Lyme disease and post-treatment Lyme disease syndrome: the neglected disease in our own backyard

Objectives

A survey was developed to assess experience and opinions about Lyme disease and post-treatment Lyme disease syndrome (PTLDS) among faculties in public health. No previous surveys of public health faculties have been found in the literature.

Study design

This is a cross sectional study of public health school faculty members designed to measure knowledge and experience with Lyme disease and PTLDS using an internet survey instrument.

Methods

Participants were recruited using all the publicly available e-mail addresses of faculty members in all the 50 accredited Schools of Public Health in the United States.

Results

A 15% response rate was seen for the survey. 50% of respondents were from Lyme endemic states. Less than 5% of faculty members consider themselves expert in Lyme or PTLDS. Many faculty members had known someone with Lyme disease or PTLDS, but few had been diagnosed themselves. Most believe that PTLDS can be severe and chronic, is not easy to treat, and does not resolve on its own, but were uncertain about its aetiology. Most respondents also felt that the incidence of Lyme disease will increase and that more education is needed.

Conclusions

The need for further understanding and communication presents an opportunity for public health research and education in Lyme disease and the sequelae of PTLDS.     

Antibody testing and Lyme disease risk

Lyme disease test results for >9,000 dogs were collected from participating veterinary clinics. Testing was conducted by using the IDEXX 3Dx kit, used widely by Maine veterinarians to screen clinically normal dogs during heartworm season. This study demonstrates how this test can be a valuable public health disease surveillance tool.     

吉林省重要媒介蜱与莱姆病关系的研究

目的探讨重要媒介蜱类与莱姆病的关系。方法根据多年收集的蜱类标本鉴定,结合血清流行病学调查结果,探讨两者关系。结果吉林省有蜱类2科5属15种。结论全沟硬蜱是吉林省莱姆病的主要媒介。     

全沟硬蜱为内蒙大兴安岭莱姆病螺旋体的主要生物媒介

我们于1990年5～8月在内蒙大兴安岭,对莱姆病螺旋体的生物媒介和人群感染进行了调查,全沟硬蜱(Ixodes persulcatus)是当地蜱类的优势种,用直接荧光抗体法检查全沟硬蜱的中肠涂片,发现其带菌率为40%;从46组(380只)全沟硬蜱中分离出19株莱姆病螺旋体。分离出的菌株在单克隆反应上与美国菌株不同。用间接荧光抗体法检测308名居民血清,阳性率为13.3%。以上研究证明,大兴安岭是莱姆病疫区,全沟硬蜱是将莱姆病螺旋体传播到人和动物的主要生物媒介。     

宁波口岸蜱类及莱姆病病原体携带情况的调查研究

目的掌握宁波口岸蜱的种群特征和莱姆病病原携带情况。方法采用人工小时布旗法采蜱,用PCR法检测蜱类中携带的莱姆病DNA片段。结果采集蜱872只,隶属于1科3属3种,分别为中华硬蜱、长角血蜱、镰形扇头蜱,其中长角血蜱占97.36%,为优势种;3-9月均可捕获蜱,3-6月为高峰期,7月下旬种群数量开始急剧减少;莱姆病螺旋体DNA片段检测均呈阴性。结论查清宁波口岸蜱的种群结构,宁波口岸尚无莱姆病自然疫源地的证据。     

Effectiveness of personal protective measures to prevent Lyme disease

After the manufacture of Lyme vaccine was discontinued in 2002, strategies to prevent Lyme disease (LD) have focused on personal protective measures. Effectiveness of these measures has not been conclusively demonstrated. The aim of our case-control study was to assess the effectiveness of personal preventive measures in a highly disease-endemic area. Case-patients were persons with LD reported to Connecticut's Department of Public Health and classified as having definite, possible, or unlikely LD. Age-matched controls without LD were identified. Study participants were interviewed to assess the practice of preventive measures and to obtain information on occupational and recreational risk factors. Use of protective clothing was 40% effective; routine use of tick repellents on skin or clothing was 20% effective. Checking one's body for ticks and spraying property with acaricides were not effective. We concluded that use of protective clothing and of tick repellents (on skin or clothing) are effective in preventing LD.     

