Étude rétrospective diagnostique d’une cohorte de patients suspects de borréliose de Lyme avec des sérologies ELISA/Western Blot discordantes au CHU de Strasbourg entre 2013 et 2017 / Caroline, Marie Sauton ; sous la direction de Yves Hansmann

Date :

Type : Livre / Book

Type : Thèse / Thesis

Langue / Language : français / French

Lyme, Maladie de


Recommandations pour la pratique clinique

Hansmann, Yves (Directeur de thèse / thesis advisor)

Université de Strasbourg (2009-....) (Organisme de soutenance / degree-grantor)

Résumé / Abstract : Summary : Introduction. Lyme borreliosis is an infectious disease, caused by a bacterium of the Borrelia burgdorferi sensu lato complex, transmitted to humans after being bitten by an infected tick of the Ixodes genus. Alsace, a highly endemic region, hosts the National Reference Centre and Functional Unit of Lyme borreliosis and tick-borne diseases. Lyme disease is a subject of major controversy in France both diagnostically and biologically. This raises the question of the serological discrepancy ELISA and WESTERN BLOT in establishing the diagnosis of this pathology. Material and methods. This is a retrospective, monocentric and descriptive study conducted at Strasbourg University Hospitals. It focuses on patients with discordant ELISA / WB serologies between 2013 and 2017. Data collection is done by the study of cases using electronic and paper versions. The diagnostic findings of practitioners are compared to those made in accordance with HAS 2018 recommendations. Results. 392 records with discordant serologies were identified. We analysed 167 suspicious EIA + / WB-, 188 EIA + / WB, 14 EIA- / WB + and 23 EIA- / WB questionable cases. The anamnestic study found a history of suspected or proven Lyme borreliosis and non-compliant treatments. Nonspecific and neurological rheumatologic symptoms predominate. Other nonspecific symptoms dominated by asthenia are enumerated. The diagnosis is retained for 19.7% of the EIA + / WB-38.8% of the doubtful EIA + / WB, 50% of the EIA- / WB + and 21.7% of the doubtful EIA- / WB and rejected for 68.2% of the cases. EIA + / WB-, 37.3% of questionable EIA + / WB, 28.5% of EIA- / WB + and 47.8% of questionable EIA- / WB. The differential diagnoses evoked are degenerative rheumatism, inflammatory or connective tissue diseases. The most represented conclusions according to the HAS recommendations are possible and unclassifiable. The 7 confirmed cases correspond to dermatological presentations (lymphocytoma, EM). Repeated serology shows spontaneous slow decay kinetics of IgM and IgG in ELISA and variation of WB bands. Conclusion. Lyme borreliosis research is increasingly in demand and the risk of discordance is proportional. The diagnosis of Lyme borreliosis remains questionable regarding discordant serologies. This work is a gateway to further study to determine in which case a WB test should be carried out when the ELISA test is negative and when there is strong clinical suspicion.