Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.521
Filtrar
1.
Rev Med Suisse ; 16(688): 629-634, 2020 Apr 01.
Artigo em Francês | MEDLINE | ID: mdl-32239836

RESUMO

Lyme borreliosis is a frequent disease in Switzerland. Due to the increasing number of symptoms attributed to this infection, the diagnostic is often controversy between different specialists and is often a subject of discussion. The diagnostic of Lyme disease lays particularly on the knowledge of cutaneous signs which are the only specific. Despite recent scientific progress, microbiological diagnostic is still delicate and serological tests currently used do not differentiate between an active infection versus a serological marker. Here we describe the different clinical presentations of Lyme disease diagnosis and management procedures according to stages of evolution.


Assuntos
Dermatologia/métodos , Doença de Lyme/diagnóstico , Doença de Lyme/terapia , Humanos , Doença de Lyme/epidemiologia , Testes Sorológicos , Suíça/epidemiologia
2.
PLoS One ; 15(2): e0228772, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32040491

RESUMO

Lyme disease (LD) diagnosis using the current two-tier algorithm is constrained by low sensitivity for early-stage infection and ambiguity in determining treatment response. We recently developed a protein microarray biochip that measures diagnostic serum antibody targets using grating-coupled fluorescent plasmonics (GC-FP) technology. This strategy requires microliters of blood serum to enable multiplexed biomarker screening on a compact surface and generates quantitative results that can be further processed for diagnostic scoring. The GC-FP biochip was used to detect serum antibodies in patients with active and convalescent LD, as well as various negative controls. We hypothesized that the quantitative, high-sensitivity attributes of the GC-FP approach permit: 1) screening of antibody targets predictive for LD status, and 2) development a diagnostic algorithm that is more sensitive, specific, and informative than the standard ELISA and Western blot assays. Notably, our findings led to a diagnostic algorithm that may be more sensitive than the current standard for detecting early LD, while maintaining 100% specificity. We further show that analysis of relative antibody levels to predict disease status, such as in acute and convalescent stages of infection, is possible with a highly sensitive and quantitative platform like GC-FP. The results from this study add to the urgent conversation regarding better diagnostic strategies and more effective treatment for patients affected by tick-borne disease.


Assuntos
Anticorpos Antibacterianos/sangue , Fluorescência , Dispositivos Lab-On-A-Chip , Doença de Lyme/sangue , Doença de Lyme/diagnóstico , Programas de Rastreamento/instrumentação , Humanos , Doença de Lyme/imunologia , Fatores de Tempo
3.
Dtsch Med Wochenschr ; 145(1): 19-28, 2020 01.
Artigo em Alemão | MEDLINE | ID: mdl-31914465

RESUMO

Lyme borreliosis is the most common zoonosis in Germany with an incidence of up to 138/100 000. More than 90 % of all cases show dermatological manifestations. Early manifestations are erythema migrans, multiple erythemata migrantia, and (less frequently) borrelial lymphocytoma. A typical late manifestation is acrodermatitis chronica atrophicans. Lyme neuroborreliosis is much less common with an incidence of about 0.8/100 000 inhabitants in Germany. Bannwarth's syndrome (painful radiculoneuritis) is the most common manifestation of Lyme neuroborreliosis in adults followed by meningitis. International case definitions exist regarding the likelihood of Lyme neuroborreliosis on the basis of diagnostic test results. A CSF analysis should be performed in patients with suspected Lyme neuroborreliosis. The first line treatment for dermatological manifestations of Lyme borreliosis is doxycycline, in children and pregnant women amoxicillin. Doxycycline and beta-lactam antibiotics show similar efficacy regarding neurological symptoms and adverse effects for treatment of neurological manifestations. Treatment duration for early manifestations is 10 to 14 days, in Lyme neuroborreliosis it should not exceed 21 days. All manifestations, also Lyme neuroborreliosis, usually show a favourable prognosis after antibiotic treatment. Antibiotic treatment does not show any efficacy in patients with unspecific symptoms and concurrent positive anti-borrelial serology.


