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Med Mal Infect. 2019 May 31. pii: S0399-077X(19)30131-3. doi: 10.1016/j.medmal.2019.05.001. [Epub ahead of print]

Lyme borreliosis and other tick-borne diseases. Guidelines from the French scientific societies (II). Biological diagnosis, treatment, persistent symptoms after documented or suspected Lyme borreliosis.

Author information

1
Laboratoire de bactériologie et cnr des Borrelia, faculté de médecine et centre hospitalo-universitaire, 67000 Strasbourg, France.
2
Médecine interne et maladies infectieuses, centre hospitalier, 24750 Périgueux, France.
3
Maladies infectieuses et tropicales, hôpital La Pitié-Salpêtrière, 75013 Paris, France.
4
Maladies infectieuses et tropicales, centre hospitalo-universitaire, UMR CNRS 6249 Université Bourgogne Franche Comté, 25000 Besançon, France.
5
Médecine du travail, centre hospitalo-universitaire, 76000 Rouen, France.
6
Maladies infectieuses et tropicales, centre hospitalo-universitaire, 54100 Nancy, France.
7
Centre d'étude et de traitement de la douleur, hôpital Cochin, 75014 Paris, France.
8
Maladies infectieuses et tropicales, ihu méditerranée infection, centre hospitalo-universitaire Timone, 13000 Marseille, France.
9
Neurologie, hôpital Delafontaine, 92300 Saint-Denis, France.
10
Maladies infectieuses et tropicales, centre hospitalo-universitaire, inserm U1070, 86000 Poitiers, France.
11
Service de pédiatrie générale et maladies infectieuses, hôpital Necker-Enfants Malades, AP-HP, 75014 Paris, France.
12
Département de neurologie, hôpitaux civil, 68000 Colmar, France.
13
Rhumatologie, centre hospitalo-universitaire, 67000 Strasbourg, France.
14
Médecine interne, hôpital Beaujon, université Paris Diderot, Inserm UMR 1137 IAME, 92110 Clichy, France.
15
Microbiologie, centre hospitalo-universitaire, 69000 Lyon, France.
16
Département de médecine générale, faculté de médecine, 42000 Saint-Etienne, France.
17
Maladies Infectieuses et tropicales, hôpital Avicenne, 93022 Bobigny, France; Santé publique France, 94410 St Maurice, France.
18
Maladies infectieuses et tropicales, centre hospitalo-universitaire, 67000 Strasbourg, France.
19
Pédiatrie, centre hospitalier, 78000 Versailles, France.
20
Médecine interne, hôpital Nord, centre hospitalo-universitaire, 42000 Saint-Etienne, France.
21
Centre Max Weber, CNRS, Université Lyon 2, 69000 Lyon, France.
22
Maternité Louis Mourier, 92700 Colombes, France.
23
Ophtalmologie, hôpital La Pitié-Salpêtrière, 75013 Paris, France.
24
Laboratoire de parasitologie-Mycologie, UMR_S 1085 Irset université Rennes1-Inserm-EHESP, centre hospitalo-universitaire, 35000 Rennes, France.
25
Cabinet de médecine générale, Saint-Ouen, département de médecine Générale, faculté de médecine. université Paris Descartes, 93400 Paris, France.
26
Dermatologie, hôpitaux universitaires de Strasbourg et faculté de médecine, université de Strasbourg, 67000 Strasbourg, France.
27
Maladies infectieuses et tropicales, centre hospitalo-universitaire, 30000 Nîmes, France.
28
Maladies infectieuses et tropicales, centre hospitalier intercommunal, 94190 Villeneuve-St-Georges, France.
29
Cardiologie, hôpital René Muret, 93270 Sevran, France.
30
Médecine générale, 67000 Strasbourg, France.
31
Psychiatrie, hôpital européen Georges-Pompidou, AP-HP.5, Inserm U1266; Université Paris Descartes, 75015 Paris, France.
32
Maladies infectieuses et réanimation médicale, hôpital Pontchaillou, centre hospitalo-universitaire, 35033 Rennes, France. Electronic address: pierre.tattevin@chu-rennes.fr.

Abstract

The serodiagnosis of Lyme borreliosis is based on a two-tier strategy: a screening test using an immunoenzymatic technique (ELISA), followed if positive by a confirmatory test with a western blot technique for its better specificity. Lyme serology has poor sensitivity (30-40%) for erythema migrans and should not be performed. The seroconversion occurs after approximately 6 weeks, with IgG detection (sensitivity and specificity both>90%). Serological follow-up is not recommended as therapeutic success is defined by clinical criteria only. For neuroborreliosis, it is recommended to simultaneously perform ELISA tests in samples of blood and cerebrospinal fluid to test for intrathecal synthesis of Lyme antibodies. Given the continuum between early localized and disseminated borreliosis, and the efficacy of doxycycline for the treatment of neuroborreliosis, doxycycline is preferred as the first-line regimen of erythema migrans (duration, 14 days; alternative: amoxicillin) and neuroborreliosis (duration, 14 days if early, 21 days if late; alternative: ceftriaxone). Treatment of articular manifestations of Lyme borreliosis is based on doxycycline, ceftriaxone, or amoxicillin for 28 days. Patients with persistent symptoms after appropriate treatment of Lyme borreliosis should not be prescribed repeated or prolonged antibacterial treatment. Some patients present with persistent and pleomorphic symptoms after documented or suspected Lyme borreliosis. Another condition is eventually diagnosed in 80% of them.

KEYWORDS:

Borréliose de Lyme; Erythema migrans; Lyme borreliosis; Neuroborreliosis; Neuroborréliose; Persistent somatic symptoms; Symptomatologie somatique persistante; Western blot; Érythème migrant

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