Hello friends! Insect bites are traditionally associated with unpleasant sensations: itching, burning, irritation on the skin ...
However, it is important to remember that this is not the only danger emanating from them. For example, the same ticks (although, strictly speaking, they are not insects) can carry dangerous infections.
One of the most common in Russia is tick-borne borreliosis, although not everyone knows what it is. Ticks are most often associated with encephalitis, it is important to know about borreliosis and its symptoms even to those who rarely go on forest walks. All the details are below!
The content of the article:
Tick-borne borreliosis (lime disease)
Tick-borne borreliosis (Lyme disease) is an infectious vector-borne natural focal disease caused by spirochetes and transmitted by ticks.
Lyme disease has a tendency to chronic and recurrent course and predominant damage to the skin, nervous system, musculoskeletal system and heart.
The incidence of Lyme disease in Russia is 1.7-3.5 per 100 thousand of the population. The fact that Lyme disease became widely known and received an independent status only relatively recently - since the mid-70s.
It is largely due to environmental changes caused by anthropogenic impacts, which led to the expansion of the distribution and growth of the number of ticks and the emergence of new foci.
The reduction of arable land, the development of landscaping, the increase in suburban construction led to a mosaic spread of forests, and therefore to the creation of ideal conditions for the existence of ticks.
Whereas previously foci of natural focal infections from vectors occurred mainly in forests and in rural areas, now there is a real threat to the urban population.
You can get Lyme disease at any age. Adult ixodid ticks infect humans with a bite. Moreover, the incidence of Lyme disease is much higher than tick-borne encephalitis.
Lyme disease is dangerous because it gives chronic forms much more often than tick-borne encephalitis. Adults and older people get sick more severely, due to the presence of concomitant chronic pathology. Fatal cases from Lyme disease have not yet been reported.
The cause of tick borreliosis
Pathogens of tick-borne borreliosis are spirochetes of the genus Borrelia. The causative agent is closely associated with ixodid ticks and their natural hosts.
The common vector for tick-borne ixodic borreliosis and tick-borne encephalitis viruses causes ticks, and therefore in patients, cases of mixed infection.
Leningrad, Tver, Yaroslavl, Kostroma, Kaliningrad, Perm, Tyumen regions, as well as the Ural, West Siberian and Far Eastern regions for tick-borne tick-borne borreliosis are considered very endemic.
In Adygea, the main custodians and carriers of borrelia are ixodid ticks. Tick infestation by Lyme disease pathogens - in different natural foci can vary over a wide range (from 5-10 to 70-90%).
Lyme disease development process
Tick borreliosis infection occurs when bitten by an infected tick. Borrelia with tick saliva enter the skin and multiply for several days, after which they spread to other areas of the skin and internal organs.
Borrelia for a long time (years) can persist in the human body, causing a chronic and relapsing course of the disease.
The chronic course of the disease can develop after a long period of time. The process of developing a disease with borreliosis is similar to the process of developing syphilis.
Signs of Lyme Disease
The incubation period of tick-borne borreliosis is from 2 to 30 days, on average - 2 weeks. A characteristic sign of the onset of the disease is the appearance of redness of the skin at the site of the bite with a tick.
Over time, the central part of the spot fades or acquires a bluish tint, a ring shape is created. In the place of the tick bite, in the center of the spot, a crust is determined, then a scar.
The stain without treatment persists for 2-3 weeks, then disappears. After 1-1.5 months, signs of damage to the nervous system, heart, and joints develop.
Lyme Disease Recognition
The appearance of a red spot at the site of a tick bite gives reason to think about Lyme disease. A blood test is performed to confirm the diagnosis.
Treatment of tick-borne borreliosis should be carried out in an infectious diseases hospital where therapy aimed at the destruction of borrelia is carried out.
Without such treatment, the disease progresses, becomes chronic, and in some cases leads to disability due to damage to the nervous system and joints.
The prognosis for life is favorable.
Those who are ill are under medical supervision for 2 years and are examined after 3, 6, 12 months and after 2 years.
Lyme Disease Prevention
Of key importance in the prevention of Lyme disease is the fight against ticks, which use both indirect measures (protective) and their direct extermination in nature.
Protection in endemic foci can be achieved with the help of special anti-mite suits. Having dressed properly, you can also protect yourself from tick bites, preventing them from "getting to the body."
Ticks usually wait for the victim, sitting on the grass or branch of the bush, and very rarely rise to a height above half a meter. Therefore, they usually cling to the legs of a person and then "crawl" up in search of a convenient place for a bite and suction.
