Lyme diseases: what is it, what causes it, how does it manifest and how to treat it

Hello! I remember how in childhood we scared each other with ticks and the infections that they could carry.

But a couple of months ago, I witnessed a completely comic story. Grandmother Anfisa Petrovna during the picking of berries was bitten by a tick.

At first they thought that it was okay, but after a while she was diagnosed with Lyme disease. There was no time for jokes. Now I will tell you in detail about Lyme disease - what it is and in what cases there is a risk of catching them. Such information should be studied very carefully.

Lyme Disease - Signs and Symptoms of an “Invisible” Disease

In the summer - the time for picnics and walks in nature - the risk of getting Lyme disease increases

The disease is transmitted by ixodid ticks, and, according to annual statistics, Lyme disease incidence rates have increased 25 times compared with 1982.

Lyme disease, which is sometimes called an "invisible" disease, is diagnosed by symptoms, including, but not limited to, the most characteristic symptom of the disease - migrating ring-shaped erythema - pathognomonic skin rash in this disease.

Story

In 1975, a group of children and adults from Lyme in Connecticut, USA, showed similar atypical symptoms of arthritis. By 1977, 51 cases of Lyme arthritis, or Lyme arthritis, as the disease was called at that time, had been diagnosed. The etiology of the disease was considered transmissible and was associated with the bites of the ixodid tick Ixodes scapularis.

In 1982, Willy Burgdorfer (Willy Burgdorfer) identified the causative agent of this infectious disease - it turned out to be Borrelia from the spirochete family, named after the scientist Borrelia burgdorferi.

During a tick bite infected with Borrelia burgdorferi, the pathogen enters the human bloodstream. The corkscrew-shaped form of borrelia allows it to be fixed and implanted in a variety of body tissues, which is the cause of multi-organ and multisystem damage in borreliosis.

It has been established that there are 5 major serotypes of Borrelia burgdorferi, numbering more than 100 different strains in the United States and more than 300 - worldwide. Many of them have resistance to a range of antibacterial drugs.

Serological diagnosis of borreliosis has become available since 1984. More than 10 years later, in 1997.- the first vaccine against Lyme disease appeared, but after 4 years, manufacturers removed the vaccine from the market.

Transmission path

Since many patients with Lyme disease do not mention the fact of a tick bite, some experts believe that Borrelia can be transmitted by other insects - mosquitoes, spiders, fleas and scabies.

Lyme disease acquired during pregnancy can lead to transplacental infection and possible fetal death or stillbirth. However, there were no cases of negative effects of an infectious disease on the fetus when pregnant women followed the prescribed antibacterial therapy.

There are also no data on cases of infection through breast milk. Data were obtained on the ability of Borrelia to remain viable in canned donated blood, and therefore people with Lyme disease are not recommended to donate blood.

Despite the existence of Lyme disease in dogs and cats, there is no evidence of the possibility of direct infection of the hosts from their pets. The most common diagnosis of Lyme disease is based on pathognomonic symptoms and information about possible contact with ticks.

Clinical symptoms and diagnosis

As with other infectious diseases, with Lyme disease, serodiagnosis in the first weeks of the disease is expected to produce negative results. A few weeks after infection, an enzyme-linked immunosorbent assay (ELISA) can detect antibodies to B. burgdorferi.

In the case of a positive ELISA, a Western blot test is used to confirm the diagnosis. The specificity and reliability of these laboratory tests depends on the stage of the disease.

Small hyperemic papules usually appear at the site of the tick bite. Such papules are a normal reaction to a tick bite, and not a specific symptom of Lyme disease.

However, over the next days, the area of ​​hyperemia may increase with the formation of a skin rash pathognomonic for Lyme disease in the form of a ring-shaped migrating erythema - with an external bright red ring surrounding the area of ​​the skin of an unchanged color. The rash in appearance resembles a target.

However, in many patients, the nature of the skin rash does not have a pronounced pathognomonic nature, in some patients rash elements occur in several areas of the skin. Flu-like symptoms such as fever, chills, lethargy, a feeling of aching throughout the body, and headache can accompany skin symptoms.

Within a few weeks, months, or even years after infection, patients may develop meningitis, temporary paralysis of one half of the face (Bell's paralysis), weakness in the limbs, and various impaired motor functions.

A few weeks after the disease, a number of patients develop less typical symptoms, such as:

Clinical Mimicry

Migratory ring-shaped erythema pathognomonic for Lyme disease is absent in more than half of patients, and less than half of patients report a tick bite.According to some reports, this part of patients can be no more than 15%.

At the same time, many patients look completely healthy, they do not reveal antibodies to the pathogen during serodiagnosis. That is why Lyme disease is often called an “invisible” disease.

Treatment

The early use of antibiotic therapy, as a rule, leads to a quick and complete recovery of patients. Most patients treated in the later stages of the disease also respond well to ongoing antibiotic therapy, although they can retain symptoms from the nervous system and joints for a long time.

In 10–20% of patients, symptoms such as weakness, muscle pain, dissomnia, and mental disorders persist even after completing the full course of antibiotic treatment.

