Abstract：
BACKGROUND: The evidence on the prevalence of Lyme borreliosis (LB) is limited, but there is a suspicion of overdiagnosis of LB in recent years. We reviewed the LB diagnosis and treatment-related data in Türkiye, based on the Infectious Diseases Society of America (IDSA) 2020 and European Society of Clinical Microbiology and Infectious Diseases Study Group for Lyme Borreliosis (ESGBOR) 2018 guidelines. By detecting the disagreements between these two, we outlined the areas to be improved for future guidelines.
METHODS: We performed a literature search according to the PRISMA guidelines in PubMed, Ovid-Medline, Web of Science, Turkish Medline, Scopus, CINAHL, ULAKBIM TR Index, Google Scholar and Cochrane Library databases. We included the published cases in a database and evaluated according to IDSA and ESGBOR guidelines. We outlined the reasons for misdiagnoses and inappropriate uses of antibiotics.
RESULTS: We included 42 relevant studies with 84 LB cases reported from Türkiye between 1990 and December 2022. Among 84 cases, the most common clinical findings were nervous system findings (n = 37, 44.0%), erythema migrans (n = 29, 34.5%) and ophthalmologic findings (n = 15, 17.9%). The IDSA 2020 and ESGBOR 2018 guidelines agreed on the diagnosis of 71 (84.5%) cases; there was an agreement that 31 cases (36.9%) were misdiagnosed and 40 cases (47.6%) were correctly diagnosed, and there was disagreement for 13 cases (15.5%). Serum immunoglobulin M (IgM), IgG measurements by ELISA and western blot were widely performed, and they were effective in definitive diagnosis merely when used according to guidelines. Inappropriate use of antibiotics was detected in 42 (50.0%) of cases which were classified in the following categories: incorrect LB diagnosis, inappropriate choice of antibiotic, inappropriate route of drug administration and prolonged antibiotic treatment.
CONCLUSIONS: Overdiagnosis and non-adherence to guidelines is a common problem. The discordance between seroprevalence and clinical studies necessitates a consensus over the best clinical approach.
METHODS: We performed a literature search according to the PRISMA guidelines in PubMed, Ovid-Medline, Web of Science, Turkish Medline, Scopus, CINAHL, ULAKBIM TR Index, Google Scholar and Cochrane Library databases. We included the published cases in a database and evaluated according to IDSA and ESGBOR guidelines. We outlined the reasons for misdiagnoses and inappropriate uses of antibiotics.
RESULTS: We included 42 relevant studies with 84 LB cases reported from Türkiye between 1990 and December 2022. Among 84 cases, the most common clinical findings were nervous system findings (n = 37, 44.0%), erythema migrans (n = 29, 34.5%) and ophthalmologic findings (n = 15, 17.9%). The IDSA 2020 and ESGBOR 2018 guidelines agreed on the diagnosis of 71 (84.5%) cases; there was an agreement that 31 cases (36.9%) were misdiagnosed and 40 cases (47.6%) were correctly diagnosed, and there was disagreement for 13 cases (15.5%). Serum immunoglobulin M (IgM), IgG measurements by ELISA and western blot were widely performed, and they were effective in definitive diagnosis merely when used according to guidelines. Inappropriate use of antibiotics was detected in 42 (50.0%) of cases which were classified in the following categories: incorrect LB diagnosis, inappropriate choice of antibiotic, inappropriate route of drug administration and prolonged antibiotic treatment.
CONCLUSIONS: Overdiagnosis and non-adherence to guidelines is a common problem. The discordance between seroprevalence and clinical studies necessitates a consensus over the best clinical approach.
摘要：
背景：关于莱姆病（LB）患病率的证据有限，但近年来怀疑LB的过度诊断。我们回顾了Türkiye的LB诊断和治疗相关数据，根据美国传染病学会（IDSA）2020和欧洲临床微生物学和传染病学会莱姆病研究小组（ESGBOR）2018指南。通过检测这两者之间的分歧，我们概述了未来准则需要改进的领域。
方法：我们根据PubMed的PRISMA指南进行了文献检索，Ovid-Medline,WebofScience,土耳其Medline，Scopus,CINAHL,ULAKBIMTR指数,谷歌学者和Cochrane图书馆数据库。我们将已发表的病例纳入数据库，并根据IDSA和ESGBOR指南进行评估。我们概述了误诊和不适当使用抗生素的原因。
结果：我们纳入了42项相关研究，从1990年至2022年12月，Türkiye报告了84个LB病例。84例病例中,最常见的临床表现是神经系统检查结果(n=37，44.0%)，游走性红斑(n=29,34.5%)和眼科发现(n=15,17.9%)。IDSA2020和ESGBOR2018指南对71例（84.5%）病例的诊断达成一致；一致认为31例（36.9%）被误诊，40例（47.6%）被正确诊断。13例(15.5%)有分歧。血清免疫球蛋白M(IgM),通过ELISA和蛋白质印迹广泛进行IgG测量，仅当根据指南使用时，它们在明确诊断中有效。在42例（50.0％）中检测到抗生素的不当使用，这些病例分为以下类别：不正确的LB诊断，抗生素的不当选择，不适当的药物给药途径和长期的抗生素治疗。
结论：过度诊断和不遵守指南是一个常见问题。血清阳性率与临床研究之间的不一致需要就最佳临床方法达成共识。
方法：我们根据PubMed的PRISMA指南进行了文献检索，Ovid-Medline,WebofScience,土耳其Medline，Scopus,CINAHL,ULAKBIMTR指数,谷歌学者和Cochrane图书馆数据库。我们将已发表的病例纳入数据库，并根据IDSA和ESGBOR指南进行评估。我们概述了误诊和不适当使用抗生素的原因。
结果：我们纳入了42项相关研究，从1990年至2022年12月，Türkiye报告了84个LB病例。84例病例中,最常见的临床表现是神经系统检查结果(n=37，44.0%)，游走性红斑(n=29,34.5%)和眼科发现(n=15,17.9%)。IDSA2020和ESGBOR2018指南对71例（84.5%）病例的诊断达成一致；一致认为31例（36.9%）被误诊，40例（47.6%）被正确诊断。13例(15.5%)有分歧。血清免疫球蛋白M(IgM),通过ELISA和蛋白质印迹广泛进行IgG测量，仅当根据指南使用时，它们在明确诊断中有效。在42例（50.0％）中检测到抗生素的不当使用，这些病例分为以下类别：不正确的LB诊断，抗生素的不当选择，不适当的药物给药途径和长期的抗生素治疗。
结论：过度诊断和不遵守指南是一个常见问题。血清阳性率与临床研究之间的不一致需要就最佳临床方法达成共识。
