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[PMID]:28457619
[Au] Autor:D'Arco C; Dattwyler RJ; Arnaboldi PM
[Ad] Endereço:Department of Microbiology and Immunology, School of Medicine, New York Medical College, Valhalla, NY 10595, United States.
[Ti] Título:Borrelia burgdorferi-specific IgA in Lyme Disease.
[So] Source:EBioMedicine;19:91-97, 2017 May.
[Is] ISSN:2352-3964
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:The laboratory diagnosis of Lyme disease is currently dependent on the detection of IgM and IgG antibodies against Borrelia burgdorferi, the causative agent of the disease. The significance of serum IgA against B. burgdorferi remains unclear. The production of intrathecal IgA has been noted in patients with the late Lyme disease manifestation, neuroborreliosis, but production of antigen-specific IgA during early disease has not been evaluated. In the current study, we assessed serum IgA binding to the B. burgdorferi peptide antigens, C6, the target of the FDA-cleared C6 EIA, and FlaB(211-223)-modVlsE(275-291), a peptide containing a Borrelia flagellin epitope linked to a modified VlsE sequence, in patients with early and late Lyme disease. Specific IgA was detected in 59 of 152 serum samples (38.8%) from early Lyme disease patients. Approximately 50% of early Lyme disease patients who were seropositive for peptide-specific IgM and/or IgG were also seropositive for peptide-specific IgA. In a subpopulation of patients, high peptide-specific IgA could be correlated with disseminated disease, defined as multiple erythema migrans lesions, and neurological disease complications. These results suggest that there may be an association between elevated levels of antigen-specific IgA and particular disease manifestations in some patients with early Lyme disease.
[Mh] Termos MeSH primário: Anticorpos Antibacterianos/sangue
Borrelia burgdorferi/imunologia
Imunoglobulina A/sangue
Doença de Lyme/imunologia
[Mh] Termos MeSH secundário: Antígenos de Bactérias/imunologia
Seres Humanos
Imunoglobulina G/sangue
Imunoglobulina M/sangue
Doença de Lyme/sangue
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antibodies, Bacterial); 0 (Antigens, Bacterial); 0 (Immunoglobulin A); 0 (Immunoglobulin G); 0 (Immunoglobulin M)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE


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[PMID]:29202704
[Au] Autor:Antonise-Kamp L; Beaujean DJMA; Crutzen R; van Steenbergen JE; Ruwaard D
[Ad] Endereço:National Institute for Public Health and the Environment, Centre for Infectious Disease Control, P.O. Box 1, 3720, BA, Bilthoven, the Netherlands. laura.kamp@rivm.nl.
[Ti] Título:Prevention of tick bites: an evaluation of a smartphone app.
[So] Source:BMC Infect Dis;17(1):744, 2017 12 04.
[Is] ISSN:1471-2334
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Lyme borreliosis (LB) is the most common reported tick-borne infection in Europe, and involves transmission of Borrelia by ticks. As long as a vaccine is not available and effective measures for controlling tick populations are insufficient, LB control is focused on preventive measures to avoid tick bites. To inform citizens about the risk of ticks, motivate them to check for tick bites, and encourage them to remove any attached tick as quickly as possible, a mobile app called 'Tekenbeet' (Dutch for 'tick bite') was developed and released. The aim of this study was to evaluate the usage and user satisfaction of the 'Tekenbeet' app and to investigate whether it affects users' knowledge, perceived severity, perceived susceptibility, self-efficacy, response efficacy, current behavior and intention to comply with preventive measures. METHODS: Usage of the app was evaluated with data obtained from Google Analytics. A survey among the Dutch general adult population with two data collection periods evaluated the usage, user satisfaction and its influence on abovementioned outcomes. RESULTS: Data obtained from Google Analytics showed the app was downloaded almost 40,000 in the 20 months following the launch. The 'tick radar' and 'tick diary' screens were viewed most often. In addition, a total of 554 respondents completed an online survey. The mean user satisfaction score was 7.44 (on a scale of 1-10) and 90.9% of respondents would recommend the app to others. On average, survey respondents who downloaded the app (n = 243) recorded significantly more often higher knowledge scores (OR 3.37; 95% CI 2.02-5.09) and had a higher intention to comply with preventive measures (OR 2.47; 95% CI 1.22-5.85) compared to respondents who did not download the app (n = 311). CONCLUSIONS: The 'Tekenbeet' app is a frequently used and well-appreciated educational tool to increase public knowledge of ticks and tick bites. It also helps to improve the user's intention to apply preventive measures. The use of smartphones and apps is now commonplace in the Netherlands; the 'Tekenbeet' app feeds into this trend and thereby offers a modern day alternative to established formats such as an information leaflet and information provision on the Internet.