According to the recommendations of the Mayo Clinic, USA, oral antibiotic therapy is the standard treatment for Lyme disease in the early stages of the disease. Adults and children over 8 years of age are recommended to take doxycycline, in young children, pregnant women and women who are breastfeeding, they use amoxicillin or cefuroxime.

Parenteral administration of antibiotics is recommended when the central nervous system is involved in the infectious process. This therapy is an effective method of eliminating the infectious agent from the body, although it may take some time to completely eliminate the symptoms of the disease.

In the absence of a vaccine against Lyme disease, the prevention of borreliosis involves the use of specific repellents and the immediate removal of ticks when detected.

Lyme Disease

Lyme disease (tick-borne borreliosis) is an infectious disease that occurs with tick bites. The disease is characterized by symptoms of intoxication and a typical skin rash called erythema migrans.

Causes of occurrence

Lyme disease is caused by bacteria of the genus Borrelia. A person becomes infected through the bite of infected ixodid ticks. With the saliva of an ixodid tick, the pathogen enters the human body.

From the place of introduction, the pathogen penetrates with the flow of blood and lymph into internal organs, lymph formations, and joints. At death, Borrelia secrete endotoxin, which causes a number of immunopathological reactions.

Symptoms of the disease

Usually 1-2 weeks pass from infection to the first manifestations. The first symptoms of the disease are nonspecific: fever, headache, chills, muscle aches, weakness.

A characteristic feature is stiff neck muscles. At the site of the tick bite, annular redness forms (migratory annular erythema). In the first 1–7 days, a macula or papule appears, then within a few days or weeks, erythema expands in all directions.

The edge of redness is intensely red, slightly rises above the skin in the form of a ring, in the center of the redness is somewhat paler. Erythema is round in shape, with a diameter of 10–20 cm (up to 60 cm), localized more often on the legs, less often on the lower back, abdomen, neck, in the axillary, inguinal areas.

In the acute period, symptoms of damage to the soft meninges (nausea, headache, frequent vomiting, photophobia, hyperesthesia, meningeal symptoms) may appear. Muscle and joint pain are often noted. After 1-3 months, stage II may begin, which is characterized by neurological, cardiac symptoms.

For systemic tick-borne borreliosis, a combination of meningitis with cranial nerve neuritis, radiculoneuritis is characteristic. The most common cardiac symptom is atrioventricular block, the development of myocarditis, pericarditis is possible.

Shortness of breath, palpitations, constricting chest pains appear. Stage III is rarely formed (after 0.5–2 years) and is characterized by damage to the joints (chronic Lyme arthritis), skin (atrophic acrodermatitis), and chronic neurological syndrome.

Diagnostics

The diagnosis is made on the basis of an epidemiological history (visiting the forest, tick bite), taking into account the clinical picture (migrating annular erythema). In the blood test - leukocytosis, increased ESR. Biochemical analysis often reveals an increase in the activity of AsAT (aspartate aminotransferase). To confirm the diagnosis, serological studies (RNIF, ELISA, PCR) are performed.

In some cases, false-positive serological reactions are possible in patients with syphilis, infectious mononucleosis, rheumatic diseases and relapsing fever.

In this case, doctors should foresee such circumstances and conduct a competent differential diagnosis to exclude other pathologies that give similar symptoms and laboratory parameters in a blood test.

Types of disease

There are latent and manifest forms of the disease. In the course of the disease, acute, subacute, chronic borreliosis is distinguished.

By severity: severe, moderate, light. Depending on the signs of infection, Lyme disease can be seronegative and seropositive.

According to the clinical course, Lyme disease proceeds in three stages:

• The first stage is the stage of local infection (occurs in erythema and non-erythema form).
• The second stage is the stage of dissemination. It proceeds in a febrile, neurotic, meningeal, cardiac and mixed form.
• The third stage is the stage of persistence. Variants of the course: chronic Lyme arthritis, atrophic acrodermatitis and other forms of the disease.

Patient Actions. If a redness of a round shape is detected at the site of the tick bite, you should immediately consult a doctor and begin treatment.

Treatment

Antibacterial drugs (tetracycline, doxycycline, amoxicillin) are used to treat Lyme disease. If patients have lesions of the nervous system, joints and heart, then they cannot be prescribed tetracycline drugs, since this can lead to complications and / or relapses after a course of therapy. In such cases, penicillin or ceftriaxone is usually used.

With Lyme arthritis, non-steroidal anti-inflammatory drugs (indomethacin, diclofenac, piroxicam, meloxicam, ibuprofen, ketoprofen), analgesics, physiotherapy are used.

To reduce allergic symptoms, desensitizing therapy is used. During the convalescence period, patients are usually prescribed adaptogens, restorative agents, vitamins of groups A, B and C.

In the treatment of Lyme disease, pathogenetic therapy is also important, which depends on the clinical manifestations of the disease and the severity of the treatment. For example, with high fever and severe intoxication of the body, detoxification drugs are prescribed to the patient.

