Discrepancy between IDSA and ESGBOR in Lyme disease: Individual participant meta-analysis in Türkiye

IF 2.4 2区农林科学 Q3 INFECTIOUS DISEASES Zoonoses and Public Health Pub Date : 2024-02-27 DOI:10.1111/zph.13119

Abdullah Burak Yıldız, Ecesu Çetin, Fatihan Pınarlık, Şiran Keske, Füsun Can, Önder Ergönül

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Abstract

Background

The evidence on the prevalence of Lyme borreliosis (LB) is limited, but there is a suspicion of overdiagnosis of LB in recent years. We reviewed the LB diagnosis and treatment-related data in Türkiye, based on the Infectious Diseases Society of America (IDSA) 2020 and European Society of Clinical Microbiology and Infectious Diseases Study Group for Lyme Borreliosis (ESGBOR) 2018 guidelines. By detecting the disagreements between these two, we outlined the areas to be improved for future guidelines.

Methods

We performed a literature search according to the PRISMA guidelines in PubMed, Ovid-Medline, Web of Science, Turkish Medline, Scopus, CINAHL, ULAKBIM TR Index, Google Scholar and Cochrane Library databases. We included the published cases in a database and evaluated according to IDSA and ESGBOR guidelines. We outlined the reasons for misdiagnoses and inappropriate uses of antibiotics.

Results

We included 42 relevant studies with 84 LB cases reported from Türkiye between 1990 and December 2022. Among 84 cases, the most common clinical findings were nervous system findings (n = 37, 44.0%), erythema migrans (n = 29, 34.5%) and ophthalmologic findings (n = 15, 17.9%). The IDSA 2020 and ESGBOR 2018 guidelines agreed on the diagnosis of 71 (84.5%) cases; there was an agreement that 31 cases (36.9%) were misdiagnosed and 40 cases (47.6%) were correctly diagnosed, and there was disagreement for 13 cases (15.5%). Serum immunoglobulin M (IgM), IgG measurements by ELISA and western blot were widely performed, and they were effective in definitive diagnosis merely when used according to guidelines. Inappropriate use of antibiotics was detected in 42 (50.0%) of cases which were classified in the following categories: incorrect LB diagnosis, inappropriate choice of antibiotic, inappropriate route of drug administration and prolonged antibiotic treatment.

Conclusion

Overdiagnosis and non-adherence to guidelines is a common problem. The discordance between seroprevalence and clinical studies necessitates a consensus over the best clinical approach.

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莱姆病 IDSA 和 ESGBOR 之间的差异：土耳其的个人参与者荟萃分析。

背景：有关莱姆病（Lyme borreliosis，LB）发病率的证据有限，但近年来存在LB过度诊断的嫌疑。我们根据美国传染病学会（IDSA）2020年指南和欧洲临床微生物学和传染病学会莱姆病研究组（ESGBOR）2018年指南，回顾了土耳其的莱姆病诊断和治疗相关数据。通过检测两者之间的分歧，我们概述了未来指南需要改进的地方：我们根据 PRISMA 指南在 PubMed、Ovid-Medline、Web of Science、Turkish Medline、Scopus、CINAHL、ULAKBIM TR Index、Google Scholar 和 Cochrane Library 数据库中进行了文献检索。我们将已发表的病例纳入数据库，并根据 IDSA 和 ESGBOR 指南进行评估。我们概述了误诊和抗生素使用不当的原因：我们共纳入了 42 项相关研究，其中包括 1990 年至 2022 年 12 月期间土耳其报告的 84 例枸橼酸结肠炎病例。在 84 例病例中，最常见的临床表现为神经系统表现（37 例，44.0%）、偏头痛红斑（29 例，34.5%）和眼科表现（15 例，17.9%）。IDSA 2020 和 ESGBOR 2018 指南对 71 例（84.5%）病例的诊断达成一致；31 例（36.9%）被误诊，40 例（47.6%）被正确诊断，13 例（15.5%）存在分歧。血清免疫球蛋白 M (IgM)、IgG 的 ELISA 和 Western 印迹法测定被广泛采用，只要按照指南使用，就能有效地进行确诊。42例（50.0%）病例发现抗生素使用不当，分为以下几类：LB诊断不正确、抗生素选择不当、给药途径不当和抗生素治疗时间过长：结论：过度诊断和不遵守指南是一个常见问题。血清流行率与临床研究之间的不一致需要就最佳临床方法达成共识。

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来源期刊

Zoonoses and Public Health 医学-传染病学

CiteScore

5.30

自引率

4.20%

发文量

115

审稿时长

6-12 weeks

期刊介绍： Zoonoses and Public Health brings together veterinary and human health researchers and policy-makers by providing a venue for publishing integrated and global approaches to zoonoses and public health. The Editors will consider papers that focus on timely collaborative and multi-disciplinary research in zoonoses and public health. This journal provides rapid publication of original papers, reviews, and potential discussion papers embracing this collaborative spirit. Papers should advance the scientific knowledge of the sources, transmission, prevention and control of zoonoses and be authored by scientists with expertise in areas such as microbiology, virology, parasitology and epidemiology. Articles that incorporate recent data into new methods, applications, or approaches (e.g. statistical modeling) which enhance public health are strongly encouraged.