[Mh] Termos MeSH primário: Doença de Lyme/prevenção & controle
Aplicativos Móveis
Smartphone
Picadas de Carrapatos
[Mh] Termos MeSH secundário: Adulto
Animais
Comportamento do Consumidor/estatística & dados numéricos
Feminino
Seres Humanos
Doença de Lyme/epidemiologia
Masculino
Meia-Idade
Aplicativos Móveis/estatística & dados numéricos
Aplicativos Móveis/utilização
Países Baixos/epidemiologia
Projetos Piloto
Smartphone/utilização
Inquéritos e Questionários
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171206
[St] Status:MEDLINE
[do] DOI:10.1186/s12879-017-2836-4


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[PMID]:28743676
[Au] Autor:Levy S
[Ti] Título:Northern Trek: The Spread of into Canada.
[So] Source:Environ Health Perspect;125(7):074002, 2017 07 24.
[Is] ISSN:1552-9924
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Vetores Aracnídeos
Ixodes
[Mh] Termos MeSH secundário: Animais
Canadá
Seres Humanos
Doença de Lyme
[Pt] Tipo de publicação:JOURNAL ARTICLE; COMMENT
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180221
[Lr] Data última revisão:
180221
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170727
[St] Status:MEDLINE
[do] DOI:10.1289/EHP2095


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[PMID]:29320145
[Au] Autor:Krstic M; Stajkovic N; Lazic S
[Ti] Título:Prevalence of Borrelia burgdorferi sensu lato in Ixodes ricinus ticks and assessment of entomological risk index at localities in Belgrade.
[So] Source:Vojnosanit Pregl;73(9):817-24, 2016 Sep.
[Is] ISSN:0042-8450
[Cp] País de publicação:Serbia
[La] Idioma:eng
[Ab] Resumo:Background/Aim: The first case of human Lyme borreliosis (LB) in Serbia was recorded in 1987. The number of reported LB cases has increased in the past decade. The aim of this study was to estimate the density of Ixodes ricinus (I. ricinus) ticks, the prevalence of Borrelia burgdorferi sensu lato (B. burgdorferi) in them, and entomological risk index (ERI) at 19 Belgrade localities which were grouped into three categories (forests, parkforests, parks). The values of ERI were compared with the number of tick bites in humans. Methods: Ticks were collected monthly by using the flag hours method and the infection rate was determined by using dark field microscopy. The ERI value was calculated for each locality where the ticks were collected. The related data about tick bites was obtained from the patient protocol of the Institute of Epidemiology, Military Medical Academy, Belgrade. Results: The total number of collected ticks, the number of nymphs and the infection rates of the nymphs were significantly higher in forests (p < 0.05) than park-forests and parks. Statistically, the ERI value was significantly higher in forests than parks of Belgrade (χ2 = 7.78, p < 0.01). In March and July, the ERI value was also significantly higher in forests, than park-forests (p < 0.01) and parks (p < 0.01). May was the month with the highest ERI value in each ecological category (forests p < 0.05; park-forests p < 0.01; parks p < 0.001). However, the number of tick bites in humans did not correlate with ERI values. Conclusion: The obtained results indicate that the risk of tick bite and human exposure to B. burgdorferi sensu lato is present at all selected localities in Belgrade. For a more comprehensive Lyme disease risk assessment the method of entomological risk index assessment should be combined with other methods, taking into consideration all tick stages and the behaviour and habits of people who may get infected B. burgdorferi sensu lato.
