Paris (AFP)

Several French doctors' societies publish their own "recommendations" on Lyme disease, less than a year after those of the Haute Autorité de Santé, adding to the confusion around the diagnosis and treatment of this complex infection transmitted by ticks.

In particular, these new recommendations address the existence of unexplained persistent symptoms of the disease, recognized by the HAS, and reaffirm the relevance of a two-step diagnosis, using tests challenged by patient associations.

Patients with various "persistent symptoms" attributed to Lyme borreliosis are overwhelmingly referred to as "another diagnosis". It is therefore "recommended not to repeat or prolong the courses of antibiotherapies", judge these experts, in two articles published May 14th and 31st on the site of Medicine and infectious diseases, the journal of the Society of infectious pathology of French language (Spilf).

"In the field, it will cause confusion.The doctors will be lost and it is the patients who will drink," fears Christian Perronne, head of infectious diseases at the Hospital Garches (Hauts-de-Seine).

"It is about + expert opinion + who self-label + recommendations +, but it is not question of recognizing them," said to AFP the one who chairs the scientific college of the French Federation of vector-borne diseases with ticks (FFMVT), collective of doctors and researchers created in 2015 to support the associations of patients.

"La Spilf crowd at the foot" the "official" work of the HAS, also takes away Bertrand Pasquet, president of the association ChroniLyme, who fears that the companies signatories of the text do not diffuse these recommendations to their members and that they 'impose de facto. "It's going to be the law of the strongest."

These new recommendations are supported in particular by the National College of General Teachers (CNGE) and by several learned societies of other specialties (dermatology, rheumatology, neurology ...)

They must be formally presented Friday, during the National days of infectiology in Lyon.

- Potential competition -

Their authors state that the incidence of the disease "has not changed significantly" since 2009, based on the average of new cases confirmed each year.

In detail, according to the figures of the Sentinel surveillance network, the incidence was stable around 26,000 new cases per year between 2009 and 2014, before increasing to 33,200 in 2015 and 54,600 in 2016, then falling back to 44,700 diagnosed cases in 2017, last year available.

Lyme disease is transmitted by the bite of ticks infected with bacteria (borreliosis). If its manifestation may be limited to a characteristic redness around the bite, it causes in some cases disabling and painful disorders, including neurological, articular and muscular.

A rare disease, insist the authors: a patient consulting for "non-specific symptoms such as fatigue, headache, cramps or muscle pain (...) is significantly more likely to suffer from another disease".

Learned societies, however, recommend that doctors take the time to provide "detailed and above all personalized" explanations, and to "avoid abusive and stigmatizing simplifications, which can be understood as" it is in the head ".

It was the Directorate General of Health (Ministry) that asked in September "the development of new practical recommendations", not to "leave health professionals and patients without benchmarks".

The HAS had just published, in June 2018, its recommendations for good practice after two years of consultation in the framework of the "Lyme plan" launched by Marisol Touraine, but the Academy of Medicine and several learned societies whose Spilf had immediately invited professionals to ignore it.

They criticized in particular the recognition by the public authority of a "symptomatic / persistent polymorphic syndrome after a possible tick bite" (SPPT).

If the recommendations of the HAS "do not have sufficient visibility, are not practical enough, and if it is not quibble about the name of a syndrome - SPPT or PTSD - we are taking improvements ", in April its president, Dominique Le Guludec.

It would be "unthinkable that recommendations, potentially competing, coexist in the care" of this disease, said the senator of the Mayenne (UDI) Elisabeth Doineau in an information report at the end of May.

? 2019 AFP