Economic impact of Lyme disease

To assess the economic impact of Lyme disease (LD), the most common vectorborne inflammatory disease in the United States, cost data were collected in 5 counties of the Maryland Eastern Shore from 1997 to 2000. Patients were divided into 5 diagnosis groups, clinically defined early-stage LD, clinically defined late-stage LD, suspected LD, tick bite, and other related complaints. From 1997 to 2000, the mean per patient direct medical cost of early-stage LD decreased from $1,609 to $464 (p<0.05), and the mean per patient direct medical cost of late-stage LD decreased from $4,240 to $1,380 (p<0.05). The expected median of all costs (direct medical cost, indirect medical cost, nonmedical cost, and productivity loss), aggregated across all diagnosis groups of patients, was approximately $281 per patient. These findings will help assess the economics of current and future prevention and control efforts.     

中国西部地区生态环境保护与莱姆病传播关系的研究

目的 了解西部地区大开发中生态环境保护与莱姆病传播的关系.方法 采用现场流行病学调查与实验室分子生物学技术相结合的方法.结果 天然林保护区莱姆病的媒介蜱类、宿主动物在种群数量、多样性指数等方面均高于苗圃林半保护区和农业开垦区;媒介昆虫和宿主动物潜能及自然疫源地活力也显著高于苗圃林半保护区和农业开垦区;农业开垦区莱姆病的媒介昆虫、宿主动物在种群数量、多样性指数方面均低于苗圃林半保护区;有蜱叮咬史的员工中,在天然林保护区工作的血清抗体阳性率高达66.7%,在苗圃林半保护区仅为2.5%;两者差异有统计学意义(P=6.45,E-11＜0.01,df=1).不同生境亚群中的遗传分散性也存在差异,在天然林保护区和农业开垦区之间有最大遗传分散系数(Fst)0.557 42.苗圃林半保护区和农业开垦区之间的系数同样大于零,有统计学意义.在苗圃林半保护区和天然林保护区之间的遗传差异系数最低(0.108 02),表明在这两个样地的亚群之间无显著遗传差异;这些亚群中的遗传距离表现出与其生境相似的变化.结论 西部大开发天然林保护和退耕还林还草战略工程的实施,对于莱姆病的媒介昆虫、宿主动物在一定程度上起保护作用,其潜能、自然疫源地活力等增加,人群感染的危险性明显增高.     

Patterns of Lyme disease diagnosis and treatment by family physicians in a southeastern state

This study examined how often physicians in Georgia diagnose and treat Lyme disease as well as the criteria they use to reach a diagnosis of Lyme disease. A survey was sent to 1,331 family physicians in Georgia concerning how many cases of Lyme disease the physicians diagnosed, and the criteria used to make the diagnosis, during the preceding 12 months. Of 710 responses, 167 physicians treated 316 cases of Lyme disease without a firm diagnosis. In addition, 125 physicians diagnosed 262 cases of Lyme disease, 130 without serologic testing and 132 with serologic testing. Family Physicians in Georgia diagnose Lyme disease at a rate 40 times greater than the surveillance case rate reported in Georgia.     

北京奥运会期间的一例输入性莱姆病病例分析

目的分析拟诊莱姆病患者血清学检查结果,为有效诊治莱姆病提供科学依据。方法应用间接免疫荧光试验（IFA）、ELISA和蛋白免疫印迹（WB）3种实验方法,对此例患者进行血清抗伯氏疏螺旋体IgM和IgG抗体检查,并结合临床疾患进行综合分析。结果 3种试验方法IgG均为阳性,其中IFA的IgG抗体滴度达到1：128,WB的IgG有2条蛋白带P83和P39;3种试验方法IgM均为阴性。结论患者临床发展病程符合莱姆病的特征,实验室结果阳性,莱姆病的诊断可以成立。     