Assuntos
Doença de Lyme , Antibacterianos/uso terapêutico , Criança , Doxiciclina/uso terapêutico , Eritema Migrans Crônico , Feminino , Dedos/patologia , Alemanha/epidemiologia , Humanos , Incidência , Doença de Lyme/diagnóstico , Doença de Lyme/tratamento farmacológico , Doença de Lyme/epidemiologia , Doença de Lyme/fisiopatologia , Masculino , Gravidez , Pele/patologia
4.
Dtsch Med Wochenschr ; 145(1): 29-34, 2020 01.
Artigo em Alemão | MEDLINE | ID: mdl-31914466

RESUMO

Lyme borreliosis caused by at least six Borrelia burgdorferi species, is the most important tick-borne disease in the northern hemisphere. With a wide spectrum of possible symptoms, the microbiological diagnosis of this disease is associated with a wide variety of ideas, divergent approaches and much uncertainty. The aim of the article is to introduce the treating physicians to a meaningful microbiological diagnostic procedure. Most important messages include that (I) the suspected diagnosis of Lyme borreliosis is first based on anamnestic data and clinical symptoms (compare "case definitions") which is substantiated by microbiological examinations; (II) microbiological diagnostics - primarily antibody detection, downstream PCR and culture - are only indicated if there are indicative symptoms, with typical erythema migrans not requiring microbiological diagnostics; (III) keep in mind: The more unspecific the symptoms are the lower the positive and the higher the negative predictive value of microbiological testing; (IV) serological diagnosis should follow a two-step procedure: a sensitive ELISA as first step, if reactive followed by immunoblot (IgM and IgG). Detection rates are ca. 50 % in localized, 70- > 90 % in disseminated early and nearly 100 % (only IgG relevant) in late disease; (V) in the immunoblot early forms of disease show a narrow band spectrum, late forms show a broad spectrum; (VI) methods that are not recommended for diagnostic purposes include lymphocyte activation or transformation tests (LTT, MELISA, ELISPOT), PCR or antigen detection from urine or blood, lymphocyte subpopulations, or direct detection of borreliae from patient material using dark field- or focus floating microscopy.


Assuntos
Doença de Lyme , Anticorpos Antibacterianos/sangue , Diagnóstico Diferencial , Ensaio de Imunoadsorção Enzimática , Humanos , Immunoblotting , Doença de Lyme/diagnóstico , Doença de Lyme/imunologia , Doença de Lyme/microbiologia , Reação em Cadeia da Polimerase
6.
J Am Podiatr Med Assoc ; 109(6): 455-458, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31755768

RESUMO

Over a time frame of less than 1 year, a 23-year-old competitive horseback rider experienced a midsubstance tear of both the tibialis anterior and extensor hallucis longus tendons without inciting injury. It was after the second spontaneous tear that the patient's recent diagnosis of Lyme disease became the likely culprit. Often, patients with chronic Lyme disease present with an elaborate clinical picture that can mimic many more common diagnoses such as septic arthritis, transient synovitis, ligamentous sprain, and various other traumatic injuries. With the pathognomonic erythema migrans rash reported to be present less than 50% of the time in late-stage infections, the diagnosis of Lyme disease can often be difficult, with a high rate of underdiagnosis. It is important that Lyme disease be included in the differential diagnosis of spontaneous tendon pathology, especially for physicians practicing in highly endemic areas. The treatment is relatively simple and successful-especially for an acute infection-and it is important to initiate treatment promptly to prevent disability.


Assuntos
Doença de Lyme/complicações , Traumatismos dos Tendões/etiologia , Animais , Feminino , Cavalos , Humanos , Extremidade Inferior , Doença de Lyme/diagnóstico , Imagem por Ressonância Magnética , Ruptura Espontânea , Esportes , Traumatismos dos Tendões/diagnóstico por imagem , Tendões/diagnóstico por imagem , Adulto Jovem
7.
BMC Infect Dis ; 19(1): 861, 2019 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-31623574

