Maladie de Lyme, syndrome autistique et traitement antibiotique : une réflexion à partir d’un cas

RésuméÀ la suite d’un rappel de la définition de l’autisme infantile et de la maladie de Lyme, un cas clinique sera développé. Il s’agit d’un jeune patient avec autisme âgé de 14 ans et demi, caractérisé par un développement initial typique pendant sa première année puis par une dégradation générale de ses aptitudes peu après avoir été atteint de la maladie de Lyme. À la suite d’une présentation sous la forme d’une vignette clinique, nous aborderons l’évolution de la symptomatologie et du comportement de ce jeune pendant un an d’antibiothérapie. Au quotidien, sont rapportées une amélioration des conduites interactionnelles et communicationnelles, de l’expression verbale, du sommeil et une réduction des comportements répétitifs. Cette présentation de cas permettra finalement d’interroger la définition de l’autisme, son étiologie et la validité du diagnostic établi initialement pour ce patient.

Following an overview of the definition of autism and Lyme disease, a clinical case will be presented of a young subject (aged 14 years and a half) diagnosed with autism, and characterized by a typical development in the first year of life, followed by a general deterioration of abilities shortly after diagnosis of the onset of Lyme disease. The subject presented positive reactivity for Mycoplasma Pneumoniae. According to recent studies, misdiagnosis of initial symptoms of Lyme disease and delayed treatment can lead to persistent interactive coinfections in the organism which may result in chronic pathologies. Thus, a link could exist between a chronic infection with Mycoplasma Pneumoniae and an atypical symptomology similar to autism. So the hypothesis proposed is that there may be a correlation between Lyme disease and autism and that long-term antibiotic therapy may be an effective treatment. Following a clinical presentation of the history of this young patient, the evolution of the subject's symptomology and behavior during one year of antibiotic therapy will be described. His cognitive level was evaluated before and during treatment, and assessment showed a marked progress. In daily life, an increase in verbal communicative skills and social interaction, an improvement of sleep and a decrease in the repetitive behaviors were reported. The antibiotic therapy was administered simultaneously to contextual changes, so it was supposed that a medicamentous treatment could only have a favorable and long-term influence on behavior when associated with a regular and adapted educational program. Finally, this case study will allow us to question the definition of autism, its etiology and the validity of the initial diagnosis established for this patient. The present study also raises the following questions: how can the subject's “late entry” in autism be explained? Was the subject misdiagnosed with autism? Did the presented behaviors have an infection-induced cause or, more precisely, is the outbreak of autistic disorders compatible with a post-Lyme disease syndrome? Or else, if it was the case that autism was present from the subject's birth and its emergence was preceded during the first months of life by a set of subtle and discreet disorders (thus not detected by the parents), could it be said that the Lyme disease has simply playing the role of revealing of the autistic syndrome? Further research is required in order to provide evidence that long-term antibiotic therapy could be an appropriate treatment for children co-morbid with Autism Spectrum Disorder and Lyme disease.