江苏省2614名莱姆病高危人群血清检测结果分析

目的 检测健康人群血清莱姆病抗体水平。方法 采用间接免疫荧光试验（ＩＦＡ）法。结果 共检测２６１４人,阳性１９２人,感染率７．４９％。男性感染率７．２０％、女性感染率７．４９％,两者间差异无显著性差异。中年组２６￣３５岁（１０．４５％）、３６￣４５岁（１２．９４％）与５６岁以上（２．１８％）感染率差异有显著性意义。１５４例莱姆病血清阳性者中,蜱叮咬率为４３．５０％, 慢性游走性红斑（ＥＣＭ）皮疹患     

天津市蓟县莱姆病流行情况调查

目的 了解天津市蓟县莱姆病的流行病学特征.方法 采用间接免疫荧光试验对该县居民进行血清流行病学调查,并用PCR方法和病原分离培养对临床确诊的莱姆病患者进行病原检测.结果 天津市蓟县人群莱姆病感染率为5.97％,学生感染率为5.28％.山区和半山区感染率高于平原地区;40-49岁年龄组感染率最高.经临床和血清学诊断为莱姆病患者25例,其主要临床表现为关节炎、慢性游走性红斑、面神经麻痹、多发性神经炎、脑膜炎和心脏损害等.收集25例患者的尿液,进行PCR检测,1例阳性.从1例多发性神经炎患者血液中分离出莱姆病螺旋体.结论 首次从天津地区莱姆病患者分离到莱姆病螺旋体.天津蓟县人群中有莱姆病的发生和流行,可能存在莱姆病的自然疫源地,为莱姆病防治提供依据.     

Repeated holdout cross-validation of model to estimate risk of Lyme disease by landscape characteristics

We previously modeled Lyme disease (LD) risk at the landscape scale; here we evaluate the model's overall goodness-of-fit using holdout validation. Landscapes were characterized within road-bounded analysis units (AU). Observed LD cases (obsLD) were ascertained per AU. Data were randomly subset 2,000 times. Of 514 AU, 411 (80%) were selected as a training dataset to develop parameter estimates used to predict observations in the remaining 103 (20%) AU, the validation subset. Predicted values were subtracted from obsLD to quantify accuracy across iterations. We calculated the percentage difference of over- and under-estimation to assess bias. Predictive ability was strong and similar across iterations and datasets; the exact number of obsLD cases per AU were predicted almost 60% of the time. However, the three highest obsLD AU were under-predicted. Our model appears to be accurate and relatively unbiased, however is conservative at high disease incidence.     

大兴安岭南段莱姆病的调查

1991年4～6月,我们在大兴安岭南段林区,对莱姆病进行了调查,应用间接免疫荧光抗体法检测496人居民血清,38人血清中抗莱姆病螺旋体IgG抗体效价≥1:128。根据临床表现和血清学调查,确诊莱姆病病例22例;从26只全沟硬蜱分离出4株莱姆病螺旋体。     

Lyme disease: Insight from social sciences

This article is a selective literature review of social science works published on Lyme disease that draws on other articles published on similar health hazards. These works present Lyme borreliosis as an “archetypal” example of modern infectious risks. It is an “invisible” risk resulting from interactions between human activities, ecosystems, and pathogens. To tackle this risk, health authorities promote individual-based prevention measures. Perceptions of the general population should thus be better understood: different from the perceptions of experts, the general population's perceptions are socially differentiated, inclined to an “optimism bias”, and influenced by personal stories. One should also not forget the dilemmas faced by the general population when contemplating preventive behavior. The “chronic Lyme disease” controversy illustrates the modern disappointment in science, the leveling of the general population's and experts’ relative opinions, and the progressive interference of the former with expert matters.     

Multidisciplinary management of patients presenting with Lyme disease suspicion

Objective

The teaching hospital of Nancy, France, implemented a specific multidisciplinary care pathway (French acronym AMDPL) to improve the management of patients presenting with Lyme borreliosis (LB) suspicion. We aimed to assess the first year of activity of this care pathway.

