{"id":15405,"date":"2023-10-19T16:58:55","date_gmt":"2023-10-19T14:58:55","guid":{"rendered":"https:\/\/francelyme.fr\/site\/?p=15405"},"modified":"2023-10-19T16:58:56","modified_gmt":"2023-10-19T14:58:56","slug":"diagnostic-de-la-borreliose-de-lyme-etat-des-lieux-des-ameliorations-et-des-innovations","status":"publish","type":"post","link":"https:\/\/francelyme.fr\/site\/diagnostic-de-la-borreliose-de-lyme-etat-des-lieux-des-ameliorations-et-des-innovations\/","title":{"rendered":"Diagnostic de la borr\u00e9liose de Lyme : \u00e9tat des lieux des am\u00e9liorations et des innovations"},"content":{"rendered":"
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La borr\u00e9liose de Lyme (BL), caus\u00e9e par la bact\u00e9rie Borrelia, se manifeste par divers sympt\u00f4mes\u00a0: l’\u00e9ryth\u00e8me migrant, qui est caract\u00e9ristique de la maladie, ainsi que d’autres, qui pr\u00e9sentent des caract\u00e9ristiques cliniques moins sp\u00e9cifiques, comme la grande fatigue, les maux de t\u00eate, les troubles et douleurs articulaires, neurologiques, etc.<\/p>\n\n\n\n

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Le diagnostic biologique de la BL, repose officiellement sur la \u00ab s\u00e9rologie standard \u00e0 deux niveaux \u00bb : il faut \u00eatre d\u2019abord positif au test Elisa, puis positif au test Western Blot, pour \u00eatre officiellement diagnostiqu\u00e9.<\/p>\n\n\n\n

Cette proc\u00e9dure fait l’objet de nombreux d\u00e9bats et controverses, car elle repose sur une approche indirecte (recherche d\u2019anticorps) qui souffre d’une faible sensibilit\u00e9 en fonction du stade de la maladie. En particulier pour les malades porteurs de la forme longue de la maladie, qui ne produisent pratiquement plus d\u2019anticorps, pass\u00e9 un certain stade.<\/p>\n\n\n\n

Et pour ne rien arranger, ces tests Elisa et Western Blot sont commercialis\u00e9s par de multiples laboratoires, qui ne pr\u00e9sentent pas les m\u00eames caract\u00e9ristiques, avec des r\u00e9sultats parfois contradictoires. A tel point que nous recevons, dans l\u2019association, un grand nombre de t\u00e9moignages de patients qui sont n\u00e9gatifs en France et positifs \u00e0 l\u2019\u00e9tranger.<\/p>\n\n\n\n

Cette \u00e9tude fran\u00e7aise fait la revue des tests disponibles, en comparant les tests directs (qui d\u00e9tectent la bact\u00e9rie) et les tests indirects (qui d\u00e9tectent les r\u00e9actions du syst\u00e8me immunitaire).<\/p>\n\n\n\n

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Les auteurs ont \u00e9tudi\u00e9 tous les types de tests existants ou en cours de d\u00e9veloppement, agr\u00e9\u00e9s ou non par les autorit\u00e9s sanitaires, en donnant pour chacun les param\u00e8tres essentiels que sont la sensibilit\u00e9 et la sp\u00e9cificit\u00e9. La sensibilit\u00e9 mesure la capacit\u00e9 du test \u00e0 d\u00e9tecter la maladie, et en compl\u00e9ment, la sp\u00e9cificit\u00e9 mesure la capacit\u00e9 \u00e0 d\u00e9tecter les individus non malades. Autrement dit la sensibilit\u00e9 indique la capacit\u00e9 \u00e0 \u00e9viter des \u00ab faux n\u00e9gatifs \u00bb, et la sp\u00e9cificit\u00e9 la capacit\u00e9 \u00e0 \u00e9viter les \u00ab faux positifs \u00bb.<\/p>\n\n\n\n

