Lyme borreliosis and other tick-borne diseases. Guidelines from the French Scientific Societies (I): prevention, epidemiology, diagnosis - 14/05/19
Borréliose de Lyme et autres maladies vectorielles à tiques. Recommandations des sociétés savantes françaises (Argumentaire I) : prévention, épidémiologie, circonstances du diagnostic
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Highlights |
• | Lyme borreliosis is transmitted en France by the tick Ixodes ricinus, endemic in metropolitan France. In the absence of vaccine licensed for use in humans, primary prevention mostly relies on mechanical protection (clothes covering most parts of the body), that may be completed by chemical protection (repulsives). Secondary prevention relies on early detection of ticks after exposure, and mechanical extraction. There is currently no situation in France when prophylactic antibiotics would be recommended. |
• | The incidence of Lyme borreliosis in France, estimated through a network of general practitioners (réseau Sentinelles), and nationwide coding system for hospital stays, has not significantly changed between 2009 and 2017, with a mean incidence estimated at 53 cases/100,000 inhabitants/year, leading to 1.1 hospital admission/100,000 inhabitants/year. Other tick-borne diseases are much more seldom in France: tick-borne encephalitis (around 20 cases/year), spotted-fever rickettsiosis (primarily mediterranean spotted fever, around 10 cases/an), tularemia (50–100 cases/year, of which 20% are transmitted by ticks), human granulocytic anaplasmosis (<10 cases/year), and babesiosis (<5 cases/year). |
• | The main circumstances of diagnosis for Lyme borreliosis are cutaneous manifestations (primarily erythema migrans, much more rarely borrelial lymphocytoma and atrophic chronic acrodermatitis), neurological (<15% of cases, mostly meningoradiculitis and cranial nerve palsy, especially facial nerve) and rheumatologic (mostly knee monoarthritis, chronic or with recurrences). Cardiac and ophtalmologic manifestations are very rarely encountered. |
Abstract |
Lyme borreliosis is transmitted en France by the tick Ixodes ricinus, endemic in metropolitan France. In the absence of vaccine licensed for use in humans, primary prevention mostly relies on mechanical protection (clothes covering most parts of the body) that may be completed by chemical protection (repulsives). Secondary prevention relies on early detection of ticks after exposure, and mechanical extraction. There is currently no situation in France when prophylactic antibiotics would be recommended. The incidence of Lyme borreliosis in France, estimated through a network of general practitioners (réseau Sentinelles), and nationwide coding system for hospital stays, has not significantly changed between 2009 and 2017, with a mean incidence estimated at 53 cases/100,000 inhabitants/year, leading to 1.3 hospital admission/100,000 inhabitants/year. Other tick-borne diseases are much more seldom in France: tick-borne encephalitis (around 20 cases/year), spotted-fever rickettsiosis (primarily mediterranean spotted fever, around 10 cases/year), tularemia (50–100 cases/year, of which 20% are transmitted by ticks), human granulocytic anaplasmosis (<10 cases/year), and babesiosis (<5 cases/year). The main circumstances of diagnosis for Lyme borreliosis are cutaneous manifestations (primarily erythema migrans, much more rarely borrelial lymphocytoma and atrophic chronic acrodermatitis), neurological (<15% of cases, mostly meningoradiculitis and cranial nerve palsy, especially facial nerve) and rheumatologic (mostly knee monoarthritis, with recurrences). Cardiac and ophtalmologic manifestations are very rarely encountered.
Le texte complet de cet article est disponible en PDF.Résumé |
La borréliose de Lyme est transmise en France par la tique Ixodes ricinus, présente sur tout le territoire métropolitain. En l’absence de vaccin, la prévention primaire repose sur les mesures de protection mécanique (vêtements couvrants), éventuellement complétées par la protection chimique (répulsifs). La prévention secondaire repose sur le repérage précoce des tiques après exposition et leur extraction mécanique. Il n’existe aucune situation justifiant une antibioprophylaxie post-piqûre de tiques en France. L’incidence de la borréliose de Lyme, estimée à travers le réseau Sentinelles et les codages des séjours hospitaliers, a été stable en France entre 2009 et 2017, avec une moyenne de 53 cas/100 000 habitants/an, à l’origine d’1,3 hospitalisation/100 000 habitants/an. Les autres maladies transmises par les tiques sont beaucoup plus rares en France : encéphalite à tiques (environ 20 cas/an), rickettsioses du groupe ‘boutonneux’ (fièvre boutonneuse méditerranéenne, environ 10 cas/an), tularémie (50 à 100 cas/an, dont 20 % transmis par des tiques), anaplasmose granulocytaire humaine (<10 cas/an) et babésiose (<5 cas/an). Les principaux points d’appel pour une borréliose de Lyme sont les manifestations cutanées (érythème migrant principalement, beaucoup plus rarement lymphocytome borrélien et acrodermatite chronique atrophiante), neurologiques (<15 % des cas, essentiellement méningoradiculite et atteinte d’un ou plusieurs nerf(s) crânien(s), surtout le nerf facial) et articulaires (principalement monoarthrite récidivante du genou). Les manifestations cardiaques et ophtalmologiques sont exceptionnelles.
Le texte complet de cet article est disponible en PDF.Keywords : Lyme borreliosis, Prevention, Ticks, France, Erythema migrans, Arthritis, Neuroborreliosis
Mots clés : Borréliose de Lyme, Prévention, Tiques, France, Érythème migrant, Arthrite, Neuroborréliose
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