ライム病の過剰診断について
A C Steere1, E Taylor, G L McHugh
1Division of Rheumatology/Immunology, New England Medical Center, Boston, MA 02111.
JAMA
|April 14, 1993
まとめ
ライム病のために紹介された788人の患者をレビューしたところ,ライム病が活発なのは23%しかいないことが判明しました. 誤診は,ライム病の患者の抗生物質治療が効果的でない主な理由でした.
科学分野:
- 医療診断 医療診断
- 感染症 感染症は感染症です.
- 神経学 神経学とは
背景:
- ライム病の診断は複雑で,誤診につながる可能性があります.
- 専門診療所へ送られた患者は,しばしば,多種多様で重複する症状を呈する.
- 正確な診断は,効果的な治療と患者のアウトカムに不可欠です.
研究 の 目的:
- 診断の正確性,血清学的結果,およびライム病の診療所で評価された患者の治療結果を分析する.
- 紹介前の診断と評価を,現在の発見と比較する.
- ライム病の疑いのある症例における治療失敗の原因を特定する.
主な方法:
- 788人の患者が4.5年に渡って紹介された,遡及的症例調査.
- 含有基準:リーム病の疑いのある患者は,医師または自己紹介により,リーム病を患っていると疑われる.
- 評価された症状,徴候,免疫診断検査,および神経機能.
主要な成果:
- 180人の患者 (23%) のみ,ライム病 (関節炎,脳症,多神経症) が活発であった.
- 156人の患者 (20%) はライム病と別の病気を患っていたが,452人 (57%) はライム病ではなかった.
- ライム病のない人のうち,45%は,他の場所で前回の陽性血清検査を受けたが,この診療所の研究室では陰性であった. 誤診は,治療を受けた患者の79%で抗生物質への反応が悪い原因でした.
結論:
- クリニックに紹介された患者の少数派は,ライム病の診断基準を満たしていました.
- 誤診は,抗生物質療法に対する反応の欠如の最も一般的な理由です.
- 専門のクリニックは,ライム病の正確な診断と管理に役割を果たします.
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