Ce qu\u2019il faut retenir de cette \u00e9tude, en synth\u00e8se :<\/p>\n\n\n\n

– Quelle que soit la technique utilis\u00e9e, une difficult\u00e9 de diagnostiquer Borrelia tient au fait qu\u2019elle circule peu dans le sang, et plus g\u00e9n\u00e9ralement que sa concentration est faible dans les diff\u00e9rents types de pr\u00e9l\u00e8vements qu\u2019on r\u00e9alise couramment (ponction lombaire, urine, tissus, etc.).
– Parmi toutes les familles de tests pass\u00e9es en revue, aucune n\u2019est dans l\u2019imm\u00e9diat en mesure de s\u2019imposer comme \u00ab\u00a0la\u00a0\u00bb r\u00e9f\u00e9rence absolue, mais plusieurs pistes sont prometteuses \u00e0 moyen terme\u00a0:<\/p>\n\n\n\n

* deux nouveaux tests de la famille des microfluidiques, bas\u00e9s classiquement sur la d\u00e9tection des anticorps anti-Borrelia IgM et IgG, les tests mChip et Luminex, et qui seraient d\u00e9j\u00e0 une am\u00e9lioration sensible dans l\u2019arsenal des tests,
* de nouveaux tests d\u00e9tectant des biomarqueurs, comme ceux ciblant la prot\u00e9ine CXCL13, dans des pr\u00e9l\u00e8vements de liquide c\u00e9phalo spinal (ponction lombaire),
* l\u2019utilisation de la spectroscopie Raman, qui permet d\u2019identifier pr\u00e9cis\u00e9ment dans le sang la pr\u00e9sence d\u2019une infection pass\u00e9e, pr\u00e9sente, active ou non,
* les tests bas\u00e9s sur la d\u00e9tection des virus bact\u00e9riophages anti-Borrelia, comme le test Phelix Phage d\u00e9velopp\u00e9 par le Dr Teuli\u00e8res,
* l\u2019Intelligence Artificielle, appliqu\u00e9e au s\u00e9quen\u00e7age de l\u2019ARN de certaines cellules du syst\u00e8me immunitaire, pour analyser l\u2019expression de certains g\u00e8nes de ces cellules, et permettant ainsi d\u2019\u00e9tablir un diagnostic fiable (personne infect\u00e9e ou non, infection pass\u00e9e ou active, en phase initiale ou tardive, etc.)<\/p>\n\n\n\n

– A l\u2019inverse, plusieurs m\u00e9thodes de test sont plut\u00f4t critiqu\u00e9es\u00a0:<\/p>\n\n\n\n

\u00a0* la culture bact\u00e9rienne de Borrelia est difficile, co\u00fbteuse et tr\u00e8s lente\u00a0(2 \u00e0 3 mois), elle n\u2019est ma\u00eetris\u00e9e que dans quelques laboratoires dans le monde, et ne peut servir qu\u2019\u00e0 des fins de recherche\u00a0; elle ne sera jamais utilis\u00e9e pour faire des diagnostics,
* l\u2019observation au microscope \u00e0 la lumi\u00e8re ou sur fond noir n\u2019est pas consid\u00e9r\u00e9e par les auteurs comme une solution satisfaisante, \u00e0 cause du faible nombre de bact\u00e9ries dans les \u00e9chantillons, et parce que l\u2019interpr\u00e9tation reste trop subjective, selon eux,
* les tests actuels de type Elispot, s\u2019ils sont reconnus comme tr\u00e8s performants du point de vue de leur sensibilit\u00e9 (20 \u00e0 200 fois plus sensibles que les tests type Elisa), mais ils p\u00eachent encore en termes de sp\u00e9cificit\u00e9, donnant lieu \u00e0 des faux positifs,<\/p>\n\n\n\n

Pour conclure, disons que malgr\u00e9 l’innovation de tests nouveaux ou am\u00e9lior\u00e9s, le diagnostic de la maladie de Lyme par les tests biologiques reste un d\u00e9fi.  Il faudra sans doute encore patienter quelques ann\u00e9es pour voir arriver une am\u00e9lioration significative de ce c\u00f4t\u00e9-l\u00e0.<\/p>\n\n\n\n

Et d\u2019ici-l\u00e0, plus que jamais, c\u2019est le diagnostic fond\u00e9 sur la clinique, c\u2019est-\u00e0-dire sur l\u2019examen et les sympt\u00f4mes pr\u00e9sent\u00e9s par le patient, qui doit primer pour la maladie de Lyme et les MVT.<\/p>\n\n\n\n

Pour en savoir plus<\/strong>\u00a0: https:\/\/bmcmicrobiol.biomedcentral.com\/articles\/10.1186\/s12866-023-02935-5<\/a><\/p>\n\n\n\n

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