Perceptions, Representations, and Experiences of Patients Presenting Nonspecific Symptoms in the Context of Suspected Lyme Borreliosis

Background: Some subjective symptoms may be reported at all stages of Lyme borreliosis (LB) and may persist for several months after treatment. Nonspecific symptoms without any objective manifestation of LB are sometimes attributed by patients to a possible tick bite. The aim of our study was to explore the perceptions, representations, and experiences that these patients had of their disease and care paths. Methods: We performed a qualitative study through individual interviews (October 2017–May 2018), based on grounded theory, following the COREQ checklist. A balanced sample of patients with diverse profiles was recruited at consultations with general practitioners and infectious disease physicians. Results: Twelve patients were interviewed. Data saturation was reached at the twelfth interview. For codes, 293 were identified, and classified into 5 themes: (1) the experience of disabling nonspecific symptoms, especially pain, causing confusion and fear, (2) long and difficult care paths for the majority of the patients, experienced as an obstacle course, (3) a break with the previous state of health, causing a negative impact on every sphere of the patient’s life, (4) empowerment of the patients and the self-management of their disease, and (5) the strong expression of a desire for change, with better listening, greater recognition of the symptoms, and simpler care paths. Conclusions: This study allows for the understanding of a patient’s behaviours and the obstacles encountered, the way they are perceived, and the necessary solutions. The patients’ expectations identified here could help physicians better understand the doctor–patient relationship in these complex management situations, which would reduce the burden of the disease. The current development of specialised reference centres could help meet the patients’ demands and those of family physicians

Borrélioses et fièvres récurrentes

National audienceBorrélioses et fièvres récurrentes Les borrélioses récurrentes (br) ou fièvres récurrentes sont dues à des bactéries du genre borrelia, de la famille des spirochètes, transmises à l’homme par des arthro¬podes vecteurs (poux de corps, tiques molles, et tiques dures pour l’une d’entre elles). La br à poux est cosmo¬polite et transmise lors d’épidémies survenant dans le contexte de crises majeures (promiscuité, conditions d’hygiène précaires, crise alimentaire, etc.). Les br à tiques se répartissent par région, selon la borrelia en cause et la distribution géographique de leur tique vec¬trice. Le temps d’incubation varie de 3 à 20jours. La première phase fébrile dure 3jours (1-14jours), suivie d’une phase d’apyrexie avec persistance des autres signes cliniques (rash cutané, pétéchies, céphalées in¬tenses, agitation, polyarthromyalgies, douleurs abdomi¬nales, nausées/vomissements, etc.). La récurrence de la fièvre décrit une périodicité de 7jours en moyenne. La bactériémie est abondante lors des pics fébriles, permet¬tant de poser un diagnostic par examen direct en mi¬croscopie, pcr borrelia ou culture sur milieu spécial, quand celle-ci est possible. Le traitement repose sur la doxycycline, sauf pour les formes neurologiques (ceftriaxone). Le taux de mortalité varie de 2 à 5 % selon la borrelia incriminée. L’évolution est le plus souvent favorable après traitement

Immunoserological Diagnosis of Human Borrelioses: Current Knowledge and Perspectives

International audienceSpirochetes of the genus Borrelia are divided into relapsing fever borreliae and Lyme disease borreliae. Immunoserological assays have been poorly developed for relapsing fever borreliae, where direct detection methods are more adapted to the pathophysiology of these infections presenting with massive bacteraemia. However, emergence of the novel agent of relapsing fever B. miyamotoi has renewed interest in serology in this context. In Lyme disease, because direct detection methods show low sensitivity, serology plays a central role in the diagnostic strategy. This diagnostic strategy is based on a two-tier methodology involving a first test (ELISA) with high sensitivity and acceptable specificity and a second, more specific test (western blot) for diagnostic confirmation. The most frequent limitations and pitfalls of serology are cross reactions, false IgM positivity, a seronegative window period at the early time of the infection, and serologic scars with a suspicion of reinfection. International guidelines have thus been proposed to avoid these difficulties with interpretation. Finally, unconventional diagnostic tests have been developed recently in the context of a highly publicized disease, with widely varying results, some of which have no available evidence-based data. New two-tier testing strategies using two ELISA tests (C6 and WCS for example) to replace immunoblot are currently proposed by some authors and guidelines, and promising new tests such as CXCL-13 in CSF are promising tools for the improvement of the diagnosis of Lyme borreliosis