莱姆病检测技术研究进展

莱姆病是由伯氏疏螺旋体引起的,经蜱叮咬人、畜所致多系统损害性传染病。该病临床表现复杂多样、发病率高,广泛流行于世界各地,对人类健康危害严重。由于目前缺乏针对该病的有效疫苗和治疗药物,只能通过采取控制媒介传播、加强检测的方法来降低该病的流行和暴发风险。本文对莱姆病的检测技术作一综述,以指导国内开展对该病的检测。     

黑龙江东部七口岸蜱种群特征及携带莱姆病病原体的研究

目的掌握黑龙江省东部七口岸蜱的种群特征及其感染的莱姆病病原体。方法采用人工小时布旗法采集蜱．接种于BSKⅡ培养基,分离莱姆病螺旋体。结果在七口岸共施蜱180人工小时,采集成蜱6554只,隶属于1科3属5种,其中长角血蜱为口岸蜱类新记录。主要种群为：森林革蜱(37．2％),全沟硬蜱(31．6％)．嗜群血蜱(27．6％);不同口岸和生境蜱种群构成有所不同。从东宁、同江口岸分离到莱姆病螺旋体3株。结论基本查清黑龙江省东部七口岸蜱的种群构成,东宁、同江口岸存在莱姆病疫源地。     

105例拟诊莱姆病患者抗伯氏疏螺旋体抗体检查结果分析

目的 分析拟诊莱姆病患者血清学检查结果,明确莱姆病临床病症及区域分布情况,为有效诊治莱姆病提供科学依据.方法 应用间接免疫荧光试验(IFA)和ELISA方法,对来自全国各地的临床拟诊莱姆病患者进行血清抗伯氏疏螺旋体IgM和IgG抗体检查,并结合临床疾患进行综合分析.结果 2007-2008年共检查临床拟诊莱姆病患者105例,血清呈阳性反应者16例,阳性率15.24%.其中神经系统患者44例,阳性4例;心血管系统患者5例,阳性1例;皮肤病变25例,阳性6例;发热患者10例,阳性1例;关节痛14例,阳性2例;精神障碍疾患7例,阳性2例.16例患者应用抗生素治疗后有效率达87.50%.16例莱姆病患者分布在9个省(直辖市、自治区),确诊病例以黑龙江、吉林、内蒙古地区较多.结论 我国人群确实存在莱姆病螺旋体散发感染,通过血清学检查能及早发现病例,提高诊疗效率.     

山东省莱姆病地理流行病学研究

目的调查山东省莱姆病地理分布、媒介生物、动物宿主及病原分离情况,为今后防治提供依据。方法采用间接免疫荧光抗体试验(IFA)对6个调查点的人群进行莱姆病抗体检测;用直接免疫荧光抗体试验(DFA)检查优势蜱种及其携带莱姆病螺旋体情况,并用BSKⅡ培养基分离培养莱姆病螺旋体。宿主调查采用DFA检查鼠肾。用单克隆抗体和IFA进行菌株的鉴定。结果共检测血清1934份,阳性121份,感染率6.26%;鲁东、鲁南、鲁中、鲁西北感染率分别为5.76%、7.03%、0、9.81%;各年龄组差异无统计学意义(P>0.05);男性感染率为5.56%,女性为6.98%,两者间差异无统计学意义(χ2=1.67,P>0.05);山东省蜱类的优势种为长角血蜱,该蜱中肠带螺旋体率为12.00%;宿主动物调查显示,鼠类带莱姆病螺旋体率为13.26%,黑线姬鼠为优势种(占45.65%),带菌率高为14.24%。从86组培养物中分离到2株莱姆病螺旋体(TSH1、TSH2)。结论不同地区生态环境和传播媒介分布不同,各地区间莱姆病感染程度差别很大。长角血蜱可能为山东省莱姆病的重要生物媒介。