If Lyme disease is accompanied by meningitis, dehydration medications are prescribed. Physiotherapeutic treatment is advisable in cases of damage to the cranial and / or peripheral nerves, neuritis, arthritis and arthralgia.

If there is a violation of cardiac activity, panangin or aspartame preparations are prescribed. In the presence of autoimmune disorders, delagil is prescribed in combination with non-steroidal anti-inflammatory drugs.

As for the prognosis for Lyme disease, it is usually favorable in case of timely and adequate therapy. If treatment is started late, then there is an increased likelihood of progression of the pathology and transition to a relapsing and chronic course.

Persistent residual effects in Lyme disease reduce the patient's ability to work and in some cases can even lead to disability.

After such a dynamic observation, an expert group of doctors draws the appropriate conclusion about the patient’s health status, the absence or chronicity of the infectious process.

Complications

Lyme disease may be accompanied by the following complications:

1. Brain complications. The most serious complications arise when the pathological process spreads to the central nervous system. There is inflammation of the meninges, sometimes damage to the cranial or peripheral nerves.
2. Cardiac complications. The heart muscle suffers, endocarditis and pericarditis may occur.
3. Complications on joints after Lyme disease. In some cases, Lyme disease inflames joints.

Prevention

The use of protective clothing, special chemicals while outdoors. After visiting places of possible localization of ixodid ticks, it is necessary to carefully examine the entire surface of the body.

What is Lyme Disease

Tick-borne Lyme borreliosis (synonyms: Lyme disease, Lyme borreliosis, Ixodes tick-borne borreliosis.) Currently Lyme disease (BL) (Lyme disease - English, la maladie de Lyme - French, Die Lyme-Krankheit - German) is considered as a natural focal, infectious, polysystemic disease with complex pathogenesis, including a complex of immune-mediated reactions.

In 1981, the spirochetal etiology of these manifestations was established, after which it was already possible to talk about the disease as a nosological form with various clinical manifestations.

Until very recently, it was believed that the causative agent of Lyme disease is one single Borrelia - Borrelia burgdoiferi. However, some differences in the protein composition of borrelia isolates from different natural foci initially suggested that Lyme borreliosis is etiologically heterogeneous.

Currently, more than 10 genomic groups belonging to the complex Borrelia burgdorferi sensu lato, which are unevenly distributed throughout the globe, have been isolated.

As for B-japonica found in Japan, it is apparently non-pathogenic for humans.

It should be noted that to date, the pathogenic potential of the VS116 group (B. valaisiana) is also unknown. The results of studies and clinical observations of recent years suggest that the nature of organ lesions in a patient may depend on the type of borrelia.

So, data were obtained on the existence of an association between B. garinii and neurological manifestations, B. burgdorferi s. s. and Lyme arthritis, B. afielii, and chronic atrophic dermatitis.

Therefore, the observed differences in the clinical picture of Lyme disease in patients at various points of the nosoareal of this infection may be based on the genetic heterogeneity of the B. burgdorferi sensu lato complex.

Given all these facts, now under the term "Lyme disease" it is customary to mean a whole group of etiologically independent ixodic tick-borne borreliosis.

Pathogenesis (what is happening) during the Disease

At the stage of accumulating knowledge about borreliosis, given the generality of epidemiology, the similarity of pathogenesis and clinical manifestations, it is quite acceptable to combine them under the general name “tick-borne tick-borne borreliosis” or “Lyme disease”, paying tribute to the first tick-borne tick-borne ixodic borreliosis.

Natural foci of Lyme disease are confined mainly to glued landscapes of the temperate climatic zone. In the USA, the main carriers are pasture ticks fxodes scapularis (old species name /. Dammini), of less importance are /. pacificus, in the Eurasian part of its nosoareal - two widespread species of ixodid ticks: taiga (/. persulcatus) and forest (/. ricinus).

Tick ​​larvae often parasitize on small rodents, nymphs and sexually mature individuals - on many vertebrates, mainly forest animals. A certain epidemiological role belongs to dogs. The natural infection of ticks with borrelia in endemic foci reaches 60%.

The possibility of symbiosis of several types of borrelia in one tick is proved. The simultaneous infection of ixodid ticks with pathogens of tick-borne encephalitis and Lyme disease determines the existence of conjugate natural foci of these two infections, which creates the prerequisites for the simultaneous infection of people and the development of mixed infection.

Human infection occurs in a vector-borne manner. The causative agent is inoculated with a tick bite with its saliva. It is not excluded, but also not completely proven that another way of infection, for example, alimentary (like tick-borne encephalitis).

Primary infections are characterized by spring-summer seasonality, due to the period of tick activity (from April to October). Infection occurs during a visit to the forest, in a number of cities - in forest parks within the city limits. In terms of the incidence rate, this infection occupies one of the first places among all natural focal zoonoses in our country.

When infected, a complex of inflammatory and allergic skin changes usually develops at the site of suction of the tick, manifesting in the form of a specific, characteristic for Lyme disease, erythema.

The local persistence of the pathogen over a certain period of time determines the clinical picture - a relatively satisfactory state of health, a mild syndrome of general intoxication, the absence of other manifestations characteristic of Lyme disease, and the delay in the immune response.

