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

Jaulhac, B.; Saunier, A.; Caumes, Éric; Bouiller, Kévin; Géhanno, Jean-François; Rabaud, Christian; Perrot, Serge; Eldin, Carole; Broucker, T. de; Roblot, F.; Toubiana, Julie; Sellal, François; Vuillemet, F.; Sordet, Christelle; Fantin, Bruno; Lina, Gérard; Sobas, C; Gocko, Xavier; Figoni, Julie; Chirouze, Catherine; Hansmann, Yves; Hentgen, Véronique; Cathébras, P.; Dieudonné, Maël; Picone, Olivier; Bodaghi, Bahram; Gangneux, Jean‐Pierre; Degeilh, B.; Partouche, Henri; Lenormand, C.; Sotto, Albert; Raffetin, A.; Monsuez, Jean‐Jacques; Michel, C; Boulanger, Nathalie; Lemogne, Cédric; Tattevin, Pierre

doi:10.1016/j.medmal.2019.05.001

Cited by 43 publications

(103 citation statements)

References 73 publications

(96 reference statements)

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“…A trial with topical azithromycin was stopped prematurely because of a lack of effect 205. In current guidelines from the US and Europe, watchful waiting is primarily recommended, while a single dose of doxycycline (200 mg) within 72 hours after a tick bite204 may be offered in highly endemic settings, when the tick has been attached for longer periods 157206207…”

Section: Post-exposure Prophylaxismentioning

confidence: 99%

“…Guidelines on management of Lyme borreliosis are available in the US 157225226 and Europe 66206207227228. For the antibiotic treatment of Lyme borreliosis, the recommended agents, doses, and durations are highly consistent through different guidelines, and are predominantly based on studies described in table 3.…”

Section: Guidelinesmentioning

confidence: 99%

“…*Two guidelines specifically focus on neurologic Lyme borreliosis manifestations,66225 one on dermatologic manifestations,227 and one on antibiotic prophylaxis after a tick bite, erythema migrans, and persistent symptoms 226Treatment recommendations for children are largely similar to adults, although for children aged under 8 or 9 doxycycline is relatively contraindicated157206207226227…”

Section: Guidelinesmentioning

confidence: 99%

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Lyme borreliosis: diagnosis and management

Kullberg

Vrijmoeth

Schoor

et al. 2020

BMJ

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Lyme borreliosis is the most common vectorborne disease in the northern hemisphere. It usually begins with erythema migrans; early disseminated infection particularly causes multiple erythema migrans or neurologic disease, and late manifestations predominantly include arthritis in North America, and acrodermatitis chronica atrophicans (ACA) in Europe. Diagnosis of Lyme borreliosis is based on characteristic clinical signs and symptoms, complemented by serological confirmation of infection once an antibody response has been mounted. Manifestations usually respond to appropriate antibiotic regimens, but the disease can be followed by sequelae, such as immune arthritis or residual damage to affected tissues. A subset of individuals reports persistent symptoms, including fatigue, pain, arthralgia, and neurocognitive symptoms, which in some people are severe enough to fulfil the criteria for post-treatment Lyme disease syndrome. The reported prevalence of such persistent symptoms following antimicrobial treatment varies considerably, and its pathophysiology is unclear. Persistent active infection in humans has not been identified as a cause of this syndrome, and randomized treatment trials have invariably failed to show any benefit of prolonged antibiotic treatment. For prevention of Lyme borreliosis, post-exposure prophylaxis may be indicated in specific cases, and novel vaccine strategies are under development.

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Section: Post-exposure Prophylaxismentioning

confidence: 99%

Section: Guidelinesmentioning

confidence: 99%

Section: Guidelinesmentioning

confidence: 99%

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Lyme borreliosis: diagnosis and management

Kullberg

Vrijmoeth

Schoor

et al. 2020

BMJ

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“…At present, no guidelines recommend using lymphocytetransformation tests because of their lack of specificity [11,13,14,16,64,65]. Studies on lymphocyte-transformation tests yielded heterogeneous results and mixed quality, without clear sensitivity and specificity.…”

