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Lyme borreliosis is transmitted en France by the tick Ixodes ricinus, endemic in metropolitan France. In the absence of vaccine licensed for use in humans, primary prevention mostly relies on mechanical protection (clothes covering most parts of the body) that may be completed by chemical protection (repulsives). Secondary prevention relies on early detection of ticks after exposure, and mechanical extraction. There is currently no situation in France when prophylactic antibiotics would be recommended. The incidence of Lyme borreliosis in France, estimated through a network of general practitioners (réseau Sentinelles), and nationwide coding system for hospital stays, has not significantly changed between 2009 and 2017, with a mean incidence estimated at 53 cases/100,000 inhabitants/year, leading to 1.3 hospital admission/100,000 inhabitants/year. Other tick-borne diseases are much more seldom in France: tick-borne encephalitis (around 20 cases/year), spotted-fever rickettsiosis (primarily mediterranean spotted fever, around 10 cases/year), tularemia (50-100 cases/year, of which 20% are transmitted by ticks), human granulocytic anaplasmosis (<10 cases/year), and babesiosis (<5 cases/year). The main circumstances of diagnosis for Lyme borreliosis are cutaneous manifestations (primarily erythema migrans, much more rarely borrelial lymphocytoma and atrophic chronic acrodermatitis), neurological (<15% of cases, mostly meningoradiculitis and cranial nerve palsy, especially facial nerve) and rheumatologic (mostly knee monoarthritis, with recurrences). Cardiac and ophtalmologic manifestations are very rarely encountered., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

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., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Nous prions nos lecteurs de nous en excuser. X. Gocko, C. Lenormand, C. Lemogne, K. Bouiller, J.-F. Gehanno, C. Rabaud, S. Perrot, C. Eldin, T. de Broucker, F. Roblot, J. Toubiana, F. Sella l, F. Vuillemet, C. Sordet, B. Fantin, G. Lina, C. Sobas, B. Jaulhac, J. Figoni,r, C. Chirouze, Y. Hansmann, V. Hentgen, E. Caumes, M. Dieudonné, O. Picone, B. Bodaghi, J.-P. Gangneux, B. Degeilh, H. Partouche, A. Saunier, A. Sotto, A. Raffetin, J.-J. Monsuez, C. Michel, N. Boulanger, P. Cathebras, P. Tattevin*, endorsed by the following scientific societies. 1 Société française de dermatologie (SFD), Société française de rhumatologie (SFR), Fédération française de neurologie (FFN), Société française de neurologie (SFN), Collège national des generalistes enseignants (CNGE), Collège de la médecine générale (CMG), Société nationale française de médecine Interne (SNFMI), Société française de microbiologie (SFM), Collège national des professionnels en psychiatrie - Collège national pour la qualité des soins en psychiatrie (CNPP-CNQSP), Association française de psychiatrie biologique et de neuropsychopharmacologie (AFPBN), Société de psychologie médicale et de psychiatrie de liaison de langue française (SPMPLLF), Société française de médecine du travail (SFMT), Société française de cardiologie (SFC), Société française de pédiatrie (SFP), Groupe de pathologies infectieuses pédiatriques (GPIP), Société française de rhumatologie et médecine interne pédiatrique (SOFREMIP), Société française d'ophtalmologie (SFO), Société française de mycologie médicale (SFMM), Société française de parasitologie (SFP), Collège des universitaires de maladies infectieuses et tropicales (CMIT), Conseil national professionnel - Fédération française d'infectiologie (CNP-FFI), Collège national des gynécologues et obstétriciens français (CNGOF), Société française d'étude et de traitement de la douleur (SFETD), Société de pathologie infectieuse de langue française (SPILF). [Extracted from the article]