RESUMO

BACKGROUND: Exposure to blacklegged ticks Ixodes scapularis that transmit pathogens is thought to occur peri-domestically. However, the locations where people most frequently encounter infected ticks are not well characterized, leading to mixed messages from public health officials about where risk is highest. METHODS: We conducted a systematic review and meta-analysis on spatial risk factors for tick-borne disease and tick bites in eastern North America. We examined three scales: the residential yard, the neighborhood surrounding (but not including) the yard, and outside the neighborhood. Nineteen eligible studies represented 2741 cases of tick-borne illness and 1447 tick bites. Using random effects models, we derived pooled odds ratio (OR) estimates. RESULTS: The meta-analysis revealed significant disease risk factors at the scale of the yard (OR 2.60 95% CI 1.96 - 3.46), the neighborhood (OR 4.08 95% CI 2.49 - 6.68), and outside the neighborhood (OR 2.03 95% CI 1.59 - 2.59). Although significant risk exists at each scale, neighborhood scale risk factors best explained disease exposure. Analysis of variance revealed risk at the neighborhood scale was 57% greater than risk at the yard scale and 101% greater than risk outside the neighborhood. CONCLUSIONS: This analysis emphasizes the importance of understanding and reducing tick-borne disease risk at the neighborhood scale. Risk-reducing interventions applied at each scale could be effective, but interventions applied at the neighborhood scale are most likely to protect human health. TRIAL REGISTRATION: The study was registered with PROSPERO: CRD42017079169 .


Assuntos
Picadas de Carrapatos/diagnóstico , Doenças Transmitidas por Carrapatos/diagnóstico , Animais , Humanos , Ixodes/fisiologia , Doença de Lyme/diagnóstico , Doença de Lyme/epidemiologia , América do Norte/epidemiologia , Razão de Chances , Características de Residência/estatística & dados numéricos , Fatores de Risco , Picadas de Carrapatos/epidemiologia , Doenças Transmitidas por Carrapatos/epidemiologia
8.
MMWR Morb Mortal Wkly Rep ; 68(32): 703, 2019 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-31415492

RESUMO

Lyme disease is a tickborne zoonosis for which serologic testing is the principal means of laboratory diagnosis. In 1994, the Association of State and Territorial Public Health Laboratory Directors, CDC, the Food and Drug Administration (FDA), the National Institutes of Health (NIH), the Council of State and Territorial Epidemiologists, and the National Committee for Clinical Laboratory Standards convened the Second National Conference on Serologic Diagnosis of Lyme Disease (1).


Assuntos
Doença de Lyme/diagnóstico , Testes Sorológicos/normas , Western Blotting , Ensaio de Imunoadsorção Enzimática , Humanos , Doença de Lyme/sangue , Testes Sorológicos/métodos , Estados Unidos , United States Food and Drug Administration
9.
Eur J Clin Microbiol Infect Dis ; 38(10): 1933-1945, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31399914

RESUMO

Lyme borreliosis (LB), caused by spirochetes belonging to the Borrelia burgdorferi sensu lato complex, is the most common tick-borne infection in Europe. Laboratory diagnosis of LB is mainly based on the patients' medical history, clinical signs and symptoms in combination with detection of Borrelia-specific antibodies where indirect enzyme-linked-immunosorbent assay (ELISA) is the most widely used technique. The objective of the study was to evaluate and compare the diagnostic accuracy (sensitivities and specificities) of serological tests that are currently in use for diagnosis of LB in clinical laboratories in Northern Europe, by use of a large serum panel. The panel consisted of 195 serum samples from well-characterized and classified patients under investigation for clinically suspected LB (n = 59) including patients with Lyme neuroborreliosis, Lyme arthritis, acrodermatitis chronica atrophicans, erythema migrans or other diseases (n = 112). A total of 201 serum samples from healthy blood donors were also included. The panel (396 serum samples altogether) was sent to 12 clinical laboratories (using five different ELISA methods) as blinded for group affiliation and the laboratories were asked to perform serological analysis according to their routine procedure. The results from the study demonstrated high diagnostic concordance between the laboratories using the same diagnostic assay and lower diagnostic concordance between laboratories using different diagnostic assays. For IgG, the results were in general rather homogenous and showed an average sensitivity of 88% (range 85-91%) compared to IgM which showed lower average sensitivity of 59% (range 50-67%) and more heterogeneous results between assays and laboratories.