When in tick habitats, avoid dark colors in clothing, as ticks are harder to spot against a dark background. Tuck outerwear into trousers, the latter into socks and boots. If there is no hood, put on a hat. It is advisable to hide long hair under a hat.
Perform a routine inspection of your clothes, inspect the head and body, especially above the waist, ticks most often stick in there.
Ticks are always more on the trails, so it is easier for them to find a victim. Therefore, you should not rest, "falling" on the grass a meter from the trail. On sunny, dry glades of ticks less than in the shade.
For most species of ticks, human housing is not suitable for comfortable living and procreation, however, for a long enough time, ticks that are in the room can be dangerous and, if necessary, attack a person.
In the event that the ticks are in the room, you should remove the carpets from the floor, conduct a thorough cleaning using a vacuum cleaner.
If you find a tick that has already stuck in your skin:
- In no case do not pull it yourself, as you can tear the body away from the head (the head can exist without the body).
- To remove the tick, it is necessary to fill it with camphor or vegetable oil, after 10-15 minutes, carefully remove the tick with tweezers.
- Grease the bite site with brilliant green or iodine.
- After you have removed the tick, you should come to the bacteriological laboratory as soon as possible to examine it for the presence of borrelia.
Tick-borne borreliosis disease
Tick-borne encephalitis - a dangerous viral disease that affects the central nervous system - hardly needs to be introduced, especially in connection with the recent surge in incidence.
In Russia, borreliosis was first serologically detected (i.e., based on the presence of specific antibodies) by employees of the Research Institute of Epidemiology and Microbiology named after N.F. Gamalei RAMS under the leadership of E.I. Korenberg in 1985
But only in 1991, ixodic tick-borne borreliosis (IKB) were included in the official state list of diseases registered in Russia.
The most common this disease is recognized in the United States: more than 16 thousand people get sick there annually. An increase in the incidence of borreliosis is currently observed in many European countries.
Pathogen - spirochete
Already from the name itself it is clear that ticks are the carriers of this disease, as well as tick-borne encephalitis. In the United States, Lyme disease is transmitted by Ixodes scapularis ticks. In Europe, this function is performed by Ixodes ricinus ticks, and in our case, by the infamous taiga ticks Ixodes persulcatus.
The causative agent of borreliosis - the spirochete of the complex under the magnificent Latin name Borrelia burgdorferi sensu lato (s. L.) - is closely related to treponema, the causative agent of the well-known syphilis, and leptospira, the causative agent of leptospirosis, a serious disease that affects many animal species, including humans.
However, recently there have been reports that another species, B. spielmanii, was isolated from patients with IKB, which indicates the possible pathogenicity of this species.
Borrelia is distributed unevenly across regions of the world. In Russia, two species, B. afzelii and B. garinii, are found in the vast forest zone from the Baltic to southern Sakhalin.
The study of borrelia was started at the Institute of Chemical Biology and Fundamental Medicine in 2000. Studies conducted jointly with the Institute for Animal Systematics and Ecology of the SB RAS aimed at revealing the species diversity of borrelia circulating in the natural foci of the Siberian Branch of the Novosibirsk Region, made it possible to establish a number of facts.
In addition to the widespread B. afzelii and B. garinii, rare genetic variants of these species were found.
According to light microscopy, the infection of taiga ticks with borrelia in the territory of the Novosibirsk Region is 12-25%.
Microscopic examination of fixed and vital preparations of Borrelia revealed both adult ticks collected from plants and partially or fully saturated larvae and nymphs.
Since these spirochetes were found at all stages of tick development - from larvae to adult individuals (adults), all of them can serve as sources of infection. The pathogen transfer cycle begins with the process of feeding a non-infectious tick on an infected animal.
The mites infected with borrelia at the next feeding are able to transmit these microorganisms to healthy animals, and also continue to perceive an additional “portion” of spirochetes from infected mammals.
In the early stages of tick development, small mammals are involved in this process; adult ticks begin to feed on large mammals, and in addition, they can "encroach" on humans, infecting them.
Having penetrated the body of a mammal along with tick saliva, spirochetes begin to multiply intensively in the skin at the site of the bite.
They can not only move under the skin, but also penetrate into the blood vessels, moving with the flow of blood to the internal organs.
The blood-brain barrier is not an obstacle for them either: when they multiply in the cerebrospinal fluid, Borrelia causes severe neuroinfections.
The first stage is reversible
Tick-borne tick-borne borreliosis is a polysystemic disease in which skin, musculoskeletal, nervous and cardiovascular systems are affected.