Borrélioses et fièvres récurrentes

National audienceBorrélioses et fièvres récurrentes Les borrélioses récurrentes (br) ou fièvres récurrentes sont dues à des bactéries du genre borrelia, de la famille des spirochètes, transmises à l’homme par des arthro¬podes vecteurs (poux de corps, tiques molles, et tiques dures pour l’une d’entre elles). La br à poux est cosmo¬polite et transmise lors d’épidémies survenant dans le contexte de crises majeures (promiscuité, conditions d’hygiène précaires, crise alimentaire, etc.). Les br à tiques se répartissent par région, selon la borrelia en cause et la distribution géographique de leur tique vec¬trice. Le temps d’incubation varie de 3 à 20jours. La première phase fébrile dure 3jours (1-14jours), suivie d’une phase d’apyrexie avec persistance des autres signes cliniques (rash cutané, pétéchies, céphalées in¬tenses, agitation, polyarthromyalgies, douleurs abdomi¬nales, nausées/vomissements, etc.). La récurrence de la fièvre décrit une périodicité de 7jours en moyenne. La bactériémie est abondante lors des pics fébriles, permet¬tant de poser un diagnostic par examen direct en mi¬croscopie, pcr borrelia ou culture sur milieu spécial, quand celle-ci est possible. Le traitement repose sur la doxycycline, sauf pour les formes neurologiques (ceftriaxone). Le taux de mortalité varie de 2 à 5 % selon la borrelia incriminée. L’évolution est le plus souvent favorable après traitement

Review of European and American guidelines for the diagnosis of Lyme borreliosis

International audienceLyme disease is a tick-borne bacterial disease with polymorphic clinical manifestations (cutaneous, rheumatological, and neurological). In recent years the issue of the diagnosis of this infection has been highly publicized on the Internet and other media in Europe and America. Some patients and physicians may share the perception that the diagnosis of the infection is not reliable in France. We reviewed current European and American guidelines on Lyme disease and performed a methodological evaluation of all guidelines. We retrieved 16 guidelines from seven countries. Our analysis revealed a global consensus regarding diagnosis at each stage of the infection. All guidelines indicate that the diagnosis is currently based on a two-tier serology at all stages of the infection, except for the early localized dermatological presentation known as Erythema migrans. One text of so-called guidelines has discordant recommendations when compared with the other guidelines, possibly explained by its low quality score. Contrary to the intense debate taking place on the Internet and in the European and American media, our analysis shows that the great majority of medical scientific guidelines with a high quality score, agree on the clinical diagnostic methods of Lyme disease

Tuberculose pulmonaire : évolution radiologique des lésions broncho-pulmonaires en fin de traitement

International audienc

The control of <i>Hyalomma</i> ticks, vectors of the Crimean–Congo hemorrhagic fever virus: Where are we now and where are we going?

This review was conducted by the ad hoc subgroup from the working expert group on the risks related to Hyalomma ticks at the French Agency for Food, Environmental and Occupational Health & Safety (ANSES) commissioned by the French authorities.International audienceAt a time of major global, societal, and environmental changes, the shifting distribution of pathogen vectors represents a real danger in certain regions of the world as generating opportunities for emergency. For example, the recent arrival of the Hyalomma marginatum ticks in southern France and the concurrent appearance of cases of Crimean–Congo hemorrhagic fever (CCHF)—a disease vectored by this tick species—in neighboring Spain raises many concerns about the associated risks for the European continent. This context has created an urgent need for effective methods for control, surveillance, and risk assessment for ticks and tick-borne diseases with a particular concern regarding Hyalomma sp. Here, we then review the current body of knowledge on different methods of tick control—including chemical, biological, genetical, immunological, and ecological methods—and the latest developments in the field, with a focus on those that have been tested against ticks from the genus Hyalomma. In the absence of a fully and unique efficient approach, we demonstrated that integrated pest management combining several approaches adapted to the local context and species is currently the best strategy for tick control together with a rational use of acaricide. Continued efforts are needed to develop and implement new and innovative methods of tick control