Assuntos
Grupo Borrelia Burgdorferi/imunologia , Doença de Lyme/diagnóstico , Testes Sorológicos/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Europa (Continente) , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Adulto Jovem
10.
BMC Infect Dis ; 19(1): 732, 2019 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-31429716

RESUMO

BACKGROUND: Lyme borreliosis (LB) is a tick-borne disease caused by spirochetes belonging to the Borrelia burgdorferi sensu lato species. Due to a variety of clinical manifestations, diagnosing LB can be challenging, and laboratory work-up is usually required in case of disseminated LB. However, the current standard of diagnostics is serology, which comes with several shortcomings. Antibody formation may be absent in the early phase of the disease, and once IgG-seroconversion has occurred, it can be difficult to distinguish between a past (cured or self-cleared) LB and an active infection. It has been postulated that novel cellular tests for LB may have both higher sensitivity earlier in the course of the disease, and may be able to discriminate between a past and active infection. METHODS: VICTORY is a prospective two-gate case-control study. We strive to include 150 patients who meet the European case definitions for either localized or disseminated LB. In addition, we aim to include 225 healthy controls without current LB and 60 controls with potentially cross-reactive conditions. We will perform four different cellular tests in all of these participants, which will allow us to determine sensitivity and specificity. In LB patients, we will repeat cellular tests at 6 weeks and 12 weeks after start of antibiotic treatment to assess the usefulness as 'test-of-cure'. Furthermore, we will investigate the performance of the different cellular tests in a cohort of patients with persistent symptoms attributed to LB. DISCUSSION: This article describes the background and design of the VICTORY study protocol. The findings of our study will help to better appreciate the utility of cellular tests in the diagnosis of Lyme borreliosis. TRIAL REGISTRATION: NL7732 (Netherlands Trial Register, trialregister.nl).


Assuntos
Doença de Lyme/diagnóstico , Adulto , Antibacterianos/uso terapêutico , Borrelia burgdorferi/imunologia , Estudos de Casos e Controles , Estudos de Coortes , Humanos , Doença de Lyme/tratamento farmacológico , Estudos Multicêntricos como Assunto , Países Baixos , Estudos Prospectivos
13.
Folia Med Cracov ; 59(1): 5-14, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31180072

RESUMO

Lyme disease is an emerging problem in Poland. Analysis has been undertaken of the medical documentation of 86 patients hospitalized in the Infectious Diseases Department, University Hospital in Cracow in 2013-2016, suspected of Lyme arthritis. It has especially considered medical history including potential exposure to the infection, detailed characteristics of the symptoms, diagnostic challenges and results of the treatment. Only some patients had a history of erythema migrans and not all of them recalled tick-bite. The majority of the patients had affected large joints, especially knee joints, and polyarthritis was rarely observed. Symptoms were resolved completely or partially after antibiotic treatment in most patients. The diagnosis of Lyme arthritis in areas endemic for Lyme disease is still a diagnostic challenge in patients with other rheumatic diseases, including osteoarthritis.


Assuntos
Artrite Infecciosa/tratamento farmacológico , Eritema Migrans Crônico/tratamento farmacológico , Doença de Lyme/tratamento farmacológico , Antibacterianos/uso terapêutico , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/fisiopatologia , Ceftriaxona/uso terapêutico , Diagnóstico Diferencial , Doxiciclina/uso terapêutico , Eritema Migrans Crônico/diagnóstico , Eritema Migrans Crônico/etiologia , Feminino , Articulações do Pé , Articulação da Mão , Articulação do Quadril , Hospitalização , Hospitais Universitários , Humanos , Articulação do Joelho , Doença de Lyme/complicações , Doença de Lyme/diagnóstico , Doença de Lyme/fisiopatologia , Masculino , Pessoa de Meia-Idade , Osteoartrite/diagnóstico , Polônia , Articulação do Ombro , Picadas de Carrapatos , Resultado do Tratamento
14.
Med Mal Infect ; 49(5): 335-346, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31155367

