Concurrent Lyme disease and babesiosis. Evidence for increased severity and duration of illness.
Concurrent Lyme disease and babesiosis. Evidence for increased severity and duration of illness.
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DOI：
10.1001/jama.1996.03530450047031
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发表时间：
1996-06
期刊：
影响因子：
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通讯作者：
P. Krause;S. Telford;A. Spielman;V. Sikand;R. Ryan;D. Christianson;G. Burke;P. Brassard;R. Pollack;J. Peck;D. Persing
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文献类型：
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作者：
P. Krause;S. Telford;A. Spielman;V. Sikand;R. Ryan;D. Christianson;G. Burke;P. Brassard;R. Pollack;J. Peck;D. Persing
目的确定在莱姆病和巴贝西虫病均为人畜共患的地方，合并感染莱姆病和巴贝西虫病的患者是否比单独感染莱姆病和巴贝西虫病的患者在更长的时间内出现更多的症状。设计：以社区为基础，年度血清学调查和以临床为基础的队列研究。从1990年到1994年，罗得岛的SETTING岛社区和2个康涅狄格州的医疗诊所。研究对象岛屿社区的长期居民和在诊所寻求治疗的患者。主要观察指标：莱姆病和巴贝虫病病原体的血清反应性，症状的数量和持续时间。结果在1156例血清学调查对象中，97例（8.4%）对莱姆病螺旋体抗原有血清反应性，其中14例（14%）对巴贝斯虫抗原也有血清反应性。在240例确诊为莱姆病的患者中，26例（11%）合并感染巴贝虫病。合并感染的患者比单纯莱姆病患者更频繁地出现疲劳（P =.002）、头痛（P <.001）、出汗（P < .001）、寒战（P = .03）、厌食（P = .04）、情绪不稳定（P = .02）、恶心（P = .004）、结膜炎（P = .04）和脾肿大（P = .01）。26例合并感染患者中有13例（50%）症状持续3个月或更长时间，而184例单独莱姆病患者中有7例（4%）有随访数据（P <0.001）。合并感染莱姆病的患者比单独感染巴贝斯虫的患者（n = 10）经历了更多的症状和更持久的疾病发作。在合并感染的患者中检测到循环螺旋体DNA的频率是单纯莱姆病患者的3倍以上（P = 0.06）。结论：在新英格兰南部，大约10%的莱姆病患者在两种疾病都是人畜共患的地方同时感染了巴贝虫病。同时患有莱姆病和巴贝西虫病的患者的症状数量和疾病持续时间比单独感染的患者要多。在莱姆病和巴贝斯虫病都有报告的地区，当诊断出中度至重度莱姆病时，应考虑伴随巴贝斯虫感染的可能性。
OBJECTIVE To determine whether patients coinfected with Lyme disease and babesiosis in sites where both diseases are zoonotic experience a greater number of symptoms for a longer period of time than those with either infection alone. DESIGN Community-based, yearly serosurvey and clinic-based cohort study. SETTING Island community in Rhode Island and 2 Connecticut medical clinics from 1990 to 1994. STUDY PARTICIPANTS Long-term residents of the island community and patients seeking treatment at the clinics. MAIN OUTCOME MEASURES Seroreactivity to the agents of Lyme disease and babesiosis and number and duration of symptoms. RESULTS Of 1156 serosurvey subjects, 97 (8.4%) were seroreactive against Lyme disease spirochete antigen, of whom 14 (14%) also were seroreactive against babesial antigen. Of 240 patients diagnosed with Lyme disease, 26 (11%) were coinfected with babesiosis. Coinfected patients experienced fatigue (P = .002), headache (P < .001), sweats (P < .001), chills (P = .03), anorexia (P = .04), emotional lability (P = .02), nausea (P = .004), conjunctivitis (P = .04), and splenomegaly (P = .01) more frequently than those with Lyme disease alone. Thirteen (50%) of 26 coinfected patients were symptomatic for 3 months or longer compared with 7 (4%) of the 184 patients with Lyme disease alone from whom follow-up data were available (P < .001). Patients coinfected with Lyme disease experienced more symptoms and a more persistent episode of illness than did those (n = 10) experiencing babesial infection alone. Circulating spirochetal DNA was detected more than 3 times as often in coinfected patients as in those with Lyme disease alone (P = .06). CONCLUSIONS Approximately 10% of patients with Lyme disease in southern New England are coinfected with babesiosis in sites where both diseases are zoonotic. The number of symptoms and duration of illness in patients with concurrent Lyme disease and babesiosis are greater than in patients with either infection alone. In areas where both Lyme disease and babesiosis have been reported, the possibility of concomitant babesial infection should be considered when moderate to severe Lyme disease has been diagnosed.