L’artésunate en dehors du paludisme

International audienceIntroduction. – Artesunate and other artemisinin derivatives are used in various infectious and non-infectious diseases. We aimed to analyze available data on artesunate and artemisinin derivatives activity in humans and their potential clinical benefits in non-malarial indications.Material and methods. – Literature review performed on PubMed and the Cochrane Library databases using the PRISMA method. We analyzed studies published in English from January 2008 to August 2017 using the same indicators of drug efficacy.Results. – We included 19 studies performed in humans (1 meta-analysis, 1 literature review, 4 randomized controlled trials, 3 prospective controlled trials, 3 prospective uncontrolled trials, 2 exploratory phase 1 or 2 trials, 1 case series, and 4 case reports). Artesunate and artemisinin derivatives demonstrated efficacy in the treatment of schistosomiasis in combination with praziquantel (P = 0.003). Artesunate monotherapy was less effective than praziquantel alone (P < 0.001) probably because its activity only affects the early stages of Schistosoma parasites. Artesunate monotherapy could be interesting as a chemoprophylactic drug against schistosomiasis (P < 0.001). Findings seem promising but are still controversial in the treatment of multidrug-resistant CMV infections. Studies do not conclude on artesunate and artemisinin derivatives efficacy in the treatment of cervix, breast, colorectal, and lung cancers. Conclusion. – Artesunate and artemisinin derivatives in combination with praziquantel were effective against schistosomiasis, and could be used as a chemoprophylactic drug alone. They could be interesting as anti-CMV and anti-tumor treatment. Additional trials in humans are required to assess the efficacy of artesunate and artemisinin derivatives in diseases other than malaria.Introduction: L’artésunate et les autres dérivés d’artémisinine sont les traitements de première ligne du paludisme. L’objectif était d’analyser les données disponibles de l’utilisation de l’artésunate et des dérivés d’artémisinine chez l’homme dans d’autres pathologies infectieuses et non infectieuses.Matériels et méthodes: Une revue systématique de littérature a été conduite sur PubMed et Cochrane Library, selon une méthodologie PRISMA. Nous avons analysé toutes les études publiées en anglais entre janvier 2008 et août 2017.Résultats: Nous avons inclus 19 études (1 méta-analyse, 1 revue de littérature, 4 essais randomisés contrôlés, 6 essais prospectifs contrôlés et non contrôlés, 2 essais de phase 1 ou 2, 1 série de cas et 4 rapports de cas). L’artésunate et les autres dérivés d’artémisinine ont montré une efficacité dans le traitement de la schistosomose en combinaison avec le praziquantel (p = 0,003). L’artésunate en monothérapie est moins efficace que le praziquantel seul (p < 0,001). L’artésunate en monothérapie pourrait être utilisé comme agent prophylactique de la schistosomose (p < 0,001). Des données d’efficacité, quoique controversées, semblent intéressantes dans le traitement de l’infection à CMV résistant. Les travaux publiés ne permettent pas de conclure à une efficacité dans le cancer du col de l’utérus, du sein, du carcinome colorectal et cancers pulmonaires.Conclusion: L’artésunate et autres dérivés d’artémisinine en combinaison avec le praziquantel sont efficaces contre la schistosomose. Ils pourraient être intéressants comme agent anti-CMV et possiblement comme agent antitumoral. Cependant, les travaux publiés ne permettent pas de positionner ces traitements dans d’autres pathologies que le paludisme

Borréliose de Lyme

National audienceLYME BORRELIOSIS. Lyme borreliosis (LB) is the most common vector-borne disease in the Northern Hemisphere, caused by the bacterium Borrelia burgdorferi sensu lato, transmitted to humans by a bite of ticks Ixodes. Prevention is based on simple measures to evict ticks, and on their rapid extractionin the event of a bite. The diagnosis of LB is based on 3 arguments: an exposure to tick bites; clinically compatible symptoms (cutaneous, neurological or rheumatological manifestations, +/- functional symptoms such as fatigue or polyarthromyalgia), evolving in 3 stages (early localized or erythema migrans, early or late disseminated LB); a positive two-tier serological test (ELISA +/- Western-Blot). Serology can be negative for the first 6 weeks, without excluding the diagnosis. Since serology can remain positive for life, evolution is only evaluated clinically. LB treatment is mainly based on doxycycline for 14 to 28 days, depending on the clinical stage and manifestations, without demonstrated interest in prolonging it, even if symptoms persist. Nonetheless their management is crucial as often responsible for medical wandering. Attentive listening to the patient is essential. The prognosis of LB in the medium-term is favorable, especially if they beneficiate of an early management.La borréliose de Lyme est la principale zoonose vectorielle en France. Elle est due à la bactérie Borrelia burgdorferi sensu lato, transmise lors d’une piqûre de tique infectée du genre Ixodes. Son diagnostic repose sur un trépied diagnostique, parfois incomplet. La prévention consiste en la protection contre les piqûres de tiques, et leur extraction rapide en cas de piqûre. Le traitement repose principalement sur la doxycycline

The control of Hyalomma ticks, vectors of the Crimean-Congo hemorrhagic fever virus: Where are we now and where are we going?

At a time of major global, societal, and environmental changes, the shifting distribution of pathogen vectors represents a real danger in certain regions of the world as generating opportunities for emergency. For example, the recent arrival of the Hyalomma marginatum ticks in southern France and the concurrent appearance of cases of Crimean-Congo hemorrhagic fever (CCHF)-a disease vectored by this tick species-in neighboring Spain raises many concerns about the associated risks for the European continent. This context has created an urgent need for effective methods for control, surveillance, and risk assessment for ticks and tick-borne diseases with a particular concern regarding Hyalomma sp. Here, we then review the current body of knowledge on different methods of tick control-including chemical, biological, genetical, immunological, and ecological methods-and the latest developments in the field, with a focus on those that have been tested against ticks from the genus Hyalomma. In the absence of a fully and unique efficient approach, we demonstrated that integrated pest management combining several approaches adapted to the local context and species is currently the best strategy for tick control together with a rational use of acaricide. Continued efforts are needed to develop and implement new and innovative methods of tick control