When the pathogen enters various organs and tissues, an active irritation of the immune system occurs, which leads to a generalized and local humoral and cellular hyperimmune response.

At this stage of the disease, the production of IgM antibodies and then IgG occurs in response to the appearance of a 41 kD flag of Borrelia flagellar flagellum. An important immunogen in the pathogenesis are surface proteins Osp C, which are characteristic mainly for European strains.

In the case of disease progression (absence or insufficient treatment), the spectrum of antibodies to spirochete antigens (to polypeptides from 16 to 93 kD) expands, which leads to prolonged production of IgM and IgG. The number of circulating immune complexes is increasing.

Immune complexes can also form in the affected tissues, which activate the main factors of inflammation - the generation of leukotactic stimuli and phagocytosis. A characteristic feature is the presence of lymphoplasmic infiltrates found in the skin, subcutaneous tissue, lymph nodes, spleen, brain, peripheral ganglia.

The cellular immune response is formed as the disease progresses, while the greatest reactivity of mononuclear cells is manifested in target tissues. Increases the level of T-helper and T-suppressors, the index of stimulation of blood lymphocytes. It was established that the degree of change in the cellular component of the immune system depends on the severity of the course of the disease.

The leading role in the pathogenesis of arthritis is played by the liposaccharides that make up borrelia, which stimulate the secretion of interleukin-1 by cells of the monocytic-macrophage series, some T-lymphocytes, B-lymphocytes, etc.

A delayed immune response associated with relatively late and mild borrelemia, the development of autoimmune reactions and the possibility of intracellular persistence of the pathogen are some of the main causes of chronic infection.

Symptoms

The course of Lyme disease is divided into early and late periods. In the early period, stage I of a local infection is distinguished, when the pathogen enters the skin after a tick is sucked, and stage II - dissemination of borrelia into various organs (characterized by a wide range of clinical manifestations resulting from the elimination of spirochetes in different organs and tissues).

The late period (stage III) is determined by the persistence of infection in any organ or tissue (unlike stage II, it manifests itself as a predominant lesion of any one organ or system). The division at the stage is rather arbitrary and applies only to the disease as a whole.

Firstly, it is important in the diagnosis of the disease, secondly, the clinical picture has its own characteristics depending on the presence or absence of erythema at the site of a tick bite and, finally, it shows the peculiarities of the relationship between macro- and microorganisms.

At the stage of dissemination of the pathogen, which is characterized by a polymorphism of clinical manifestations, it is still possible to identify the prevailing group of symptoms that determine the variant of the clinical course: febrile, neuritic, meningeal, cardiac, mixed.

The identification of the course and the severity of the clinical syndrome help determine the severity of the pathological process: mild, moderate, severe and extremely severe (rarely) forms.

The disease usually begins subacute with the appearance of soreness, itching, swelling and redness at the site of suction of the flare. Patients complain of moderate headache, general weakness, malaise, nausea, constriction and impaired sensation in the area of ​​a flare bite.

At the same time, characteristic skin erythema appears (up to 70% of patients).Body temperature rises more often to 38 ° C, sometimes accompanied by chills. The febrile period lasts 2-7 days, after a decrease in body temperature, subfebrile temperature is sometimes observed for several days.

Migratory erythema - the main clinical marker of the disease - appears after 3-32 days (on average 7) in the form of a red macula or papule at the site of a tick bite.

The area of ​​redness around the bite site expands, delimiting from unaffected skin with a bright red border; in the center of the lesion, the intensity of the changes is less pronounced. The size of erythema can be from a few centimeters to tens (3-70 cm), however, the severity of the disease is not related to their size.

the site of the initial lesion, intense erythema is sometimes observed, vesicle and necrosis appear (primary affect). The intensity of color, spreading skin lesions is uniform throughout; within the outer border several red rings may appear, the central part of which fades with time. In place of the former erythema, often increased pigmentation and peeling of the skin.

In some patients, the manifestations of the disease are limited to skin lesions at the site of the tick bite and mild general symptoms, in some patients, apparently, hematogenous and lymphogenous borrelia can spread to other areas of the skin, secondary erythema occurs, but unlike the main one, there is no primary affect.

Other skin symptoms may appear: a rash on the face, urticaria, transient punctate and small annular rashes, conjunctivitis.

Generalized lymphadenopathy, sore throat, dry cough, conjunctivitis, testicular edema are less common. The first symptoms of the disease usually subside and completely disappear within a few days (weeks) even without treatment.

Stage II is associated with dissemination of Borrelia from the primary focus to various organs. With non-erythema forms, the disease often manifests itself with manifestations characteristic of this stage of the disease and is more severe than in patients with erythema.

Signs indicating a possible damage to the meninges may appear early, when skin erythema still persists, but at this time they are usually not accompanied by an inflammatory changes syndrome of cerebrospinal fluid.

