Infectious diseases now最新文献_第2页

Sepsis as Seen through the Eyes of AI: A Comparative evaluation of ChatGPT and Gemini AI眼中的脓毒症：ChatGPT和Gemini的比较评价

IF 2.2 4区医学 Q2 INFECTIOUS DISEASES

Infectious diseases now

Pub Date : 2025-12-09 DOI: 10.1016/j.idnow.2025.105228

Tayibe Bal , Rahmet Güner

Introduction

More and more people are using large language models (LLMs) to seek out health information online. Although these tools have great potential to improve digital health literacy, not enough is known about their accuracy and consistency, especially in life-threatening conditions such as sepsis. The aim of this study was to test and compare the effectiveness of two popular LLMs, ChatGPT 4o and Gemini 2.5 Flash, in providing accurate and consistent answers to questions about sepsis.

Material and Methods

A cross-sectional benchmarking study was conducted using a standardized set of sepsis-related questions, comprising two main categories: frequently asked questions (FAQs) and items drawn from the Surviving Sepsis Campaign (SSC) guidelines. The responses generated by the two models were independently assessed by two raters using the Global Quality Score (GQS), and reproducibility was evaluated by submitting each question twice.

Results

Gemini significantly outperformed ChatGPT in overall quality and reproducibility. More specifically, 94% of Gemini’s responses received the highest GQS rating (GQS 5), compared to only 35.4% of the ChatGPT answers. Gemini also demonstrated higher reproducibility (97.5% vs. 76.5%). Both models underperformed in the “prevention” domain. Gemini showed greater potential than ChatGPT in delivering accurate and consistent sepsis-related health information, which is crucial for patients and caregivers alike.

Conclusion

These findings underscore the importance of rigorous benchmarking before integrating LLMs into digital health platforms, and illustrate a need for refinement of LLMs to enhance their reliability in public-facing health communication.

越来越多的人使用大型语言模型（llm）在网上查找健康信息。尽管这些工具在提高数字卫生素养方面具有巨大潜力，但对其准确性和一致性的了解还不够，特别是在脓毒症等危及生命的疾病中。本研究的目的是测试和比较两种流行的llm， ChatGPT 40和Gemini 2.5 Flash，在为脓毒症问题提供准确和一致的答案方面的有效性。材料和方法一项横断面基准研究使用一套标准化的败血症相关问题进行，包括两大类：常见问题（FAQs）和幸存败血症运动（SSC）指南中的项目。由两个模型生成的回答由两个评分员使用全球质量评分（GQS）独立评估，并通过提交每个问题两次来评估可重复性。结果gemini在综合质量和重现性方面明显优于ChatGPT。更具体地说，94%的双子座回答获得了最高的GQS评级（GQS 5），而ChatGPT的答案只有35.4%。Gemini也显示出更高的再现性（97.5% vs. 76.5%）。这两个模型在“预防”领域都表现不佳。Gemini在提供准确和一致的败血症相关健康信息方面显示出比ChatGPT更大的潜力，这对患者和护理人员都至关重要。这些发现强调了在将法学硕士整合到数字健康平台之前进行严格的基准测试的重要性，并说明需要对法学硕士进行改进，以提高其在面向公众的健康沟通中的可靠性。

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引用次数: 0

Prognosis of central venous catheter-related Candida infection during hospitalization in conventional medical or surgical wards: A 13-year retrospective cohort study 传统内科或外科病房住院期间中心静脉导管相关念珠菌感染的预后：一项13年回顾性队列研究

IF 2.2 4区医学 Q2 INFECTIOUS DISEASES

Infectious diseases now

Pub Date : 2025-12-09 DOI: 10.1016/j.idnow.2025.105227

Aida Zaghdoudi , Arthur Hacquin , Stéphane Valot , Mathieu Blot , Lionel Piroth , Thibault Sixt

Objectives

While catheter-related Candida infections in intensive care settings are well-described, data from conventional medical or surgical wards remain limited. This study aims to identify the clinical characteristics and prognostic factors of catheter-related Candida infections in such settings.

