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Abstract(s)
A doença de Lyme é uma das doenças transmissíveis de notificação obrigatória mais
comuns em Portugal, sendo o principal agente etiológico a Bbsl. Na verdade, é
considerada uma doença emergente em Portugal, manifestando-se de forma
multissistémica. Ocorre habitualmente em três estágios. No primeiro são visíveis
manifestações cutâneas características, nomeadamente o EM. Posteriormente, surge o
segundo estágio, após disseminação hematogénea da Bbsl, podendo haver atingimento
cardíaco (cardite e bloqueio auriculoventricular), reumatológico (artralgias),
neurológico (meningoradiculite ou paralisia do nervo facial) e cutâneo, considerandose o linfocitoma uma manifestação rara que pode persistir durante meses. O terceiro
estágio é caracterizado pela ACA, uma afeção cutânea que atinge, principalmente, as
extremidades, causando inflamação, diminuição do espessamento da pele e neuropatia.
Para além disso, podem ocorrer fenómenos neurológicos (neuroborreliose tardia),
articulares (artrite de Lyme), oculares (uveíte) e cardíacos (bloqueios
auriculoventriculares de 2º e 3º grau).
O diagnóstico deve basear-se em critérios clínicos e epidemiológicos, suportados por
exames complementares de diagnóstico. Habitualmente são utilizados testes diretos e
indiretos, com maior enfoque nos testes serológicos.
Frequentemente, o diagnóstico desta espiroquetose é dificultado pela apresentação
atípica da doença e presença de manifestações clínicas inespecíficas. Isso pode atrasálo, impedindo a instituição de terapêutica adequada e promovendo o aparecimento de
complicações. O tratamento consiste habitualmente na administração de antibioterapia
com beta-lactâmicos, macrólidos ou tetraciclinas. Este costuma ser eficaz e bem
tolerado.
Pretendo com esta revisão bibliográfica sistematizar os conhecimentos atuais sobre esta
doença.
Lyme disease is one of the most common communicable diseases in Portugal, being the main etiologic agent the Bbsl. In fact, it is considered an emerging disease in Portugal, manifesting itself in a multisystemic way. It usually occurs in three stages. In the first, characteristic cutaneous manifestations are visible, namely EM. Subsequently, the second stage appears, after hematogenous dissemination of Bbsl, with cardiac (carditis and atrioventricular block), rheumatological (arthralgias), neurological (meningoradiculitis or facial nerve palsy) and cutaneous affection, considering the lymphocytoma a rare manifestation that it can persist for months. The third stage is characterized by ACA, a skin condition that mainly affects the extremities, causing inflammation, decreased skin thickening and neuropathy. In addition, neurological (late neuroborreliosis), articular (Lyme arthritis), ocular (uveitis) and cardiac manifestations (2nd and 3rd degree atrioventricular blocks) phenomena can occur. The diagnosis must be based on clinical and epidemiological criteria, supported by complementary diagnostic tests. Direct and indirect tests are usually used, with a greater focus on serological tests. Often, the diagnosis of these spirochetes is hampered by the atypical presentation of the disease and the presence of nonspecific clinical manifestations. This can delay it, preventing the institution of adequate therapy and promoting the appearance of complications. Treatment usually consists of administering antibiotics with betalactams, macrolides or tetracyclines. This is usually effective and well tolerated. With this bibliographic review I intend to systematize the current knowledge about this disease.
Lyme disease is one of the most common communicable diseases in Portugal, being the main etiologic agent the Bbsl. In fact, it is considered an emerging disease in Portugal, manifesting itself in a multisystemic way. It usually occurs in three stages. In the first, characteristic cutaneous manifestations are visible, namely EM. Subsequently, the second stage appears, after hematogenous dissemination of Bbsl, with cardiac (carditis and atrioventricular block), rheumatological (arthralgias), neurological (meningoradiculitis or facial nerve palsy) and cutaneous affection, considering the lymphocytoma a rare manifestation that it can persist for months. The third stage is characterized by ACA, a skin condition that mainly affects the extremities, causing inflammation, decreased skin thickening and neuropathy. In addition, neurological (late neuroborreliosis), articular (Lyme arthritis), ocular (uveitis) and cardiac manifestations (2nd and 3rd degree atrioventricular blocks) phenomena can occur. The diagnosis must be based on clinical and epidemiological criteria, supported by complementary diagnostic tests. Direct and indirect tests are usually used, with a greater focus on serological tests. Often, the diagnosis of these spirochetes is hampered by the atypical presentation of the disease and the presence of nonspecific clinical manifestations. This can delay it, preventing the institution of adequate therapy and promoting the appearance of complications. Treatment usually consists of administering antibiotics with betalactams, macrolides or tetracyclines. This is usually effective and well tolerated. With this bibliographic review I intend to systematize the current knowledge about this disease.
Description
Keywords
Borrelia Burgdorferi Sensu Lato Borreliose Diagnóstico Doença de Lyme