During this period, it is advisable to distinguish syndromes of serous meningitis, meningo-encephalitis and syndromes of damage to the peripheral nervous system: sensory, mainly algic syndrome in the form of myalgia, neuralgia, plexalgia, radiculoalgni; amyotrophic syndrome due to limited segmental radiculoneuritis, isolated facial neuritis, mononeuritis, regional to the site of tick suction, common polyradiculoneuritis (Bannwart syndrome), myelitis; sometimes it is possible to distinguish paralytic syndrome of damage to the peripheral nervous system, but, as a rule, it is not isolated.

Within a few weeks from the moment of infection, signs of heart damage may appear. More often it is an atrioventricular block (1 or II degree, sometimes complete), intraventricular conduction disturbances, rhythm disturbances. In some cases, more diffuse heart lesions develop, including myopericarditis, dilated myocardiopathy, or pancreatitis.

In stage III, in the period from several months to several years from the onset of the disease, late manifestations of Lyme disease may appear. Recurrent oligoarthritis of large joints is typical, however small joints may be affected. A biopsy of the synovial membrane reveals deposits of fibrin, villus hypertrophy, vascular proliferation and severe plasmocytic and lymphocytic infiltration.

The number of leukocytes in the synovial fluid ranges from 500 to 000 in 1 mm. Most of them are segmented. Often there is an increased content of protein (from 3 to 8 g / l) and glucose.

Lyme arthritis is similar to reactive arthritis in its course. Over time, changes typical of chronic inflammation are noted in the joints: osteoporosis, thinning and loss of cartilage, cortical and marginal usuras, sometimes degenerative changes: subarticular sclerosis, osteophytosis.

Late lesions of the nervous system are manifested by chronic encephalomyelitis, spastic paraparesis, ataxia, erased memory disorders, chronic axonal radiculopathy, dementia. Often there is polyneuropathy with radicular pain or distal parasthesia.

Patients note headache, increased fatigue, hearing loss. Children have a slowdown in growth and sexual development. Skin lesions in stage III are manifested in the form of common dermatitis, atrophic acrodermatitis, and scleroderma-like changes.

Complications of Lyme borreliosis are very rare and more often manifest as residual phenomena.

Diagnostics

The diagnosis of Lyme disease is difficult especially in the late period due to pronounced clinical polymorphism and the frequent absence of typical manifestations of the disease.

Borrelia cultures from a sick person are difficult to distinguish. Serological methods are widely used to confirm the diagnosis. In our country, the indirect immunofluorescence reaction (n-RIF) and the reaction with enzyme-labeled antibodies (ELISA) are used to detect antibodies to borrelia.

However, there are seronegative variants of the course of the disease. Often false-positive results are observed with syphilis. Possible infection can be judged by the detection of borrelia in the intestinal preparations of a sucking tick using dark-field microscopy.

Borrelia can be detected in affected organs and tissues by electron microscopy, special silver staining and monoclonal anti-borreliosis antibodies. A promising method of polymerization of chains (polimerase chain reaction - PCR), the use of which allows you to confirm the diagnosis with a small number of microbial bodies in the body.

Differential diagnosis is carried out with tick-borne encephalitis, a group of serous meningitis and meningoencephalitis, reactive and rheumatoid arthritis, acute rheumatism, neuritis, radiculoneuritis, heart diseases with conduction and rhythm disturbances, myocarditis, dermatitis of various etiologies.

Treatment

The treatment of Lyme disease includes a set of therapeutic measures in which etiotropic therapy plays a leading role.Medicines are prescribed orally or parenterally, depending on the clinical picture and the period of the disease.

Of the oral preparations, tetracycline antibiotics are preferred. The drugs are prescribed in the first period of the disease in the presence of erythema at the site of tick suction, fever and symptoms of general intoxication, provided there are no signs of damage to the nervous system, heart, joints.

You can not reduce a single dose of the drug and reduce the frequency of taking medications, since in order to obtain a therapeutic effect, it is necessary to constantly maintain a sufficient bacteriostatic concentration of the antibiotic in the patient's body.

If patients show signs of damage to the nervous system, heart, joints (in patients with acute and subacute course), it is not advisable to prescribe tetracycline drugs, since in some patients relapses occurred after the course of treatment, late complications, the disease acquired a chronic course.

When detecting neurological, cardiac and articular lesions, penicillin or ceftriaxone is usually used. In contrast to the recommended penicillin therapy regimens, we specified a single dose of the drug, the frequency of its administration and the duration of the course of treatment.

Benzylpenicillin (penicillin G) is prescribed 500 thousand units intramuscularly 8 times a day (with an interval strictly after 3 hours). The course lasts 14 days. For patients with clinical signs of meningitis (meningoencephalitis), a single dose of penicillin increases to 2-3 million units depending on body weight and decreases to 500 thousand units after normalization of cerebrospinal fluid.

Repeated administration of penicillin maintains a constant bactericidal concentration of it in the blood and affected tissues. A similar penicillin therapy regimen has been tested and successfully used in the treatment of syphilis, the pathogenesis of which is largely similar to the pathogenesis of Lyme disease.

Thus, a similar mechanism of early damage to the central nervous system in these infections is noted, common features of immunological processes and the similarity of pathogens of both infections.

