised patients with babesiosis, with no parasites detected on blood smear for at least the final two weeks of treatment.. Evidence is evolving regarding the diagnosis, treatment and prevention of Lyme disease, HGA and babesiosis. Newer evidence supports treating patients with erythema migrans for no longer than 10 days when doxycycline is used, and for prescribing a 14-day course of oral doxycycline for early neurologic Lyme disease in ambulatory patients. The duration of antimicrobial therapy for babesiosis in highly immunocompromised patients should be extended to ≧6 weeks.
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影响因子：
3.6
作者：
Avery, RA;Frank, G;Eppes, SC
通讯作者：
Eppes, SC
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5.1
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通讯作者：
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