Section: Tests Exploring Cellular Immunity Lymphocyte-transformation mentioning

confidence: 99%

Unconventional diagnostic tests for Lyme borreliosis: a systematic review

Raffetin

Saunier²,

Bouiller

et al. 2020

Clinical Microbiology and Infection

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Background: Lyme borreliosis (LB) diagnosis currently relies mainly on serological tests and sometimes PCR or culture. However, other biological assays are being developed to try to improve Borrelia-infection diagnosis and/or monitoring. Objectives: To analyse available data on these unconventional LB diagnostic assays through a systematic literature review. Methods: We searched PubMed and Cochrane Library databases according to the PRISMA-DTA method and the Cochrane Handbook for Systematic Reviews of Interventions. We analysed controlled and uncontrolled studies (published 1983e2018) on biological tests for adults to diagnose LB according to the European Study Group for Lyme Borreliosis or the Infectious Diseases Society of America definitions, or identify strongly suspected LB. Two independent readers evaluated study eligibility and extracted data from relevant study reports; a third reader analysed full texts of papers to resolve disagreements. The quality of each included study was assessed with the QUADAS-2 evaluation scale. Results: Forty studies were included: two meta-analyses, 25 prospective controlled studies, five prospective uncontrolled studies, six retrospective controlled studies and two case reports. These biological tests assessed can be classified as: (i) proven to be effective at diagnosing LB and already in use (CXCL-13 for neuroborreliosis), but not enough to be standardized; (ii) not yet used routinely, requiring further clinical evaluation (CCL-19, OspA and interferon-a); (iii) uncertain LB diagnostic efficacy because of controversial results and/or poor methodological quality of studies evaluating them (lymphocyte transformation test, interferon-g, ELISPOT); (iv) unacceptably low sensitivity and/or specificity (CD57 þ natural killer cells and rapid diagnostic tests); and (v) possible only for research purposes (microscopy and xenodiagnoses). Discussion: QUADAS-2 quality assessment demonstrated high risk of bias in 25/40 studies and uncertainty regarding applicability for 32/40, showing that in addition to PCR and serology, several other LB diagnostic assays have been developed but their sensitivities and specificities are heterogeneous and/or under-evaluated or unassessed. More studies are warranted to evaluate their performance parameters.

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“…As is the case in localized early Lyme disease, timely antibiotic treatment is recommended for Lyme arthritis . This is based on several double‐blinded randomized trials.…”

Section: Therapy Of Lyme Arthritismentioning

confidence: 99%

A joint effort: The interplay between the innate and the adaptive immune system in Lyme arthritis

Brouwer

Schoor

Vrijmoeth

et al. 2020

Immunological Reviews

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Articular joints are a major target of Borrelia burgdorferi, the causative agent of Lyme arthritis. Despite antibiotic treatment, recurrent or persistent Lyme arthritis is observed in a significant number of patients. The host immune response plays a crucial role in this chronic arthritic joint complication of Borrelia infections. During the early stages of B. burgdorferi infection, a major hinder in generating a proper host immune response is the lack of induction of a strong adaptive immune response. This may lead to a delayed hyperinflammatory reaction later in the disease. Several mechanisms have been suggested that might be pivotal for the development of Lyme arthritis and will be highlighted in this review, from molecular mimicry of matrix metallopeptidases and glycosaminoglycans, to autoimmune responses to live bacteria, or remnants of Borrelia spirochetes in joints. Murine studies have suggested that the inflammatory responses are initiated by innate immune cells, but this does not exclude the involvement of the adaptive immune system in this dysregulated immune profile. Genetic predisposition, via human leukocyte antigen‐DR isotype and microRNA expression, has been associated with the development of antibiotic‐refractory Lyme arthritis. Yet the ultimate cause for (antibiotic‐refractory) Lyme arthritis remains unknown. Complex processes of different immune cells and signaling cascades are involved in the development of Lyme arthritis. When these various mechanisms are fully been unraveled, new treatment strategies can be developed to target (antibiotic‐refractory) Lyme arthritis more effectively.

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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

Cited by 43 publications

References 73 publications

Lyme borreliosis: diagnosis and management

Lyme borreliosis: diagnosis and management

Unconventional diagnostic tests for Lyme borreliosis: a systematic review

A joint effort: The interplay between the innate and the adaptive immune system in Lyme arthritis

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