Diagnosis of Lyme-associated uveitis: value of serological testing in a tertiary centre
Diagnosis of Lyme-associated uveitis: value of serological testing in a tertiary centre
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DOI：
10.1136/bjophthalmol-2017-310251
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发表时间：
2018-03-01
影响因子：
4.1
通讯作者：
Seve, Pascal
中科院分区：
文献类型：
--
作者：
Bernard, Alexia;Kodjikian, Laurent;Seve, Pascal
目的了解葡萄膜炎患者莱姆病的发病频率和临床表现，探讨伯氏疏螺旋体血清学检测的价值。方法回顾性分析2003 - 2016年在我院三级医院转诊的所有葡萄膜炎患者莱姆病血清学检测结果。筛选采用ELISA法测定伯氏疏螺旋体血清IgG和IgM。如果IgM和/或IgG的elisa阳性结果被IgM和/或IgG的免疫印迹阳性证实，则认为患者的血清学阳性。莱姆病相关性葡萄膜炎的诊断基于血清学结果以及对抗生素的反应，并排除其他诊断。结果430例符合入选标准的葡萄膜炎患者（60%为女性，平均年龄49岁）中，63例（14.7%）血清elisa阳性，34例（7.9%）经免疫印迹证实。7例患者（1.6%）最终保留了莱姆病相关葡萄膜炎的诊断。这些患者报告了以前的接触，包括蜱叮咬或森林行走（n=5），莱姆病的症状（n=5）和局部和/或全身类固醇耐药性（n=7）。在其余27例阳性患者中，22例有其他确定的病因，另外5例未分类。结论葡萄膜炎患者伯氏疏螺旋体的血清阳性率为7.9%，而法国普通人群的血清阳性率为6 - 8.5%，血清学检测的预测价值较低。它的使用应保留给有不明原因的葡萄膜炎、暴露史、提示莱姆病的全身检查结果和类固醇抵抗的患者。
Aims To determine the frequency and clinical presentation of Lyme disease in patients with uveitis and to assess the value of Borrelia burgdorferi serological testing.Methods Retrospective study on all patients with uveitis who were referred to our tertiary hospital were serologically tested for Lyme in our laboratory between 2003 and 2016. Screening consisted of determining B. burgdorferi serum IgG and IgM by ELISA method. The patient's serology was considered as positive if the ELISA-positive result in IgM and/or IgG was confirmed by an immunoblot positive in IgM and/or IgG. Lyme-associated uveitis was diagnosed based on serological results as well as response to antibiotics and exclusion of other diagnosis.Results Of the 430 patients with uveitis (60% women, mean age 49 years) fulfilling inclusion criteria, 63 (14.7%) had an ELISA-positive serology, confirmed by immunoblot for 34 patients (7.9%). The diagnosis of Lyme-associated uveitis was finally retained in seven patients (1.6%). These patients reported either a previous exposure including tick bite or forest walks (n=5), symptoms suggestive of Lyme disease (n=5) and resistance to local and/or systemic steroids (n=7). Among the remaining 27 positive patients, 22 had other established aetiologies and 5 other were unclassified.Conclusion The seroprevalence of B. burgdorferi among our patients with uveitis was 7.9% compared with 6 to 8.5% in the general French population which leads to a low predictive value of serological testing. Its use should be reserved for patients with unexplained uveitis, an exposure history, systemic findings suggestive of Lyme disease and steroids resistance.