Currently, the most effective drug for the treatment of Lyme disease is ceftriaxone (longacef, rocefin), in a daily dose of 1-2 g. Course duration 14-21 days.

In a chronic course with isolated skin lesions, positive results can be obtained from the treatment of tetracycline antibiotics.

In cases of mixed infection (Lyme disease and tick-borne encephalitis), anti-tick-borne gamma globulin is used along with antibiotics.

Preventive treatment of victims of a bite of a tick infected with borrelia (examine the contents of the intestines and hemolymph of the tick by dark field microscopy) is carried out with tetracycline 0.5 g 4 times a day for 5 days.

Along with antibiotic therapy, pathogenetic treatment is also used. It depends on the clinical manifestations and severity of the course.So, with high fever, severe intoxication, detoxification solutions are given parenterally, with meningitis - dehydration agents, with neuritis of the cranial and peripheral nerves, arthralgia and arthritis - physiotherapeutic treatment.

Patients with signs of heart damage are prescribed panangin or aspark 0.5 g 3 times a day, riboxin 0.2 g 4 times a day. In cases of detection of immunodeficiency, thymalin is prescribed at 10-30 mg per day for 10-15 days.

In patients with signs of autoimmune manifestations, for example, often recurring arthritis, delagil is prescribed at 0.25 g once a day in combination with non-steroidal anti-inflammatory drugs (indomethacin, methindole, brufen, etc.). The course of treatment is 1-2 months.

Those who have been ill are subject to dynamic medical observation during the year (examination by an infectious disease specialist, therapist, neuropathologist, staging an indirect immunofluorescence reaction every 3 months), after which it is concluded that the infection is absent or chronic.

Prevention

Specific prophylaxis of Lyme disease has not yet been developed. Non-specific preventive measures are similar to those for tick-borne encephalitis. A very effective way to prevent infection is to prevent the suction of ticks (the use of protective clothing and deterrents).

Symptoms and treatment of Lyme disease

Lyme disease is a vector-borne disease caused by bacteria of the genus Borrelia. It is difficult to give an exhaustive answer about the prevalence of the disease. Lyme disease is referred to in the medical literature as the “great mimic”.

This name is due to the fact that the disease is accompanied by a polymorphism of symptoms, and patients turn to a dermatologist, neuropathologist, rheumatologist and rarely get to the infectious diseases office.

Lyme disease is reported in Europe, North America, Asia, Australia. There is a tendency towards an increase in the incidence rate in Russia and Ukraine. The susceptibility to Borrelia in humans is high. So, such famous personalities as Ben Stiller, Christy Turlington, Richard Gere, Avril Lavigne, Ashley Olsen suffered from Lyme disease.

Causes

The causative agent of the disease is bacteria of the genus Borrelia (B.burgdorferi, B. afzelii, garinii), belonging to the family Spirochaetaceae. Ixodid ticks (I.ricinus, I.pacificus, I.damini) are the carrier of Borrelia.

An infected tick is infectious at any active stage of its life cycle: at the stage of a larva, nymph or sexually mature individual.

The rise in the incidence of Lyme disease is noted in the spring-autumn period, which, of course, is associated with the high activity of ticks in this season. Ixodid ticks live in forests, forest-park urban areas.

Symptoms

The incubation period averages one to two weeks, but can increase even up to a year. In the clinical picture of Lyme disease, it is customary to distinguish three stages. But it is worth noting that not all cases of an infected person develop all three stages. So, in some patients the disease ends in the first stage, in others it becomes pronounced only in the third stage.

First stage symptoms. A papule (nodule) appears at the site of the tick bite.Gradually, the redness area expands along the periphery. The edges of erythema are intensely red, slightly rising above the skin. In the center of erythema, the skin is paler.

The size of erythema in diameter is 10-50 cm. Often, erythema is localized on the lower extremities, abdomen, lower back, neck, axillary region and groin. The skin in the area of ​​erythema is warmer in comparison with healthy areas of the skin. Sometimes itching, burning in the bite. The stain persists for several days, then gradually turns pale, leaving pigmentation and peeling.

In some patients, benign lymphocytoma appears - a moderately painful red seal on the swollen skin. Most often, the lymphocytoma is localized in the area of ​​the earlobes, nipples, face, genitals.

Borrelia from the primary lesion site spreads through the lymphatic vessels to the regional lymph nodes. So, lymphadenopathy can be observed. In addition, an infected person may complain of weakness, muscle and headaches, fever.

Symptoms of the second stage. Borrelia disseminate to organs and tissues. So, secondary erythema, roseolous or papular rash, new lymphocytomas can form on the skin.

Generalization of the infectious process is accompanied by headache, muscle pain, nausea (less often vomiting), in some cases, an increase in temperature.

For this stage, the following syndromes are characteristic:

• Meningeal;
• Neurological;
• Cardiological.

More often, signs of the second stage occur in the fourth or fifth week and persist for several months.

