Lyme borreliosis
Lyme borreliosis
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DOI：
10.1016/s0140-6736(98)01146-5
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发表时间：
1998-08-15
期刊：
影响因子：
168.9
通讯作者：
Wormser, GP
中科院分区：
文献类型：
--
作者：
Nadelman, RB;Wormser, GP
莱姆病（Lyme borreliosis）通常被认为与“千变万化”的表现有关，这是对古代神Proteus的一种参考，他可以采取多种形式，从而逃避他的追求者。这种传奇的品质已经模糊了对莱姆病的理解，因为它给伯氏疏螺旋体感染带来了一种神秘的光环。这篇综述表明，这种疾病，虽然不完全理解，是远远超过变形杆菌更明显，是（在大多数情况下）更容易制服。莱姆病的临床表现在北美和欧亚大陆确实不同，可能是由于伯氏疏螺旋体不同基因种的致病性不同。然而，在这两个大陆最常见的表现是游走性红斑。诊断应依赖于仔细的病史和客观的临床表现，并辅以适当选择的实验室检查。与其他蜱传疾病合并感染的报告应该促使人们重新审视莱姆病。关于B burgdorferi感染的“多变表现”的说法应该重新评价。实验室技术的进步是受欢迎的，但培养仍然是诊断的金标准，任何实验室检查结果都不能代替仔细的临床观察和批判性分析。
Lyme borreliosis (Lyme disease) is often said to be associated with "protean" manifestations, a reference to the ancient god Proteus, who could assume many forms and thus elude his pursuers. This legendary quality has clouded out understanding of Lyme borreliosis by giving Borrelia burgdorferi Infection a mythical aura of its own. This review shows that this illness, while incompletely understood, is far more palpable than Proteus and is (in most cases) much more readily subdued. The clinical presentations of Lyme borreliosis do differ in North America and Eurasia, possibly due to the differing pathogenicity of distinct genospecies of Borrelia burgdorferi The most common manifestation, however, in both continents is erythema migrans. Diagnosis should rest on a careful history and objective clinical findings, supported by appropriately chosen laboratory tests. Reports of coinfection with other tickborne diseases should prompt a fresh look at Lyme borrellosis. Assertions about "protean manifestations" of B burgdorferi Infection should be reappraised. Advances in laboratory techniques are welcome but culture remains the gold standard for the diagnosis-and no laboratory test result should substitute for careful clinical observation and critical analysis.