Methods

We conducted a retrospective single-center cohort study from 2008 to 2022, including patients with confirmed catheter-related Candida infection. Diagnosis was based on a positive central blood culture, along with either a positive peripheral blood culture, local inflammatory signs, or radiological signs suggesting catheter-related candidemia. The main outcome was either transfer to the intensive care unit or death within 30 days.

Results

Following a univariate analysis, 15 (30 %) patients among a total of 50 had an unfavorable outcome: eight (16 %) were transferred to the intensive care unit, and seven (14 %) died within 30 days. Poor outcome was associated with age over 60 years, clinical severity, and positive mannan biomarkers.

Conclusion

Catheter-related Candida infections in non-critical care settings are associated with significant morbidity and mortality. Fungal biomarkers may hold clinically relevant prognostic value, necessitating further investigations.

虽然重症监护病房中导管相关念珠菌感染的描述很好，但来自传统内科或外科病房的数据仍然有限。本研究旨在确定导管相关念珠菌感染的临床特征和预后因素。方法对2008年至2022年确诊导管相关念珠菌感染的患者进行回顾性单中心队列研究。诊断基于中心血培养阳性，外周血培养阳性，局部炎症征象或提示导管相关念珠菌病的放射学征象。主要结局是转入重症监护病房或在30天内死亡。结果：单因素分析显示，50例患者中有15例（30%）出现不良结局：8例（16%）转入重症监护病房，7例（14%）在30天内死亡。不良预后与60岁以上的年龄、临床严重程度和甘露聚糖生物标志物阳性相关。结论导管相关性念珠菌感染在非重症监护环境中具有显著的发病率和死亡率。真菌生物标志物可能具有临床相关的预后价值，需要进一步的研究。

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引用次数: 0

Characteristics of tuberculosis in elderly adults: A multicenter French study 老年人肺结核的特点：一项法国多中心研究。

IF 2.2 4区医学 Q2 INFECTIOUS DISEASES

Infectious diseases now

Pub Date : 2025-12-07 DOI: 10.1016/j.idnow.2025.105226

Martin Trichet , Jean-Philippe Lanoix , Sylvain Diamantis , Emmanuel Forestier , Thibaut Fraisse , Julia Brochard-Libois , Carine Dokoula , Flora Ketz , Aurélia Henn , Alain Putot , Benoît Cazenave , Nicolas Baclet , Cédric De Villelongue , Nadège Lemarie , Claire Roubaud-Baudron , Gaëtan Gavazzi , Benoît De Wazières , Sébastien Gallien , Pauline Caraux-Paz , On behalf of GInGer

Introduction

The incidence of tuberculosis (TB) remains high in elderly adults in France. Immunosenescence and comorbidities challenge both diagnosis and treatment in this population. Recent data describing TB characteristics and outcomes in the elderlies are scarce. We aimed to describe clinical and microbiological features of TB in the elderly population and to identify factors associated with 2-year mortality.

Patients and methods

We conducted a retrospective multicenter study including patients aged ≥ 75 years who were diagnosed with TB between 2010 and 2020 across 18 centers. A multivariate analysis was used to identify factors independently associated with 2-year mortality.

Results

A total of 295 patients were included: mainly born in France (57%). Immunosuppression was rare (9.8%). Fever and cough were uncommon, while weight loss was the most frequent symptom (60.3%), significantly associated with diagnostic delays. Pulmonary TB was the predominant form (63.1%) with higher culture positivity observed in this group and in the oldest patients. Isoniazid resistance was rare (5.2%). Standard quadritherapy was the most common initial regimen and was not associated with higher rates of adverse events. At two-year follow-up, overall mortality was 31.3%. In multivariate analysis, mortality was significantly associated with severe renal failure, living in nursing home or long-term care facilities, and weight loss at presentation.

Conclusion

This study highlights the atypical presentation of TB in elderly adults and the continued use of standard quadritherapy despite low drug resistance. Weight loss, though nonspecific, appears to be the most prognostic symptom and is associated with delayed diagnosis and higher mortality.

