Reinfection versus relapse in Lyme disease.
نویسنده
چکیده
To the Editor: Nadelman et al. (Nov. 15 issue)1 report that patients may be reinfected with different genotypes of Borrelia burgdorferi. Their observations, however, do not provide evidence that patients with continuing symptoms (i.e., patients with what is often termed chronic Lyme disease or post–Lyme disease syndrome) are not persistently infected. Although bacteria may be cultured from initial and subsequent erythema migrans rashes, it cannot currently be determined whether such patients are or are not infected. The results of recent studies involving macaque monkeys2 show that viable organisms can be recovered months after “standard” treatments. In the corresponding editorial, the comment by Steere3 that patients with persisting symptoms no longer have a response to further antibiotic therapy is misleading, since that conclusion is based primarily on a single trial that used an unsuccessful antibiotic regimen.4 As I mentioned in a letter about that trial,5 it did not address possible reasons for the unsuccessful outcome, and there are probable pharmacologic reasons for the failure of the trial. Alternative successful regimens exist.6 It would be helpful if there was support to conduct additional controlled treatment trials, but there has been no such support thus far.
منابع مشابه
Differentiation of reinfection from relapse in recurrent Lyme disease.
BACKGROUND Erythema migrans is the most common manifestation of Lyme disease. Recurrences are not uncommon, and although they are usually attributed to reinfection rather than relapse of the original infection, this remains somewhat controversial. We used molecular typing of Borrelia burgdorferi isolates obtained from patients with culture-confirmed episodes of erythema migrans to distinguish b...
متن کاملRecurrent melioidosis in patients in northeast Thailand is frequently due to reinfection rather than relapse.
Human melioidosis is associated with a high rate of recurrent disease, despite adequate antimicrobial treatment. Here, we define the rate of relapse versus the rate of reinfection in 116 patients with 123 episodes of recurrent melioidosis who were treated at Sappasithiprasong Hospital in Northeast Thailand between 1986 and 2005. Pulsed-field gel electrophoresis was performed on all isolates; is...
متن کاملReinfection in patients with Lyme disease.
Lyme disease is the most common tick-borne infection in the United States and Europe. A surprising number of patients experience a subsequent episode of Lyme disease after the first episode has resolved. Reinfection has been well-documented only after successfully treated early infection (nearly always erythema migrans) and can often be recognized clinically by the development of a repeat episo...
متن کاملThe temporal dynamics of relapse and reinfection tuberculosis after successful treatment: a retrospective cohort study.
BACKGROUND There is increasing evidence from tuberculosis high-burden settings that exogenous reinfection contributes considerably to recurrent disease. However, large longitudinal studies of endogenous reactivation (relapse) and reinfection tuberculosis are lacking. We hypothesize a relationship between relapse vs reinfection and the time between treatment completion and recurrent disease. M...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- The New England journal of medicine
دوره 368 11 شماره
صفحات -
تاریخ انتشار 2012