C Jacquet1, F Goehringer2, E Baux2, J A Conrad2, M O Ganne Devonec2, J L Schmutz3, G Mathey4, H Tronel5, T Moulinet6, I Chary-Valckenaere7, T May2, C Rabaud2. 1. Service de maladies infectieuses et tropicales, CHRU de Nancy, rue du Morvan, 54500 Vandoeuvre-les-Nancy, France. Electronic address: caroline.jacquet08@yahoo.fr. 2. Service de maladies infectieuses et tropicales, CHRU de Nancy, rue du Morvan, 54500 Vandoeuvre-les-Nancy, France. 3. Service de dermatologie, CHRU de Nancy, rue du Morvan, 54500 Vandoeuvre-les-Nancy, France. 4. Service de neurologie, CHRU de Nancy, rue du Morvan, 54500 Vandoeuvre-les-Nancy, France. 5. Laboratoire de microbiologie, CHRU de Nancy, rue du Morvan, 54500 Vandoeuvre-les-Nancy, France. 6. Département de medecine interne et immunologie clinique, CHRU de Nancy, rue du Morvan, 54500 Vandoeuvre-les-Nancy, France. 7. Service de rhumatologie, CHRU de Nancy, rue du Morvan, 54500 Vandoeuvre-les-Nancy, France.
Abstract
OBJECTIVE: The teaching hospital of Nancy, France, implemented a specific multidisciplinary care pathway (French acronym AMDPL) to improve the management of patients presenting with Lyme borreliosis (LB) suspicion. We aimed to assess the first year of activity of this care pathway. PATIENTS AND METHODS: We included all patients managed in the AMDPL pathway from November 1, 2016 to October 31, 2017. The first step was a dedicated Lyme disease consultation with an infectious disease specialist. Following this consultation, the LB diagnosis was either confirmed and adequate treatment was prescribed, or a differential diagnosis was established and patients received adequate management, or further investigations were required and patients were offered multidisciplinary management as part of a day hospitalization. RESULTS: A total of 468 patients were included. LB diagnosis was confirmed in 15% of patients (69/468), 49% of patients received a differential diagnosis, and 26% (122/468) of patients had the LB diagnosis ruled out without receiving any other diagnosis. CONCLUSIONS: This is to our knowledge the first multidisciplinary center implemented in France for the management of patients presenting with LB suspicion related to polymorphous signs and symptoms. Several diagnoses could be confirmed or corrected, although some symptoms and complaints could not be explained. This cohort could improve our knowledge of LB and its differential diagnoses.
OBJECTIVE: The teaching hospital of Nancy, France, implemented a specific multidisciplinary care pathway (French acronym AMDPL) to improve the management of patients presenting with Lyme borreliosis (LB) suspicion. We aimed to assess the first year of activity of this care pathway. PATIENTS AND METHODS: We included all patients managed in the AMDPL pathway from November 1, 2016 to October 31, 2017. The first step was a dedicated Lyme disease consultation with an infectious disease specialist. Following this consultation, the LB diagnosis was either confirmed and adequate treatment was prescribed, or a differential diagnosis was established and patients received adequate management, or further investigations were required and patients were offered multidisciplinary management as part of a day hospitalization. RESULTS: A total of 468 patients were included. LB diagnosis was confirmed in 15% of patients (69/468), 49% of patients received a differential diagnosis, and 26% (122/468) of patients had the LB diagnosis ruled out without receiving any other diagnosis. CONCLUSIONS: This is to our knowledge the first multidisciplinary center implemented in France for the management of patients presenting with LB suspicion related to polymorphous signs and symptoms. Several diagnoses could be confirmed or corrected, although some symptoms and complaints could not be explained. This cohort could improve our knowledge of LB and its differential diagnoses.
Authors: Jacques Sevestre; Antoine Benichou; Vanessa Rio; Pascal Delaunay; Géraldine Gonfrier; Cécile Martaresche; Virginie Carlo; Sarah Nakam; Véronique Mondain; Michel Carles; Pierre Yves Jeandel; Jacques Durant Journal: Front Med (Lausanne) Date: 2022-03-22