The nature of the clinical manifestations of the disease depends on its stage. Three stages of borreliosis infection are conventionally distinguished. The disease, as a rule, develops sequentially, passing from one stage to another.
It begins with a small spot at the site of suction of the tick, which gradually migrates to the periphery. In typical cases, the center of the spot brightens, and the peripheral areas form a bright red roller in the form of an irregularly shaped ring with a diameter of up to 15 cm.
Studies of skin samples taken from different sites of erythema indicate that in the center of the erythema ring Borrelia is practically absent, but, as a rule, they are always found on the periphery.
Compared with other inflammatory changes, erythema can persist on the skin for a sufficiently long period of time.
In about a quarter of patients, skin manifestations of the disease are accompanied by symptoms such as chills, drowsiness, muscle weakness, joint pain and swollen lymph nodes.
In addition, there is the so-called non-erythema form, which, as a rule, begins acutely and is complicated by fever, joint pain and headache.
It should also be noted that the absence of symptoms of the disease in the first time after a tick bite does not exclude the development of the disease in the future. With timely treatment at the first stage of the disease, a complete recovery is possible.
The second stage of borreliosis develops on average 1-3 months after infection. By this time, borrelia with blood and lymph flow enter various organs and tissues, such as muscles, joints, myocardium, spinal cord and brain, as well as the spleen, liver, retina, and affect them.
That is why this stage is characterized by such a significant variety of clinical manifestations of the disease: neurological, cardiac, skin, etc.
Signs of damage to the nervous system are manifested in the form of meningitis, mono- and polyneuritis, very often - facial neuritis, etc. Many of these symptoms can be observed simultaneously.
Finally, the third stage of borreliosis develops in six months - a year after infection penetrates the body. Most often, joints, skin and chronic lesions of the nervous system are found.
Treatment of the late stage of borreliosis requires a long course of antibacterial therapy, however, subsequently, in some patients with arthritis, signs of chronic infection are observed for months or even several years after a course of antibiotic treatment.
Immune response
As a rule, several pathogenic mechanisms are involved in the development of borreliosis infection. Some syndromes, such as meningitis and sciatica, probably reflect the result of a direct organ infection, but arthritis and polyneuritis may be associated with indirect effects caused by a secondary autoimmune response.
The body's immune response to borreliosis infection manifests itself in different ways. To control the spread of infection, the body uses both an innate (non-specific resistance) and an adaptive specific immune response, i.e., the production of specific antibodies against an infectious agent.
In the first two weeks after the onset of the disease, most patients actually show immunoglobulins against certain borrelia antigens - infectious proteins that trigger the body's immune response mechanism.
Back in the 90s. of the last century, the first studies were conducted in the United States aimed at developing an anti-borreliosis vaccine. But to date, an effective vaccine that protects against this dangerous disease does not exist.
Probably, difficulties in obtaining safe vaccines are related to the peculiarities of the immune response observed in borreliosis infection.
It can initiate the production of antibodies against some of the body's own proteins, i.e., cause dangerous autoimmune reactions.
The reason for this immune response is molecular mimicry, a similarity that is produced by our T cells in the synovial membrane lining the inner surfaces of the joints.
Thus, the complications arising after vaccination with the OspA lipoprotein vaccine were in most cases manifested in the form of arthritis and autoimmune rheumatoid arthritis. Work to create an acceptable, harmless and at the same time effective vaccine is still ongoing.
How to diagnose ICD
Diagnosis of UTI is usually carried out on the basis of the so-called epidemiological history (establishing the fact of visiting the forest, tick bite), as well as clinical signs of the disease, the main of which is the presence of erythema migrans.
Of particular difficulty for diagnosis are diseases that occur in non-erythema forms, along with other infections transmitted by ticks, such as tick-borne encephalitis or anaplasmosis.
In clinical practice, there are cases when the patient simultaneously revealed an erythema form of borreliosis and tick-borne encephalitis, which led him to re-hospitalization due to complications.
Cases of non-erythema forms can only be diagnosed with laboratory tests. Isolation of borrelia from skin samples, blood serum samples, cerebrospinal or synovial fluids to special media by cultivation requires special conditions, expensive reagents, it takes a lot of time, and most importantly, is ineffective.
Microscopic studies are usually used in the analysis of tick borrelia infection, but they are practically not used in the diagnosis of IKB, since Borrelia does not accumulate in tissues and body fluids of an infected person so that they can be detected under a microscope.
For the detection of borrelia, a polymerase chain reaction (PCR) can be used, which can detect the DNA of the pathogen.
