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Médecine et maladies infectieuses
Volume 39, n° 2
pages 108-115 (février 2009)
Doi : 10.1016/j.medmal.2008.11.012
Received : 13 November 2007 ;  accepted : 12 November 2008
Efficacy of a long-term antibiotic treatment in patients with a chronic Tick Associated Poly-organic Syndrome (TAPOS)
Efficacité d’une antibiothérapie au long cours pour un « syndrome poly-organique postmorsure de tiques » (SPOT) chronique

J. Clarissou a, A. Song a, C. Bernede b, D. Guillemot b, A. Dinh a, F. Ader a, C. Perronne a, , J. Salomon a, b
a Unité des maladies infectieuses, CHU Raymond-Poincaré, AP–HP, 104, boulevard Raymond-Poincaré, 92380 Garches, France 
b Inserm U657, PhEMI, Institut Pasteur, Paris, France 

Corresponding author.

Despite a now codified antibiotic treatment for Lyme disease, a significant proportion of patients treated according to recommendations complain of persistent signs and symptoms. The pathophysiological mechanisms which underlie this syndrome of post-treatment chronic systemic illness remain unclear. For some physicians post-treatment symptoms indicate a persistent infection requiring prolonged antibiotic therapy. For others, there is no benefit from antimicrobial therapy. The difficulty of assessment encountered in studies is significant because many symptoms are subjective. We think that the term “chronic Lyme disease” is not appropriate and should be replaced by chronic “tick associated poly-organic syndrome” (TAPOS).


This open-label prospective study was made on a group of 100 patients having followed a medical treatment for a chronic TAPOS and to evaluate their evolution under prolonged antibiotic treatment.


The medical management was found to be effective for symptoms, especially for patients with a high probability of chronic TAPOS (NEJM score). Patients with post tick-bite symptoms, which often worsens their quality of life, deserve particular attention.


This study had methodological limitations but could help in terms of feasibility, choice of inclusion criteria, and design of follow-up for a future randomized, double blind study to test for an optimal management of TAPOS.

The full text of this article is available in PDF format.

Malgré un traitement antibiotique désormais consensuel de la maladie de Lyme, une part significative de patients correctement traités présentent des signes chroniques. Les mécanismes physiopathologiques impliqués dans ce « syndrome poly-organique postmorsure de tiques » demeurent mal connus. Pour certains cliniciens, ce syndrome est lié à la persistance d’une infection bactérienne et requiert une antibiothérapie prolongée. Pour d’autres, il n’y a pas de bénéfice à traiter par antibiotiques. L’évaluation de l’efficacité des traitements est rendue difficile du fait du caractère subjectif des symptômes. Nous pensons que le terme de Lyme chronique est inapproprié et proposons donc l’appellation de « syndrome poly-organique associé à une morsure de tiques » (SPOT).


L’objectif de cette étude prospective monocentrique est de décrire les symptômes du SPOT et l’évolution sous traitement antibiotique prolongé de 100 patients.


L’efficacité du traitement antibiotique prolongé semble plus nette chez les patients ayant une forte probabilité de SPOT (score NEJM). Les patients ayant des troubles chroniques subjectifs avec un fort impact sur la vie courante méritent une attention particulière.


Malgré les biais évidents, cette étude peut aider à choisir les critères de faisabilité et d’inclusion ainsi que les bras d’une étude randomisée double insu permettant d’optimiser la prise en charge thérapeutique des patients traités présentant un SPOT.

The full text of this article is available in PDF format.

Keywords : Antibiotic, Chronic Lyme disease, Tick-bites, Open-label prospective study

Mots clés : Antibiotique, Lyme chronique, Morsure de tiques, Étude ouverte prospective

© 2008  Elsevier Masson SAS. All Rights Reserved.
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