[Mh] Termos MeSH primário: Borrelia burgdorferi/isolamento & purificação
Ixodes/microbiologia
Ixodes/parasitologia
Doença de Lyme/microbiologia
Picadas de Carrapatos/microbiologia
Zoonoses/microbiologia
[Mh] Termos MeSH secundário: Animais
Florestas
Seres Humanos
Doença de Lyme/diagnóstico
Doença de Lyme/epidemiologia
Doença de Lyme/transmissão
Parques Recreativos
Medição de Risco
Fatores de Risco
Estações do Ano
Sérvia/epidemiologia
Picadas de Carrapatos/diagnóstico
Picadas de Carrapatos/epidemiologia
Fatores de Tempo
Saúde da População Urbana
Zoonoses/diagnóstico
Zoonoses/epidemiologia
Zoonoses/transmissão
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180213
[Lr] Data última revisão:
180213
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180111
[St] Status:MEDLINE
[do] DOI:10.2298/VSP150115069K


  5 / 9046 MEDLINE  
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[PMID]:29281675
[Au] Autor:Clow KM; Leighton PA; Ogden NH; Lindsay LR; Michel P; Pearl DL; Jardine CM
[Ad] Endereço:Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada.
[Ti] Título:Northward range expansion of Ixodes scapularis evident over a short timescale in Ontario, Canada.
[So] Source:PLoS One;12(12):e0189393, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The invasion of the blacklegged tick, Ixodes scapularis into Ontario, Canada poses a significant risk to public health because it is a vector for numerous pathogens, including Borrelia burgdorferi sensu stricto, the causative agent of Lyme disease. Baseline field sampling in 2014 and 2015 detected I. scapularis and B. burgdorferi at sites across southern, eastern and central Ontario, including a hot spot in eastern Ontario. A "speed of spread" model for I. scapularis developed by Leighton and colleagues (2012) estimated that the tick's range was expanding northward at 46 km/year. In 2016, we revisited a subset of sites sampled in 2014 and 2015 to understand the changing nature of risk, and assess whether the rate of tick invasion is consistent with the speed of spread estimate. Ticks were collected via tick dragging at 17 out of 36 sites, 5 of which were new sites for I. scapularis. Samples were positive for B. burgdorferi at 8 sites. No other I. scapularis-borne pathogens were detected. Centrographic statistics revealed an increase in the dispersion of I. scapularis positive sites in eastern Ontario. Field data for each site were then compared to the model's predicted year of establishment for each census subdivision. Our findings illustrate that the range expansion of I. scapularis and the emergence of B. burgdorferi is ongoing, and provide short timescale evidence of the processes associated with I. scapularis spread. The range front appears to be moving at a rate of ~46 km/year, with colonization of the tick behind this range front occurring at a slower and heterogeneous rate. Assessment of site-level ecological factors did not provide any insight into the underlying processes that may be influencing the colonization of I. scapularis in specific areas. Ongoing field sampling is needed to monitor this dynamic process. This study highlights the current geographic risk associated with Lyme disease, which can be used to target public health interventions to the areas of greatest risk.
[Mh] Termos MeSH primário: Ixodes/fisiologia
[Mh] Termos MeSH secundário: Animais
Vetores Aracnídeos
Borrelia burgdorferi/isolamento & purificação
Ixodes/microbiologia
Doença de Lyme/transmissão
Ontário
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180129
[Lr] Data última revisão:
180129
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171228
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0189393


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[PMID]:29284249
[Au] Autor:Schreterova E; Bhide M; Potocnakova L; Borszekova Pulzova L
[Ad] Endereço:Laboratory of Biomedical Microbiology and Immunology, Department of Microbiology and Immunology, University of Veterinary Medicine and Pharmacy, 041 81 Kosice, Slovakia. eva.kendrovska@gmail.com.
[Ti] Título:Design, construction and evaluation of multi-epitope antigens for diagnosis of Lyme disease.