Meningeal syndrome is a consequence of serous meningitis. This condition is characterized by fever, severe headache, pain when looking up, vomiting that does not bring relief, sensitivity to light, sound stimuli.

Stiff neck and other typical meningeal signs are recorded. A person can also develop encephalitis or encephalomyelitis, occurring with paraparesis or tetraparesis. Possible neuritis of the cranial nerves, more often auditory and oculomotor.

Patients may experience sleep disturbances, emotional lability, anxiety, and short-term visual and hearing impairments.

Lyme disease is characterized by Bannavart lymphocytic meningoradiculoneuritis, characterized by the development of cervicothoracic radiculitis, meningitis with lymphocytic pleocytosis.

Cardiac syndrome often forms in the fifth week of the disease and is manifested by a violation of atrioventricular conduction, slowing or increasing heart rate, signs of myocarditis or pericarditis. It is worth noting that heart damage is less common than the nervous system. In addition, conjunctivitis, iritis, tonsillitis, pharyngitis, bronchitis, hepatitis, splenitis can be observed.

Symptoms of the third stage. Symptoms of this stage arise quite late: after a few months, and sometimes years after infection. The most characteristic lesions of the joints (60% of patients), skin, heart and nervous system.

In Lyme disease, mainly large joints (ulnar, knee) are affected. The affected joints are swollen and painful, there is a restriction of movements.The symmetry of joint damage is characteristic, the process has a relapsing character. A prolonged inflammatory process in the joints and cartilage leads to destructive changes in them.

Chronic neurological lesions occur in the form of:

Skin manifestations are characterized by the development of acrodermatitis. This is skin atrophy with local hyperpigmentation, often the process is localized on the limbs.

Diagnostics

The diagnosis of Lyme disease is made taking into account the data of the epidemic history (visiting the forest, tick bite), as well as the clinical picture. It is worth noting that many people do not even notice a tick bite at one time.

Using PCR, laboratory assistants can determine the DNA of borrelia in a biopsy of the skin, cerebrospinal and synovial fluids, and blood. PCR avoids false results.

Treatment

In the treatment of patients with Lyme disease, etiotropic and pathogenetic therapy is used. It is also important to consider the stage of the disease.

Etiotropic treatment is carried out using various antibiotics. So, at the first stage of the disease, in the presence of erythema and without damage to internal organs, tetracyclines, aminopenicillins are prescribed orally. Antibacterial therapy, begun in the first stage of the disease, will prevent the further progression of Lyme disease.

Pathogenetic therapy is based on existing concomitant lesions of internal organs. So, with heart damage, with disorders that are not eliminated by taking antibiotics, prolonged meningitis, meningoencephalitis, corticosteroids are prescribed.

With arthritis, corticosteroids are prescribed not only intramuscularly or orally, but also intraarticularly. With monoarthritis and the absence of the effect of drug treatment, synovectomy is indicated.

With high fever, severe intoxication, detoxification agents are parenterally administered.

Prevention

When visiting a forest area (park area), general prevention comes down to the use of repellents, wearing clothes that cover the body as much as possible. In the case of a tick bite, you should immediately contact the clinic, where it will be removed correctly, they will examine the place of the bite and provide further monitoring of your health condition.

If a person is often in their own summer cottage, it will not be amiss to make acaricidal measures. After walking with the dog, you should carefully examine the pet for a tick on the body.

After a tick bite in an endemic region, prolonged-acting antibiotics are prescribed as emergency prophylaxis (for example, bicillin-5 once intramuscularly at a dosage of 1,500 thousand units).

LYME: first signs, treatment, prognosis and consequences

Lyme disease (tick-borne borreliosis) is an infectious naturally focal vector-borne disease caused by spirochetes and transmitted by ticks and has a tendency to relapse and chronic course and predominantly affect the skin, nervous system, heart and musculoskeletal system.

The reservoir and source of the pathological process are many species of domestic and wild birds and vertebrates (rodents, moose, white-tailed deer, etc.) More than two hundred species of wild animals are tick-feeders.

The main mechanism of Lyme disease transmission is transmission (via blood). In rare cases, pathogens enter the body when consuming raw milk (goat), with saliva through tick bites, feces (when rubbed during combing at the site of the bite).

Immunity after this disease is unstable, a couple of years after recovery, re-infection is possible. Risk factors for infection can be called a stay in mixed forests (tick habitat), from May to the end of September.

Symptoms and signs

The course of this disease is divided into early and late periods. The first of them includes the first stage of local infection. During this period, the pathogen enters the skin after a tick bite. Borrelia then spreads to various organs, so symptoms of multiple organ damage are typical at this stage.

The division into such stages is conditional and acceptable only to the disease as a whole. Sometimes staging may not be observed, in some cases only the first stage may be present, and sometimes Lyme disease is manifested only by late symptoms.

In the early period, the non-erythema and erythema form is distinguished. This is important for the diagnosis of this disease, in addition, the clinical picture has certain features, depending on the presence or absence of erythema at the site of a bite of borrelia.

