Bonjour,
Sous antibiothérapie depuis plus de 7 mois, pour une borréliose persistante avec acrodermatite athrophiante chronique enfin diagnostiquée dans un pays de CEE, donc hors France où ma pathologie est déniée malgré une PCR positive à l'ADN de la borrélia...........'au secours Monsieur Kafka!)
je vous livre le fruit de ma recherche.... qui servira peut être à faire avancer le "smillblic".
1 * : J Neurol. 1995 Sep;242(9):604-7
Neuroborreliosis as a cause of respiratory failure.
Silva MT, Sophar M, Howard RS, Spencer GT.
Lane Fox Respiratory Unit, St. Thomas' Hospital, London, UK.
We report three cases of neuroborreliosis presenting with acute respiratory impairment. All the patients had encephalopathy and focal neurological signs with brain stem abnormalities in two. All three patients had respiratory arrest associated with progressive nocturnal hypoventilation or prolonged central apnoea. Tracheostomy and prolonged periods of ventilatory support were necessary in all cases and weaning was complicated by residual central respiratory disturbances. These cases emphasise that Borrelia infection should be considered in the differential diagnosis of unexplained respiratory failure.
PMID: 8551324 [PubMed - indexed for MEDLINE]
2 * (Chest. 1999;116:222-230.)
© 1999 American College of Chest Physicians
Tick-Borne Pulmonary Disease*
Update on Diagnosis and Management
John L. Faul, MD; Ramona L. Doyle, MD, FCCP; Peter N. Kao, MD and Stephen J. Ruoss, MD
* From the Division of Pulmonary and Critical Care Medicine, Stanford University Medical Center, Palo Alto, CA.
Correspondence to: Stephen J. Ruoss, MD, Division of Pulmonary and Critical Care Medicine, Stanford University Medical Center, Palo Alto, CA 94305; e-mail:
ruoss@leland.stanford.edu Ticks are capable of transmitting viruses, bacteria, protozoa, and rickettsiae to man. Several of these tick-borne pathogens can lead to pulmonary disease. Characteristic clinical features, such as erythema migrans in Lyme disease, or spotted rash in a spotted fever group disease, may serve as important diagnostic clues. Successful management of tick-borne diseases depends on a high index of suspicion and recognition of their clinical features. Patients at risk for tick bites may be coinfected with two or more tick-borne pathogens. A Lyme vaccine has recently become available for use in the United States. Disease prevention depends on the avoidance of tick bites. When patients present with respiratory symptoms and a history of a recent tick bite or a characteristic skin rash, a differential diagnosis of a tick-borne pulmonary disease should be considered. Early diagnosis and appropriate antibiotic therapy for these disorders lead to greatly improved outcomes.
Key Words: Ehrlichia • Lyme • pulmonary • respiratory • tick • tularemia
3* Chest, July 1999 by John L. Faul, Ramona I. Doyle, Peter N.Kao, Stephen J Ruoss
Clinical Features and Epidemiology
Lyme disease is the most commonly reported vector-borne disease in the United States and Europe.1 2 9 Its cause is Borrelia burgdorferi, a spirochete that is transmitted to man through the bite of the black-legged tick.15 16 B burgdorferi can infect rodents, deer, and several species of human-biting ticks, including the western black-legged tick (Fig 1) , the American dog tick, and the Lone Star tick.17 Because the small mammals that carry the ticks that transmit B burgdorferi are commonly found in wooded areas or parks, patients often provide a history of outdoor activities.12 In the United States, > 50,000 cases of Lyme disease were reported between 1982 and 1992 in 48 states.18 Most cases in the United States have occurred in the northeastern coastal states and in the upper Midwest where the vector is the black-legged tick, and in northern California where the vector is the western black-legged tick. In the parts of Europe where the vector is the sheep tick, the annual incidence of Lyme disease approximates 70/100,000 of the population.9 19 In the Netherlands, the incidence of erythema migrans is approximately 40/100,000 of the population.20 Human infections occur during the months of May through August when outdoor activities and tick nymphal stages are at their peak.21 Transmission of the spirochete requires a minimum of 36 to 48 h of attachment.22 Tick nymphs are small and hard to detect, and they may remain attached for long periods of time. Nymphs, therefore, are thought to be the most important vectors of Lyme disease (Fig 1) . It has been estimated that approximately 1.4% of tick bites lead to clinical features of Lyme disease in endemic areas.19 20 More than 1,000 people acquire the infection in the United States each year.1 18
In 75% of the cases of Lyme disease, there is no history of a tick bite.3 9 21 22 However, within 1 week of infection by B burgdorferi, a characteristic macular skin rash, erythema migrans, develops at the site of the tick bite in 80% of the cases (stage 1 Lyme disease).23 This rash may be accompanied by fever, headache, fatigue, arthralgia, and myalgia. Although respiratory symptoms are unusual, cough has been reported.24 Erythema migrans resolves spontaneously within 4 weeks, but untreated infection with B burgdorferi can lead to disseminated disease, with widespread skin lesions and progressive neurologic involvement in at least a small proportion of the cases (stage 2 Lyme disease).25 The most frequent neurologic manifestation of early or disseminated Lyme disease is cranial neuritis. Facial palsy is particularly common, and it is reported in approximately 3% of the cases (Fig 3 ). Many other neurologic sequelae of Lyme disease have been described, including aseptic meningitis, transverse myelitis, and mononeuritis multiplex.25 26 Only a small proportion of the cases demonstrates neurologic disease, and the overall prognosis of stage 2 Lyme disease appears to be excellent.27 Pharyngitis has been reported in 17% of the patients with stage 2 Lyme disease.24 One fatal case of ARDS has been reported.7 Neuroborreliosis has been implicated as a cause of respiratory failure.28 Three cases of Lyme disease associated with encephalopathy and nocturnal hypoventilation or prolonged central apnea have been reported. In these cases, tracheotomy and prolonged ventilatory support were required because of abnormal central respiratory disturbances.28
Bien cordialement
Louise
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