[So] Source:Ann Agric Environ Med;24(4):696-701, 2017 Dec 23.
[Is] ISSN:1898-2263
[Cp] País de publicação:Poland
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Introduction and objective. Lyme disease (LD) is the most common vector-borne disease in the temperate zone of the Northern Hemisphere. Diagnosis of LD is mainly based on clinical symptoms supported with serology (detection of anti-Borrelia antibodies) and is often misdiagnosed in areas of endemicity. MATERIAL AND METHODS: In this study, the chimeric proteins (A/C-2, A/C-4 and A/C-7.1) consisting of B-cell epitopes of outer surface proteins OspA and OspC from Borrelia genospecies prevalent in Eastern Slovakia, were designed, over-expressed in E. coli, and used to detect specific anti-Borrelia antibodies in serologically characterized sera from patients with Lyme-like symptoms to evaluate their diagnostic potential. RESULTS: Results showed that chimeras vary in their immuno-reactivity when tested with human sera. Compared with the results obtained from a two-tier test, the application of recombinant multi-epitope chimeric proteins as diagnosis antigens, produced fair agreement in the case of A/C-2 (0.20<κ<0.40) and good agreement (0.60<κ<0.80) when A/C-7.1 was used as capture antigen. Chimera A/C-4 were excluded from further study due to loss of reactivity with OspA-specific antibodies. CONCLUSIONS: The combination of specific B-cell epitopes from OspA and OspC proteins may improve the diagnostic accuracy of serologic assays, but further studies are required to address this hypothesis.
[Mh] Termos MeSH primário: Borrelia burgdorferi/isolamento & purificação
Ensaio de Imunoadsorção Enzimática/métodos
Epitopos de Linfócito B/análise
Doença de Lyme/diagnóstico
[Mh] Termos MeSH secundário: Anticorpos Antibacterianos/análise
Anticorpos Antibacterianos/imunologia
Antígenos de Superfície/análise
Antígenos de Superfície/genética
Antígenos de Superfície/imunologia
Proteínas da Membrana Bacteriana Externa/análise
Proteínas da Membrana Bacteriana Externa/genética
Proteínas da Membrana Bacteriana Externa/imunologia
Vacinas Bacterianas/análise
Vacinas Bacterianas/genética
Vacinas Bacterianas/imunologia
Borrelia burgdorferi/genética
Borrelia burgdorferi/imunologia
Epitopos de Linfócito B/imunologia
Seres Humanos
Lipoproteínas/análise
Lipoproteínas/genética
Lipoproteínas/imunologia
Doença de Lyme/imunologia
Doença de Lyme/microbiologia
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antibodies, Bacterial); 0 (Antigens, Surface); 0 (Bacterial Outer Membrane Proteins); 0 (Bacterial Vaccines); 0 (Epitopes, B-Lymphocyte); 0 (Lipoproteins); 0 (OspA protein)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180105
[Lr] Data última revisão:
180105
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171230
[St] Status:MEDLINE


  7 / 9046 MEDLINE  
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[PMID]:29206879
[Au] Autor:Alkishe AA; Peterson AT; Samy AM
[Ad] Endereço:Biodiversity Institute, University of Kansas, Lawrence, Kansas, United States of America.
[Ti] Título:Climate change influences on the potential geographic distribution of the disease vector tick Ixodes ricinus.
[So] Source:PLoS One;12(12):e0189092, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Ixodes ricinus is a species of hard tick that transmits several important diseases in Europe and North Africa, including Lyme borreliosis and tick-borne encephalitis. Climate change is affecting the geographic distributions and abundances of arthropod vectors, which in turn influence the geographic distribution and epidemiology of associated vector-borne diseases. To date, few studies have investigated effects of climate change on the spatial distribution of I. ricinus at continental extents. Here, we assessed the potential distribution of I. ricinus under current and future climate conditions to understand how climate change will influence the geographic distribution of this important tick vector in coming decades. METHOD: We used ecological niche modeling to estimate the geographic distribution of I. ricinus with respect to current climate, and then assessed its future potential distribution under different climate change scenarios. This approach integrates occurrence records of I. ricinus with six relevant environmental variables over a continental extent that includes Europe, North Africa, and the Middle East. Future projections were based on climate data from 17 general circulation models (GCMs) under 2 representative concentration pathway emissions scenarios (RCPs), for the years 2050 and 2070. RESULT: The present and future potential distributions of I. ricinus showed broad overlap across most of western and central Europe, and in more narrow zones in eastern and northern Europe, and North Africa. Potential expansions were observed in northern and eastern Europe. These results indicate that I. ricinus populations could emerge in areas in which they are currently lacking, posing increased risks to human health in those areas. However, the future of I. ricinus ticks in some important regions such the Mediterranean was unclear owing to high uncertainty in model predictions.