At the stage of spread of the pathogen, which is characterized by a multiplicity of clinical manifestations, one can distinguish the dominant symptoms that determine the course of the disease:

The severity and variant of the course of Lyme disease helps to determine the severity of the pathological process:

1. easy
2. average
3. severe degree
4. in rare cases, extremely severe form.

The incubation period of this disease ranges from one to twenty days. Its reliability is determined by the accuracy of establishing the fact of tick suction. About thirty percent of patients do not remember him or deny the fact of a bite.

At present, specific erythema of the skin appears (up to seventy percent of patients). Body temperature rises to subfebrile numbers, sometimes chills may appear. The duration of the febrile period is up to one week.

The main clinical sign of Lyme disease is erythema migrans. It appears after three to thirty two days (an average of seven days) in the form of a red papule or macula at the site of a direct tick bite. The redness area around this area is gradually expanding, limited to healthy skin with a bright red border.

In the center of the lesion, a lesser degree of severity of changes is observed. The size of erythema can vary from a few centimeters to seventy millimeters, however, the severity of the disease does not depend on their size.

At the site of the initial lesion, in some cases, intense erythema can be observed, while a vesicle and a focus of necrosis appear.The intensity of staining of the spreading pathological focus is uniform throughout its length, several red rings may be noted within the outer borders. Over time, their central part fades.

At the location of the former erythema, pigmentation, as well as peeling of the skin, can often persist. In some patients, the manifestations of this disease can be limited to skin lesions in the immediate place of the tick bite, while the general symptoms are mild.

Sometimes borrelia spreads to other areas of the skin, with secondary erythema occurring. Other skin symptoms include urticaria, a rash on the face, transient small and pinpoint rashes of a ring-shaped form, conjunctivitis.

Erythema with Lyme disease can sometimes be similar to erysipelas, the presence of regional lymphadenitis can mask as tularemia and typhus. Skin symptoms in most cases are supplemented by stiff neck muscles, headaches, chills, fever, migratory pains in the bones and muscles, arthralgia, severe fatigue and weakness.

The second stage of Lyme disease is characterized by the spread of borrelia from the primary focus to various organs. The non-erythema form of the disease is characterized by a greater severity of clinical symptoms. Quite early signs may appear that indicate damage to the meninges.

At this time, erythema of the skin may still persist. However, in this case, inflammatory changes in the cerebrospinal fluid are still absent. Within a few weeks or months from the onset of the disease, fifteen percent of patients have obvious symptoms of damage to the nervous system.

During this period, syndromes of serous meningitis, meningo-encephalitis, as well as lesions of the peripheral nervous system are distinguished: myalgia, plexalgia, neuralgia, amyotrophic syndrome, isolated facial neuritis. Signs of heart damage usually develop within a few weeks of the onset of the disease.

These include recurrent oligoarthritis of large joints. During a biopsy of the synovial membrane, fibrin deposits, villous hypertrophy, and vascular proliferation are detected.

Among the late lesions of the nervous system, chronic encephalomyelitis, spastic paraparesis, ataxia, erased memory disorders, dementia, chronic axonal radiculopathy can be noted.

Patients report increased fatigue, headache, hearing impairment. Children have a delay in sexual development and growth. At the third stage, lesions of the skin appear in the form of a common form of dermatitis, scleroderma-like changes and atrophic acrodermatitis.

Diagnostics

Diagnosis of Lyme disease is difficult, especially in the later stages of the disease due to the multiplicity of clinical lesions and the frequent absence of typical symptoms. It is based on epidemiological data, the clinical picture and is confirmed by the results of serological studies.

A reliable diagnosis can be considered in the case when a history of erythema migrans was noted - a marker of this pathological process.

The chain polymerization method is also effective, the use of which confirms the diagnosis with a minimum number of microbes in the body.

Non-specific changes are noted in the peripheral blood; they mainly reflect the degree of inflammatory changes.

Treatment

Lyme disease is treated at the infectious diseases hospital. In the first stage, antibiotic therapy is indicated for two to three weeks. The drugs of choice are doxycycline, amoxicillin, the antibiotic of the reserve - ceftriaxone.

However, against the background of such treatment, allergic reactions (intoxication due to the mass death of pathogens, fever) may be noted. In this case, antibacterial drugs are canceled, and then their intake is resumed in smaller doses.

In the second stage of this disease, antibiotic therapy is carried out for three to four weeks. If there are no changes in the cerebrospinal fluid, then amoxicillin and doxycycline are indicated. In the presence of such changes, cefotaxime, ceftriaxone or benzylpenicillin is used.

In the third stage of Lyme disease, antibacterial therapy with amoxicycline or doxycycline is also prescribed. The minimum treatment period is four weeks. In the absence of effect, ceftriaxone, cefotaxime or benzylpenicillin is indicated.

Consequences and forecast

Early use of antibacterial agents can significantly reduce the duration of therapy and prevent the development of the third stage of the disease.

In Lyme disease, complications are rare, often they manifest as residual (residual) phenomena.

Prevention

Currently, specific methods for the specific prevention of this disease have not been developed. Non-specific measures include the use of deterrents and special protective clothing, the restriction of the use of raw milk.