Efficacy of a long-term antibiotic treatment in patients with a chronic Tick Associated Poly-organic Syndrome (TAPOS)

Settings.- 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). Objective. -This open-label prospective Study was made oil a group of 100 patients having followed a medical treatment for a chronic TAPOS and to evaluate their evolution under prolonged antibiotic treatment. Results. - 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. Conclusion. - 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. (C) 2008 Elsevier Masson SAS. All rights reserved.