[Mh] Termos MeSH primário: Mudança Climática
Ixodes/microbiologia
[Mh] Termos MeSH secundário: África do Norte
Animais
Ecossistema
Europa (Continente)
Doença de Lyme/transmissão
Oriente Médio
Modelos Teóricos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171229
[Lr] Data última revisão:
171229
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171206
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0189092


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[PMID]:27771334
[Au] Autor:Aenishaenslin C; Bouchard C; Koffi JK; Ogden NH
[Ad] Endereço:Groupe de Recherche en Épidémiologie des Zoonoses et Santé Publique (GREZOSP), Faculté de médecine vétérinaire, Université de Montréal, CP 5000, Saint-Hyacinthe, J2S 7C6, Québec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1140 Pine Avenue, Montreal
[Ti] Título:Exposure and preventive behaviours toward ticks and Lyme disease in Canada: Results from a first national survey.
[So] Source:Ticks Tick Borne Dis;8(1):112-118, 2017 01.
[Is] ISSN:1877-9603
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:Lyme disease (LD) risk is increasing in Canada. In 2014, the government of Canada launched a national communication campaign to raise awareness and promote the adoption of individual preventive behaviours toward ticks and LD. The objectives of this study were to evaluate and compare the adoption of LD preventive behaviours and the exposure to tick bites of Canadians in the five main targeted regions (British Columbia, Prairie provinces, Ontario, Quebec and the Atlantic provinces). A national survey was conducted in December 2014 (n=2876) to collect data on LD awareness, behaviours and risk factors. Overall, the proportion of respondents reporting tick exposure was high (20%). The results suggest that even though LD awareness was found to be high (with only 12% of the respondents reporting that they never heard about LD), less than half of the Canadians who heard about it have adopted specific preventive behaviours toward tick bites, such as regular tick checks (reported by 52%), protective clothing (50%), using tick repellent (41%) or shower or bath (41%) after visiting a wooded area in a LD risk area. Moreover, significant differences were found between regions, gender, age groups and dog ownership status, regarding preventive behaviours and factors of exposure. A high level of knowledge of Lyme disease, living in the Prairie region, as well as having found a tick on oneself or a relative, were found to be associated with the adoption of preventive behaviours. This study underlines the importance to take into account specific regional characteristics of risk and to maintain public health communication efforts through time in order to increase the adoption of preventive behaviours of Canadians.
[Mh] Termos MeSH primário: Conhecimentos, Atitudes e Prática em Saúde
Doença de Lyme/prevenção & controle
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Animais
Canadá/epidemiologia
Coleta de Dados
Feminino
Seres Humanos
Doença de Lyme/epidemiologia
Masculino
Meia-Idade
Fatores Socioeconômicos
Inquéritos e Questionários
Picadas de Carrapatos/prevenção & controle
Controle de Ácaros e Carrapatos
Carrapatos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171228
[Lr] Data última revisão:
171228
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE


  9 / 9046 MEDLINE  
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[PMID]:29190281
[Au] Autor:Pollett S; Althouse BM; Forshey B; Rutherford GW; Jarman RG
[Ad] Endereço:Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America.
[Ti] Título:Internet-based biosurveillance methods for vector-borne diseases: Are they novel public health tools or just novelties?
[So] Source:PLoS Negl Trop Dis;11(11):e0005871, 2017 Nov.
