Pourquoi le diagnostic de neuroborréliose aiguë reste-t-il difficile ? De la physiopathologie au diagnostic en passant par l'abduction et le théorème de Bayes Why can it be sometimes difficult for clinicians to diagnose acute Lyme Neuroborreliosis ? From physiopathology to diagnosis, via abductive reasoning and Bayes theorem

The diagnosis of acute neuroborreliosis may be difficult if it’s regarded as a " classical " infectious disease. Through a clinical case, we illustrate the difficulties met and we suggest two ways of reflexion to assist in the diagnosis : - firstly, we explain how the comprehension of the behavior of the pathogen agent, which is similar to a parasitic behavior, can help to choose and interpret the results of additional tests ; - secondly, we develop practically the clinical form of Bayes’s theorem to demonstrate the interest of a rational Bayesian and abductive approach which should be preferred to the classical hypothetical and deductive reasoning. Rev Med Brux 2014 ; 35 : 440-4