简介：法国老年人结核病（TB）的发病率仍然很高。免疫衰老和合并症对这一人群的诊断和治疗都提出了挑战。描述老年人结核病特征和结果的最新数据很少。我们旨在描述老年人群中结核病的临床和微生物特征，并确定与2年死亡率相关的因素。患者和方法：我们进行了一项回顾性多中心研究，包括年龄 ≥ 75 岁的患者，这些患者在2010年至2020年间在18个中心被诊断为结核病。采用多变量分析确定与2年死亡率独立相关的因素。结果：共纳入295例患者：主要出生在法国（57%）。免疫抑制罕见（9.8%）。发烧和咳嗽不常见，而体重减轻是最常见的症状（60.3%），与诊断延误显著相关。肺结核是主要形式（63.1%），在本组和老年患者中观察到较高的培养阳性。异烟肼耐药罕见（5.2%）。标准四联疗法是最常见的初始方案，与较高的不良事件发生率无关。在两年随访中，总死亡率为31.3%。在多变量分析中，死亡率与严重肾功能衰竭、住在养老院或长期护理机构以及就诊时体重减轻显著相关。结论：这项研究强调了老年人结核病的非典型表现，尽管耐药性低，但仍继续使用标准四疗程。体重减轻，虽然非特异性，但似乎是最具预后的症状，并与延迟诊断和更高的死亡率有关。

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引用次数: 0

Digital severity scoring and viral metagenomics: A feasibility study on integrated diagnosis of pediatric influenza-like illness 数字严重程度评分和病毒宏基因组学：儿童流感样疾病综合诊断的可行性研究

IF 2.2 4区医学 Q2 INFECTIOUS DISEASES

Infectious diseases now

Pub Date : 2025-12-06 DOI: 10.1016/j.idnow.2025.105223

Patrick E. Obermeier , Maren Alchikh , Xiaolin Ma , Janine Reiche , Brunhilde Schweiger , Barbara A. Rath

Introduction

Metagenomic next-generation sequencing (mNGS) holds promise for identifying diverse pathogens in complex cases of influenza-like illness (ILI). Interpreting results requires comprehensive clinical context. We aimed to explore the feasibility of an integrated diagnostic approach by linking shotgun viral mNGS with standardized clinical data for unbiased ascertainment and hypothesis generation in pediatric ILI patients.

Patients and methods

We studied a cohort of 6,073 pediatric ILI patients (mean age 3.1 years, range 0–18.8 years), assessed using the VIVI ScoreApp for immediate computation of Disease Severity and Risk Factor Scores. Nasopharyngeal samples were tested for nine respiratory viruses by PCR. In a nested pilot feasibility study, we linked the clinical dataset of 100 ILI patients with neurological complications (mean age 3.9 years, range 0–17.8 years) to additional viral mNGS. PCR and mNGS were compared by agreement rates and Cohen’s κ for inter-method reliability.

Results

In the pilot feasibility study, the mean VIVI Disease Severity Score was above the cohort average (>67th percentile, p < 0.0001), with ‘age < 2 years’ as the most prevalent risk factor (n = 44/100). mNGS identified 15 viruses, expanding the range of viral identifications by six viruses compared to PCR. Linking VIVI Scores with mNGS-discovered viruses suggested high disease severity. Sensitivity of mNGS was relatively low; overall agreement with PCR was 77–98 % and overall reliability was ‘moderate’ (κ scores of 0.1–0.85).

Conclusions

Digital surveillance tools can successfully integrate with mNGS to capture complex clinical patterns and generate data-driven hypotheses. Large-scale investigation and technical refinement are warranted.

