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Lyme Anxiety Extensive (often inaccurate) publicity about both the risks and the outcomes of Lyme disease has produced considerable anxiety about this disease (many states with no endemic disease have Lyme disease support groups organized by patients). This concern has also led to inappropriate use of serological tests for Lyme disease as a screening test (often ordered as a result of requests by patients) in an attempt to identify the cause of widely prevalent, nonspecific symptoms such as pain and fatigue. This has, in turn, led to a virtual epidemic of overdiagnosis and overtreatment of patients for Lyme disease, which only serves to perpetuate the myth that Lyme disease is commonly associated with severe, long-term morbidity. Most studies indicate that with rare exceptions, the outcomes for persons with Lyme disease are excellent. It is important for clinicians to consider what evidence (both clinical and epidemiological) there is to "rule in" Lyme disease before serological tests are ordered to rule out the diagnosis. Persons with only nonspecific symptoms and no objective signs of Lyme disease are very unlikely to have Lyme disease, regardless of the results of serological tests. Inappropriate use of these tests frequently will result in misdiagnosis of Lyme disease and may prevent or delay the patient from receiving appropriate care for the true problem. E. D. Shapiro and M. A. Gerber. Lyme Disease. Clinical Infectious Diseases 2000;31:533-542 62
www.eucalb.com n Media reports have coloured European public perceptions of LB by suggesting that the infection is difficult to diagnose and treat and has a high morbidity, but this applies only to a tiny minority of cases. Some of these misconceptions are due to misdiagnosis (mainly overdiagnosis) which may occur because clinical presentations of LB are not unique to that condition. Diagnosis is primarily clinical and takes into account the risk of tick bite. Supporting evidence is provided by laboratory investigation, usually antibody tests. n EUROPEAN UNION CONCERTED ACTION ON LYME BORRELIOSIS 63
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« Maladie de Lyme » Borréliose E
Page 7 and 8:
Ixodes ricinus 7
Page 9 and 10:
Distribution d’Ixodes ricinus 9
Page 11 and 12: Borrelia 11
Page 13 and 14: Transmission n Tiques porteuses (Fr
Page 15 and 16: Incidence en France 15
Page 17 and 18: Clinique
Page 19 and 20: Contexte n Notion de morsure de tiq
Page 21 and 22: Phase primaire n Erythème chroniqu
Page 23 and 24: Erythème chronique migrant 23
Page 25 and 26: Phase secondaire n Si phase primair
Page 27 and 28: Atteinte articulaire n Rare en Euro
Page 29 and 30: Phase tertiaire n Neurologique n En
Page 31 and 32: n Arthrites n Aigues n Chroniques n
Page 33 and 34: Syndrome post Lyme n Asthénie n Al
Page 35 and 36: Symptômes cliniques Kalish 2001 Se
Page 37 and 38: Type de test n Détection antigène
Page 39: ELISA n Attention n Réactions croi
Page 42 and 43: Démarche diagnostic n 1er : ELISA
Page 45 and 46: Term Clinical Case Definition Labor
Page 47 and 48: Oter la tique... Ne pas utiliser d
Page 49 and 50: Indication Thérapeutique n Erythè
Page 51 and 52: ECM n Doxycycline 200 mg/j n Amoxic
Page 53 and 54: Arthrite n Doxycycline 200 mg/j n A
Page 55 and 56: Vaccination n Vaccin à partir de l
Page 57: Phases secondaires et tertiaires 57
Page 64 and 65: Référence n U.R. Hengee et al. Ly
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