RESUMO

The serodiagnosis of Lyme borreliosis is based on a two-tier strategy: a screening test using an immunoenzymatic technique (ELISA), followed if positive by a confirmatory test with a western blot technique for its better specificity. Lyme serology has poor sensitivity (30-40%) for erythema migrans and should not be performed. The seroconversion occurs after approximately 6 weeks, with IgG detection (sensitivity and specificity both>90%). Serological follow-up is not recommended as therapeutic success is defined by clinical criteria only. For neuroborreliosis, it is recommended to simultaneously perform ELISA tests in samples of blood and cerebrospinal fluid to test for intrathecal synthesis of Lyme antibodies. Given the continuum between early localized and disseminated borreliosis, and the efficacy of doxycycline for the treatment of neuroborreliosis, doxycycline is preferred as the first-line regimen of erythema migrans (duration, 14 days; alternative: amoxicillin) and neuroborreliosis (duration, 14 days if early, 21 days if late; alternative: ceftriaxone). Treatment of articular manifestations of Lyme borreliosis is based on doxycycline, ceftriaxone, or amoxicillin for 28 days. Patients with persistent symptoms after appropriate treatment of Lyme borreliosis should not be prescribed repeated or prolonged antibacterial treatment. Some patients present with persistent and pleomorphic symptoms after documented or suspected Lyme borreliosis. Another condition is eventually diagnosed in 80% of them.


Assuntos
Técnicas de Laboratório Clínico , Doença de Lyme , Doenças Transmitidas por Carrapatos , Animais , Técnicas de Laboratório Clínico/métodos , Técnicas de Laboratório Clínico/normas , Diagnóstico Diferencial , Progressão da Doença , França , Humanos , Doença de Lyme/complicações , Doença de Lyme/diagnóstico , Doença de Lyme/patologia , Doença de Lyme/terapia , Guias de Prática Clínica como Assunto , Sociedades Científicas/organização & administração , Sociedades Científicas/normas , Doenças Transmitidas por Carrapatos/complicações , Doenças Transmitidas por Carrapatos/diagnóstico , Doenças Transmitidas por Carrapatos/patologia , Doenças Transmitidas por Carrapatos/terapia
15.
BMJ Case Rep ; 12(6)2019 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-31167768

RESUMO

We present a case of a 23-year-old man coming with palpitations, found to be in atrial fibrillation (AF). He was initially managed with metoprolol for rate-controlled therapy-reverted to normal sinus rhythm and discharged home. He returned a few days later-this time in varying degrees of atrioventricular block including transient complete heart block. He was empirically started on intravenous ceftriaxone for suspected Lyme carditis, which subsequently led to the resolution of high-degree heart block. Lyme immunoglobulin G (IgG) and IgM returned positive. Follow-up ECG after the course of antibiotic exhibited normal sinus rhythm. AF is a rare presentation of Lyme disease but still exists. It should be considered in terms of appropriate treatment, especially in Lyme-endemic areas.


Assuntos
Fibrilação Atrial/diagnóstico , Bloqueio Atrioventricular/diagnóstico , Doença de Lyme/diagnóstico , Administração Intravenosa , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/etiologia , Fibrilação Atrial/fisiopatologia , Bloqueio Atrioventricular/tratamento farmacológico , Bloqueio Atrioventricular/etiologia , Bloqueio Atrioventricular/fisiopatologia , Ceftriaxona/administração & dosagem , Ceftriaxona/uso terapêutico , Diagnóstico Diferencial , Eletrocardiografia , Humanos , Doença de Lyme/tratamento farmacológico , Doença de Lyme/imunologia , Masculino , Resultado do Tratamento , Adulto Jovem
17.
Sante Publique ; S1(HS): 51-63, 2019 May 13.
Artigo em Francês | MEDLINE | ID: mdl-31210491