新一代宏基因组测序（mNGS）有望在复杂的流感样疾病（ILI）病例中识别多种病原体。解释结果需要全面的临床背景。我们的目的是通过将霰弹枪病毒mNGS与标准化临床数据联系起来，探索一种综合诊断方法的可行性，从而对儿童ILI患者进行无偏倚的确定和假设生成。患者和方法：我们研究了6073名儿童ILI患者（平均年龄3.1 岁，范围0-18.8 岁），使用VIVI ScoreApp进行评估，以立即计算疾病严重程度和风险因素评分。采用聚合酶链式反应（PCR）对鼻咽标本进行9种呼吸道病毒检测。在一项嵌套的试点可行性研究中，我们将100名患有神经系统并发症的ILI患者（平均年龄3.9 岁，范围0-17.8 岁）的临床数据集与额外的病毒mNGS联系起来。PCR与mNGS比较方法间信度的符合率和Cohen’s κ。结果：在试点可行性研究中，平均VIVI疾病严重程度评分高于队列平均水平（bbbb67百分位数，p ）。结论：数字监测工具可以成功地与mNGS集成，以捕获复杂的临床模式并生成数据驱动的假设。大规模的调查和技术改进是必要的。

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引用次数: 0

Seasonal influenza and pneumococcal vaccination coverage among immunocompromised adults in France: A need for improvement 法国免疫功能低下成年人的季节性流感和肺炎球菌疫苗接种覆盖率：需要改进。

IF 2.2 4区医学 Q2 INFECTIOUS DISEASES

Infectious diseases now

Pub Date : 2025-12-06 DOI: 10.1016/j.idnow.2025.105225

Marine Cailleaux , Frédéric Balusson , Fabienne Pelé , Gaëlle Bury , Sophie Reissier , Marion Baldeyrou , Lilian Alix , Anastasia Saade , Elisabeth Polard , Pierre Tattevin

Objective

To estimate influenza and pneumococcal vaccination coverage in immunocompromised adults in France.

Methods

We used the Echantillon Généraliste des Bénéficiaires database, a representative sample of 850,000 patients covered by health insurance, with prospective collection of data on health care. We included adult patients with at least one of the following conditions: people living with HIV (PLWH), solid organ transplant, cancer treated by chemotherapy, any patient under immunosuppressive/immunomodulating therapy.

Results

We enrolled 10,784 immunocompromised patients, with a median age of 49 years [35–63]. During 2011–2017, complete seasonal influenza vaccine coverage (i.e., one shot each year) was 14.3 % [13.6–15.0] and closely correlated with age: 1.2 %, 2.8 %, 10.9 %, and 38.7 %, in the age groups 18–34, 35–49, 50–65, and > 65 years, respectively (P < 0.01). Pneumococcal vaccine coverage was complete (13-valent conjugated vaccine followed by 23-valent polysaccharide vaccine) in 6.9 %, not correlated with age.

Conclusions

Influenza and pneumococcal vaccine coverage in France during the study period, was very low, complete in < 15 % of immunocompromised adults.

目的：估计法国免疫功能低下成人的流感和肺炎球菌疫苗接种覆盖率。方法：我们使用了Echantillon g 以萨萨为例的医疗保险数据库，该数据库是85万名医疗保险患者的代表性样本，并对医疗保健数据进行了前瞻性收集。我们纳入了至少具有以下条件之一的成年患者：HIV感染者（PLWH），实体器官移植，接受化疗和免疫抑制/免疫调节治疗的癌症患者。结果：我们纳入了10784例免疫功能低下患者，中位年龄为49 岁[35-63]。2011 - 2017年期间,完整的季节性流感疫苗覆盖率(即每年一次)是14.3 %(13.6 - -15.0),与年龄密切相关:1.2 % 2.8 %, % 10.9和38.7 %,在18 - 34岁的年龄组35-49,50 - 65,和 > 65 年,(分别P 结论:流感和肺炎球菌疫苗覆盖率在法国学习期间,非常低,并完成

{"title":"Seasonal influenza and pneumococcal vaccination coverage among immunocompromised adults in France: A need for improvement","authors":"Marine Cailleaux , Frédéric Balusson , Fabienne Pelé , Gaëlle Bury , Sophie Reissier , Marion Baldeyrou , Lilian Alix , Anastasia Saade , Elisabeth Polard , Pierre Tattevin","doi":"10.1016/j.idnow.2025.105225","DOIUrl":"10.1016/j.idnow.2025.105225","url":null,"abstract":"<div><h3>Objective</h3><div>To estimate influenza and pneumococcal vaccination coverage in immunocompromised adults in France.</div></div><div><h3>Methods</h3><div>We used the <em>Echantillon Généraliste des Bénéficiaires</em> database, a representative sample of 850,000 patients covered by health insurance, with prospective collection of data on health care. We included adult patients with at least one of the following conditions: people living with HIV (PLWH), solid organ transplant, cancer treated by chemotherapy, any patient under immunosuppressive/immunomodulating therapy.</div></div><div><h3>Results</h3><div>We enrolled 10,784 immunocompromised patients, with a median age of 49 years [35–63]. During 2011–2017, complete seasonal influenza vaccine coverage (i.e., one shot each year) was 14.3 % [13.6–15.0] and closely correlated with age: 1.2 %, 2.8 %, 10.9 %, and 38.7 %, in the age groups 18–34, 35–49, 50–65, and > 65 years, respectively (<em>P</em> < 0.01). Pneumococcal vaccine coverage was complete (13-valent conjugated vaccine followed by 23-valent polysaccharide vaccine) in 6.9 %, not correlated with age.</div></div><div><h3>Conclusions</h3><div>Influenza and pneumococcal vaccine coverage in France during the study period, was very low, complete in < 15 % of immunocompromised adults.</div></div>","PeriodicalId":13539,"journal":{"name":"Infectious diseases now","volume":"56 1","pages":"Article 105225"},"PeriodicalIF":2.2,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145707788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Assessment of the educational and entertainment value of the serious antibiotic game: "AntibioLab". 评估教育和娱乐价值的严肃抗生素游戏：“AntibioLab”。

IF 2.2 4区医学 Q2 INFECTIOUS DISEASES

Infectious diseases now

Pub Date : 2025-12-04 DOI: 10.1016/j.idnow.2025.105219

L Cornu, V Guyetand, C Lambert, O Lesens, L Sauvat

Objectives: A serious game is a learning tool stimulating the participant's interest through its original pedagogical approach. We aimed to assess the value of AntibioLab, a serious game designed to review antibiotic prescribing.

Material and methods: AntibioLab is a card game designed for common infectious diseases. A prospective single-center pilot study was performed with medical students. The AntibioLab group played two sessions one week apart, and the control group had to review the items corresponding to the serious game on their own between each questionnaire. Knowledge acquisition was assessed before the game, seven days after and at three months, with multiple-choice questions. A Likert-scale questionnaire was used to assess the game's entertainment and pedagogical contribution. The primary endpoint (final score) was compared between groups using ANCOVA.

Results: Thirty-nine students (n = 21 AntibioLab group, n = 18 Control group) were included. The mean score at Day 0 was 10.8 ± 2.9 out of 20 without any significant difference between groups. At Month 3, the mean score was higher in the AntibioLab group (12.9 ± 3.0 and 10.5 ± 2.2 respectively, p = 0.03). In the longitudinal analysis, the score evolution between Day 0, Day 7 and Month 3 was not statistically different between the groups. In the AntibioLab group, students who responded to the questionnaire (n = 20) found the game fun, challenging and recommended it.

Conclusions: We highlighted the value of AntibioLab for consolidating knowledge in antibiotic therapy. Feedback from participants about the game's benefits was excellent. AntibioLab could be an additional tool to review infectious diseases.

目的：严肃游戏是一种学习工具，通过其原始的教学方法激发参与者的兴趣。我们的目标是评估AntibioLab的价值，这是一个旨在审查抗生素处方的严肃游戏。材料与方法：AntibioLab是一款针对常见传染病设计的纸牌游戏。对医学生进行了一项前瞻性单中心试点研究。AntibioLab组每隔一周玩两次游戏，对照组必须在每次问卷调查之间自己复习与严肃游戏相对应的项目。在游戏前、游戏后7天和三个月时，通过多项选择题对知识获取情况进行评估。李克特量表用于评估游戏的娱乐和教学贡献。使用ANCOVA比较两组间的主要终点（最终评分）。结果：共纳入39名学生（n = 21 AntibioLab组，n = 18对照组）。第0天的平均得分为10.8 ± 2.9分（满分20分），组间无显著差异。在第3个月，AntibioLab组的平均得分更高（分别为12.9 ± 3.0和10.5 ± 2.2,p = 0.03）。在纵向分析中，第0天、第7天和第3个月的评分演变在组间无统计学差异。在AntibioLab组中，回答问卷的学生（n = 20）发现游戏很有趣，具有挑战性，并推荐了它。结论：我们强调了AntibioLab在巩固抗生素治疗知识方面的价值。参与者对游戏好处的反馈非常好。AntibioLab可能是审查传染病的另一个工具。

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引用次数: 0

Acknowledging Our 2025 Reviewers 感谢我们的2025位审稿人

IF 2.2 4区医学 Q2 INFECTIOUS DISEASES

Infectious diseases now

Pub Date : 2025-12-04 DOI: 10.1016/j.idnow.2025.105222

引用次数: 0

Guidelines for tick-borne diseases (excluding Lyme borreliosis): diagnosis and management 蜱传疾病（不包括莱姆病）指南：诊断和管理。

IF 2.2 4区医学 Q2 INFECTIOUS DISEASES

Infectious diseases now

Pub Date : 2025-12-01 DOI: 10.1016/j.idnow.2025.105206

Y. Hansmann , E. Baux , C. Eldin , C. Cazorla , B. Jaulhac , H. Yssel , R. Ghozzi , C. Lenormand , A. Gautier , J. Sevestre , A. Raffetin

Other tick-borne microorganisms can cause symptoms that differ from those of Lyme borreliosis, often with a more acute course. Fever is the primary clinical warning sign, which may be accompanied by various other symptoms—cutaneous, neuromeningeal, and lymphatic—that help guide diagnosis. A clinical approach makes it relatively straightforward to distinguish Lyme borreliosis from other tick-borne diseases, with the common factor being the tick as the vector. Biological abnormalities (anaemia, thrombocytopenia, cytolysis, etc.) are often present in tick-borne diseases, unlike in Lyme borreliosis.

However, these other infectious agents remain poorly known and understood. Although diagnostic tools exist, they are often not readily accessible in primary care settings or even in hospitals, which likely leads to underdiagnosis of these infections. This final section of the guidelines details eight tick-borne diseases in order of frequency: rickettsiosis, tularaemia, tick-borne encephalitis, tick-borne relapsing fever, anaplasmosis, babesiosis, neoehrlichiosis, and Crimean–Congo haemorrhagic fever. Co-infections, which are very rare, are also presented with their definitions and characteristics.

The choice of doxycycline as the first-line treatment for Lyme borreliosis seems particularly appropriate, as most of these infectious agents (except Babesia and TBEV) are sensitive to this antibiotic.

As scientific research advances, our understanding continues to grow. Agents such as Neoehrlichia are recent discoveries, and their significance in human pathology remains to be fully elucidated. It is expected that in the coming years, expanding knowledge of other tick-borne diseases will improve diagnosis and patient care.