[Is] ISSN:1935-2735
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Internet-based surveillance methods for vector-borne diseases (VBDs) using "big data" sources such as Google, Twitter, and internet newswire scraping have recently been developed, yet reviews on such "digital disease detection" methods have focused on respiratory pathogens, particularly in high-income regions. Here, we present a narrative review of the literature that has examined the performance of internet-based biosurveillance for diseases caused by vector-borne viruses, parasites, and other pathogens, including Zika, dengue, other arthropod-borne viruses, malaria, leishmaniasis, and Lyme disease across a range of settings, including low- and middle-income countries. The fundamental features, advantages, and drawbacks of each internet big data source are presented for those with varying familiarity of "digital epidemiology." We conclude with some of the challenges and future directions in using internet-based biosurveillance for the surveillance and control of VBD.
[Mh] Termos MeSH primário: Infecções Bacterianas/epidemiologia
Biovigilância/métodos
Vetores de Doenças
Internet
Doenças Parasitárias/epidemiologia
Saúde Pública
Viroses/epidemiologia
[Mh] Termos MeSH secundário: Animais
Infecções Bacterianas/transmissão
Controle de Doenças Transmissíveis
Culicidae/parasitologia
Culicidae/virologia
Dengue/epidemiologia
Seres Humanos
Leishmaniose/epidemiologia
Doença de Lyme/epidemiologia
Malária/epidemiologia
Doenças Parasitárias/transmissão
Pobreza
Estatística como Assunto
Viroses/transmissão
Infecção pelo Zika virus/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171219
[Lr] Data última revisão:
171219
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171201
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pntd.0005871


  10 / 9046 MEDLINE  
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[PMID]:29175973
[Au] Autor:Nigrovic LE; Bennett JE; Balamuth F; Levas MN; Chenard RL; Maulden AB; Garro AC; for Pedi Lyme Net
[Ad] Endereço:Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts; lise.nigrovic@childrens.harvard.edu.
[Ti] Título:Accuracy of Clinician Suspicion of Lyme Disease in the Emergency Department.
[So] Source:Pediatrics;140(6), 2017 Dec.
[Is] ISSN:1098-4275
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: To make initial management decisions, clinicians must estimate the probability of Lyme disease before diagnostic test results are available. Our objective was to examine the accuracy of clinician suspicion for Lyme disease in children undergoing evaluation for Lyme disease. METHODS: We assembled a prospective cohort of children aged 1 to 21 years who were evaluated for Lyme disease at 1 of the 5 participating emergency departments. Treating physicians were asked to estimate the probability of Lyme disease (on a 10-point scale). We defined a Lyme disease case as a patient with an erythema migrans lesion or positive 2-tiered serology results in a patient with compatible symptoms. We calculated the area under the curve for the receiver operating curve as a measure of the ability of clinician suspicion to diagnose Lyme disease. RESULTS: We enrolled 1021 children with a median age of 9 years (interquartile range, 5-13 years). Of these, 238 (23%) had Lyme disease. Clinician suspicion had a minimal ability to discriminate between children with and without Lyme disease: area under the curve, 0.75 (95% confidence interval, 0.71-0.79). Of the 554 children who the treating clinicians thought were unlikely to have Lyme disease (score 1-3), 65 (12%) had Lyme disease, and of the 127 children who the treating clinicians thought were very likely to have Lyme disease (score 8-10), 39 (31%) did not have Lyme disease. CONCLUSIONS: Because clinician suspicion had only minimal accuracy for the diagnosis of Lyme disease, laboratory confirmation is required to avoid both under- and overdiagnosis.
[Mh] Termos MeSH primário: Competência Clínica
Serviço Hospitalar de Emergência
Doença de Lyme/diagnóstico
[Mh] Termos MeSH secundário: Adolescente
Criança
Pré-Escolar
Diagnóstico Diferencial
Feminino
Seres Humanos
Lactente
Masculino
Estudos Prospectivos
Reprodutibilidade dos Testes
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171219
[Lr] Data última revisão:
171219
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171128
[St] Status:MEDLINE



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