Epidemiology of Lyme borreliosis in France - both certainties and uncertainties

Abstract

Epidemiological evidence for tick-borne infections, particularly those related to Lyme borreliosis, is heterogeneous. Lyme borreliosis is a tick-born zoonosis transmitted by ticks of the genus Ixodes ricinus. After tick bite, the risk of transmission of an infectious agent remains low, most often represented by Borrelia burgdorferi sensu lato; co-infections in Humans by several different infectious agents (bacterial, viral or parasitic) are possible but a priori rare. In addition, besides well-known tick-borne pathogens, new species or gender of micro-organisms are regularly described in ticks but their pathogenicity in human pathology is not described or not yet established. The clinical presentation of Lyme borreliosis is varied, with localized and disseminated forms occurring long ago after tick bite, making diagnosis sometimes difficult. The natural course of Lyme borreliosis is insufficiently known because of recommendations of antibiotherapy in case of illness; however, some historical studies seem reassuring with possible spontaneous healing and seemingly minor sequelae. The diagnosis of disseminated forms requires paraclinical examinations, in first place serology, whose sensitivity increases with time of evolution of borreliosis; this is all the more interesting as the disseminated forms are of more difficult clinical diagnosis. After antibiotherapy, the clinical course is good, the sequelae remain possible especially in case of late diagnosis or late disseminated form; however, their frequency remains unknown.