其他蜱传微生物可引起与莱姆病不同的症状，通常具有更急性的病程。发烧是主要的临床警告信号，它可能伴有各种其他症状-皮肤，神经脑膜和淋巴-有助于指导诊断。临床方法可以相对直接地将莱姆病与其他蜱传疾病区分开来，其共同因素是蜱作为媒介。与莱姆病不同，蜱传疾病通常存在生物学异常（贫血、血小板减少、细胞溶解等）。然而，对这些其他传染因子的认识和了解仍然很少。虽然存在诊断工具，但在初级保健机构甚至医院往往不易获得这些工具，这可能导致对这些感染的诊断不足。指南的最后一节按发生频率详细介绍了八种蜱传疾病：立克次体病、兔热病、蜱传脑炎、蜱传回归热、无形体病、巴贝斯虫病、新立克体病和克里米亚-刚果出血热。本文还介绍了罕见的合并感染的定义和特征。选择强力霉素作为莱姆病的一线治疗似乎特别合适，因为大多数感染源（除了巴贝斯虫和TBEV）对这种抗生素敏感。随着科学研究的进步，我们的理解也在不断增长。像新立体这样的病原体是最近发现的，它们在人类病理学中的意义仍有待充分阐明。预计在未来几年，扩大对其他蜱传疾病的了解将改善诊断和病人护理。

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引用次数: 0

CV2 : ANNONCE IDNOW 21X28 UK PRINT.pdf CV2：公告IDNOW 21X28 UK PRINT.pdf

IF 2.2 4区医学 Q2 INFECTIOUS DISEASES

Infectious diseases now

Pub Date : 2025-12-01 DOI: 10.1016/S2666-9919(25)00172-1

引用次数: 0

Guidelines for Lyme borreliosis: treatment 莱姆病：治疗指南。

IF 2.2 4区医学 Q2 INFECTIOUS DISEASES

Infectious diseases now

Pub Date : 2025-12-01 DOI: 10.1016/j.idnow.2025.105204

A. Raffetin , F. Roblot , C. Lenormand , Y. Hansmann , E. Baux , S. Nguala , P. Tattevin , C. Sobas , H. Yssel , A. Gautier , P. Arias , K. Bouiller

The aim of the clinical practice guideline is to support healthcare professionals in the diagnosis and management of patients with proven or suspected Lyme borreliosis (LB). The guideline provides an evidence-based algorithm for antibiotic therapy in confirmed LB cases and outlines recommendations for complex presentations where the three diagnostic criteria are not fully met, suggesting a possible challenge antibiotic therapy in specialized settings. Updated in accordance with international literature and previous French recommendations (HAS, 2022), the guidelines detail antibiotic selection and treatment duration according to clinical manifestations. Doxycycline remains the first-line treatment in most situations, including for children under eight years and pregnant or breastfeeding women. Treatment duration varies from 10 to 28 days depending on disease presentation: 10 days for isolated erythema migrans, 14 days for multiple erythema migrans or early neuroborreliosis, 21 days for lymphocytoma or late neuroborreliosis, and 28 days for Lyme arthritis or acrodermatitis chronica atrophicans. Longer treatments are not justified. In complex or recurrent cases, referral to a reference center is recommended. The guideline discourages the use of anti-inflammatory drugs in acute LB management and notes that corticosteroids do not worsen Lyme-related peripheral facial palsy. European treatment recommendations remain largely consistent across countries.

临床实践指南的目的是支持卫生保健专业人员在确诊或疑似莱姆病（LB）患者的诊断和管理。该指南为LB确诊病例的抗生素治疗提供了一种基于证据的算法，并概述了对未完全满足三个诊断标准的复杂症状的建议，这表明在特殊情况下可能存在抗生素治疗的挑战。该指南根据国际文献和以前的法国建议（HAS, 2022）进行了更新，根据临床表现详细说明了抗生素的选择和治疗时间。多西环素在大多数情况下仍然是一线治疗，包括对8岁以下儿童和孕妇或哺乳期妇女。根据疾病的表现，治疗时间从10天到28 天不等：孤立性移动性红斑10 天，多发性移动性红斑或早期神经疏螺旋体病14 天，淋巴细胞瘤或晚期神经疏螺旋体病21 天，莱姆病或慢性萎缩性肢端皮炎28 天。延长治疗时间是不合理的。在复杂或复发的情况下，推荐转介到参考中心。该指南不鼓励在急性LB治疗中使用抗炎药物，并指出皮质类固醇不会加重莱姆病相关周围性面瘫。欧洲的治疗建议在各国之间基本保持一致。

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引用次数: 0