短篇通讯:莱姆病的早期血源性播散  

Brief communication: Hematogenuos dissemination in early lyme disease

作　　者：Wormser G.P. McKenna D. Carlin J. 惠海英 

机构地区：[1]Dr.Division of Infectious Diseases, New York Medical College, Munger Pavilion, Valhalla, NY 10595, United States

出　　处：《世界核心医学期刊文摘（皮肤病学分册）》2005年第8期39-40,共2页Digest of the World Core Medical JOurnals:Dermatology

摘　　要：Background: Bloodstream invasion in Lyme disease has been difficult to study because until recently blood culture methods were too insensitive to detect spirochetemia. Objective: To evaluate the clinical and laboratory features of spirochetemic patients. Design: Cross- sectional study. Setting: Lyme Disease Diagnostic Center in Valhalla, New York, 1997 to 2002. Patients: 213 untreated adults with erythema migrans. Intervention: Blood culture for Borrelia burgdorferi. Measurements: Symptom scores and selected laboratory measures. Results: Spirochetemia was found in 93 (43.7% ) patients. Spirochetemic patients were more often symptomatic (89.2% vs. 74.2% ; P=0.006) and more often had multiple erythema migrans lesions (41.9% vs. 15.0% ; P < 0.001) than patients without spirochetemia. However, 8 (22.9% ) of the 35 asymptomatic patients with a single skin lesion nevertheless had a positive blood culture. Risk for spirochetemia was present the day the patient noticed the lesion and continued for more than 2 weeks. Limitations: Long- term outcome data were not available. Conclusions: The high rate, early onset, and prolonged duration of risk for spirochetemia explain why untreated patients with erythema migrans are at risk for dissemination of B. burgdorferi to anatomic sites beyond the lesion site. Differences in the strain of the infecting spirochete, as well as host factors, may be important determinants of hematogenous dissemination.Background: Bloodstream invasion in Lyme disease has been difficult to study because until recently blood culture methods were too insensitive to detect spirochetemia. Objective: To evaluate the clinical and laboratory features of spirochetemic patients. Design: Cross- sectional study. Setting: Lyme Disease Diagnostic Center in Valhalla, New York, 1997 to 2002. Patients: 213 untreated adults with erythema migrans. Intervention: Blood culture for Borrelia burgdorferi. Measurements: Symptom scores and selected laboratory measures. Results: Spirochetemia was found in 93 (43.7% ) patients. Spirochetemic patients were more often symptomatic (89.2% vs. 74.2% ; P=0.006) and more often had multiple erythema migrans lesions (41.9% vs. 15.0% ; P < 0.001) than patients without spirochetemia. However, 8 (22.9% ) of the 35 asymptomatic patients with a single skin lesion nevertheless had a positive blood culture. Risk for spirochetemia was present the day the patient noticed the lesion and continued for more than 2 weeks. Limitations: Long- term outcome data were not available. Conclusions: The high rate, early onset, and prolonged duration of risk for spirochetemia explain why untreated patients with erythema migrans are at risk for dissemination of B. burgdorferi to anatomic sites beyond the lesion site. Differences in the strain of the infecting spirochete, as well as host factors, may be important determinants of hematogenous dissemination.

关 键 词：莱姆病 血源性 螺旋体血症 游走性红斑 横断面调查 血液培养 血培养阳性 皮损部位 哈拉 无症状患者 

分 类 号：R514[医药卫生—内科学]