RESUMO

Epidemiological evidence for tick-borne infections, particularly those related to Lyme borreliosis, is heterogeneous. Lyme borreliosis is a tick-born zoonosis transmitted by ticks of the genus Ixodes ricinus. After tick bite, the risk of transmission of an infectious agent remains low, most often represented by Borrelia burgdorferi sensu lato; co-infections in Humans by several different infectious agents (bacterial, viral or parasitic) are possible but a priori rare. In addition, besides well-known tick-borne pathogens, new species or gender of micro-organisms are regularly described in ticks but their pathogenicity in human pathology is not described or not yet established. The clinical presentation of Lyme borreliosis is varied, with localized and disseminated forms occurring long ago after tick bite, making diagnosis sometimes difficult. The natural course of Lyme borreliosis is insufficiently known because of recommendations of antibiotherapy in case of illness; however, some historical studies seem reassuring with possible spontaneous healing and seemingly minor sequelae. The diagnosis of disseminated forms requires paraclinical examinations, in first place serology, whose sensitivity increases with time of evolution of borreliosis; this is all the more interesting as the disseminated forms are of more difficult clinical diagnosis. After antibiotherapy, the clinical course is good, the sequelae remain possible especially in case of late diagnosis or late disseminated form; however, their frequency remains unknown.


Assuntos
Ixodes/microbiologia , Doença de Lyme/epidemiologia , Doenças Transmitidas por Carrapatos/epidemiologia , Animais , França/epidemiologia , Humanos , Doença de Lyme/diagnóstico , Doença de Lyme/microbiologia
18.
Aerosp Med Hum Perform ; 90(7): 652-654, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31227041

RESUMO

BACKGROUND: Physicians rely on intuition and pattern recognition to rapidly evaluate and treat patients. While the realities of our medical system require liberal use of these heuristics to efficiently make clinical decisions, such thinking patterns are error-prone-leaving the clinician at the whims of their cognitive biases.CASE REPORT: We describe a case of Lyme disease in which a pilot's rash and radicular pain were misdiagnosed on two separate occasions until, nearly a month after initially seeking medical care, the pilot was appropriately diagnosed and treated.DISCUSSION: This case highlights Lyme disease's mimicry of other common diseases and underscores the need to use slower, more deliberate evaluation in conjunction with pattern recognition and intuition to provide optimal care to flyers.Saul S, Tanael M. Rash, radiculopathy, and cognitive biases. Aerosp Med Hum Perform. 2019; 90(7):652-654.


Assuntos
Tomada de Decisão Clínica/métodos , Erros de Diagnóstico/psicologia , Heurística , Doença de Lyme/diagnóstico , Cirurgiões/psicologia , Adulto , Medicina Aeroespacial , Celulite (Flegmão)/complicações , Celulite (Flegmão)/diagnóstico , Exantema/etiologia , Humanos , Doença de Lyme/complicações , Masculino , Militares , Pilotos , Síndrome do Músculo Piriforme/complicações , Síndrome do Músculo Piriforme/diagnóstico , Radiculopatia/etiologia
19.
Artigo em Inglês | MEDLINE | ID: mdl-31245298

RESUMO

The identification of microbial biomarkers is critical for the diagnosis of a disease early during infection. However, the identification of reliable biomarkers is often hampered by a low concentration of microbes or biomarkers within host fluids or tissues. We have outlined a multi-platform strategy to assess microbial biomarkers that can be consistently detected in host samples, using Borrelia burgdorferi, the causative agent of Lyme disease, as an example. Key aspects of the strategy include the selection of a macaque model of human disease, in vivo Microbial Antigen Discovery (InMAD), and proteomic methods that include microbial biomarker enrichment within samples to identify secreted proteins circulating during infection. Using the described strategy, we have identified 6 biomarkers from multiple samples. In addition, the temporal antibody response to select bacterial antigens was mapped. By integrating biomarkers identified from early infection with temporal patterns of expression, the described platform allows for the data driven selection of diagnostic targets.


Assuntos
Biomarcadores , Borrelia burgdorferi/isolamento & purificação , Doença de Lyme/diagnóstico , Animais , Anticorpos Antibacterianos/sangue , Antígenos de Bactérias/imunologia , Técnicas Bacteriológicas , Biomarcadores/sangue , Biomarcadores/urina , Borrelia burgdorferi/imunologia , Diagnóstico Precoce , Humanos , Doença de Lyme/imunologia , Doença de Lyme/microbiologia , Macaca mulatta , Proteômica , Soro/química , Urina/química
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA