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Revue Neurologique
Volume 165, n° 8-9
pages 694-701 (août 2009)
Doi : 10.1016/j.neurol.2009.04.001
Received : 18 January 2009 ;  accepted : 3 April 2009
Épidémiologie de la borréliose et de la neuroborréliose de Lyme en France
Epidemiology of Lyme borreliosis and neuroborreliosis in France
 

F. Blanc a, b, c
a Département de neurologie, service de neuropsychologie, CMRR, hôpitaux universitaires de Strasbourg, 1, place de l’Hôpital, 67091 Strasbourg cedex, France 
b UMR 7191, CNRS, laboratoire d’imagerie et de neurosciences cognitives (LINC), université Louis-Pasteur, Strasbourg, France 
c Groupe d’étude des Borrélioses de Lyme (GEBLY), hôpitaux universitaires de Strasbourg, Strasbourg, France 

Résumé

La borréliose de Lyme (BL) est une pathologie systémique à type de zoonose transmise par la piqûre d’une tique du genre Ixodes et due à une bactérie du genre Borrelia . Le diagnostic de sa forme neurologique ou neuroborréliose (NB) peut être difficile du fait de tableaux variés. La méningoradiculite aiguë est la plus fréquente, mais il existe aussi des cas de méningite pauci-symptomatique, d’encéphalite, de myélite, de polyneuropathie, d’accidents vasculaires... Le vecteur Ixodes ricinus (I. ricinus ) se trouve sur la quasi-totalité du territoire métropolitain. Son taux d’infestation par Borrelia est en moyenne en France de 7 %, mais avec des disparités importantes. L’incidence de la BL a été estimée à 9,4/100 000 et celle de la NB à 0,6/100 000 par le réseau Sentinelles. Il existe des zones de plus forte incidence : en Alsace, l’incidence de la BL a été estimée à 200/100 000 et celle de la NB à 10/100 000 grâce à l’initiative de l’Institut national de veille sanitaire. Ainsi, la France est un pays à risque modéré pour la BL. Cependant, certaines régions comme le Limousin, l’Auvergne, la Lorraine, et l’Alsace ont un risque fort comparable à celui de pays du nord-est de l’Europe.

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Abstract

Lyme borreliosis (LB) is a systemic disease called neuroborreliosis (NB) when neurological symptoms are pre-eminent. LB is a zoonosis caused by Borrelia bacteria transmitted by Ixodes tick-bite. Because of the absence of a national registry, epidemiology of LB in France is not well known. Moreover, diagnosis of NB may be difficult because of the various clinical forms. Acute meningoradiculitis is the most common presentation, but pauci-symptomatic meningitis, encephalitis, myelitis, polyneuropathy, cerebrovascular involvement, and rarely chronic encephalomyelitis are also described. The vector Ixodes ricinus (I. ricinus ) is found throughout metropolitan France excepting border areas of the Mediterranean seaside and in regions with an altitude above 1500 meters. In France, the Borrelia infestation rate of Ixodes is 7% with wide disparity between administrative districts. Prospective work in 1999–2000 by 875 general practitioners participating in the “Sentinel” network established the estimated incidence of BL (9.4/100 000) and of NB (0.6/100 000) in France. Incidence is higher in certain regions: in Alsace, prospective work by 419 general practitioners and specialists in cooperation with the national surveillance agency (Institut national de veille sanitaire ), estimated BL incidence at 86 to 200/100 000 inhabitants and NB at 10/100 000. Thus, although globally France is a country with a moderate risk for LB, some regions such as Limousin, Auvergne, Lorraine and Alsace, have a high risk of LB, comparable to countries in the northeastern Europe such as Germany and Sweden.

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Mots clés : Borréliose de Lyme, Maladie de Lyme, Neuroborréliose, Épidémiologie, Incidence, Index de synthèse intrathécale anti-Borrelia , Sérologie de Lyme

Keywords : Lyme borreliosis, Lyme disease, Neuroborreliosis, Epidemiology, Incidence, intrathecal anti-Borrelia antibody index, Lyme serology




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