When conducting such studies, we showed that the number of borrelia contained in one tick varies from one to six thousand.
However, at present, the PCR method, like all other methods for the diagnosis of borreliosis, is not recommended as an independent test for the diagnosis of the disease.
Since in this case the sensitivity of this method is insufficient, which can lead to the so-called "false negative" results.
For the timely detection of mixed infections, DNA determination must be carried out in the first four weeks after tick suction.
However, a negative result, which can be obtained, does not exclude the presence of the disease and after 3-6 weeks requires serological tests (for specific antibodies).
In the USA and Europe, it was recommended to use a two-stage blood serum testing scheme to increase the reliability of serodiagnosis of borreliosis, but in Russia a two-stage approach is not applied due to the lack of domestic test systems.
In addition, immunoglobulins from the blood serum of patients with ICD may react differently with the main proteins of different types of borrelia, so the testing criteria developed for one country may not be suitable for another.
Serological methods of detection are now widely used in Russia: enzyme-linked immunosorbent assay (ELISA) and indirect immunofluorescence reaction (RNIF), the diagnostic significance of which is comparable.
In general, the effectiveness of detecting antibodies in patients even using a combination of modern serological tests depends on the stage of the disease.
So what is borreliosis - a common infection or illness for life? In fact, this ailment is not as harmless as it seems at first glance.
Sometimes infection of the body with borrelia causes serious long-term consequences, diseases that, only upon closer examination, can be associated with borreliosis previously suffered by patients.
And treatment of ICD should not consist in mindlessly taking antibiotics, as it sometimes happens. This is the business of professionals who are able to identify not only clinical symptoms, but also the individual characteristics of the course of the disease and the presence of concomitant diseases.
What it is
The causative agent of Lyme disease is one of the species of Borrelia (Borrelia burgdorferi), from the family Spirochetaceae. This is the only species of borrelia pathogenic to humans and widespread in the temperate climate zone.
In Russia, Lyme disease can be infected after a tick bite in the forests of the Leningrad, Tver, Yaroslavl, Kostroma, Kaliningrad, Perm, Tyumen regions.
In the Urals, in Western Siberia and in the Far East, ticks bearing borreliosis are found on pastures. Depending on the season, the probability of illness after a tick bite varies from 5 to 90%.
What's happening
Infection occurs when bitten by an infected tick.Borrelia with tick saliva enter the skin and multiply for several days, after which they spread to other areas of the skin and internal organs (heart, brain, joints, etc.).
Borrelia for a long time (years) can persist in the human body, causing a delayed onset of the disease, the chronic course of the disease or the return of borelliosis after an apparent recovery.
What is manifested
From a bite to the onset of the first symptoms, 2 to 30 days pass, on average - 2 weeks. A characteristic sign of the onset of the disease in 70% of cases is redness of the skin at the site of the bite.
The red spot gradually increases, reaching 1-10 cm in diameter, sometimes up to 60 cm or more. The spot shape is round or oval, less often irregular. The outer edge of the inflamed skin is redder, rises somewhat above the level of the skin.
Over time, the central part of the spot fades or acquires a bluish tint, a ring shape is created. In the place of the tick bite, in the center of the spot, you can first see the crust, then the wound is scarred.
The stain without treatment persists for 2-3 weeks, then disappears. After 1-1.5 months, signs of damage to the nervous system, heart or joints develop.
Diagnostics
Establishing a diagnosis of Lyme disease at the stage of skin manifestations should be considered great success. Unfortunately, often the disease can be suspected very late, when damage to the internal organs manifested itself in full force.
Confirm the diagnosis of borreliosis using a special blood test. Such studies are carried out in specialized laboratories at infectious diseases hospitals.
Treatment
Lyme disease is treated in the infectious diseases hospital, where, first of all, therapy is carried out aimed at the destruction of Borrelia.
Without such treatment, the disease progresses, becomes chronic, and in some cases leads to disability.
In order to prevent Lyme disease after being bitten by an infected tick, it is recommended to take doxycycline 1 tablet (0.1 g) 2 times a day for 5 days (children under 12 are not prescribed). However, before taking an antibiotic, you should consult your doctor - the drug has contraindications.
Historical reference
In 1922, French doctors Garin (Ch. Garin) and Bujadou (A. Bujadoux) described a patient with meningoencephalitis, combined with radiculoneuritis and gradually migrating spots on the skin.
In 1930, Swedish dermatologist Sven Hellerström established that these symptoms are related to a previous tick bite. In 1941, a German neurologist Alfred Bannwart (1903-1970) published his observations of patients with similar symptoms, but a chronic course of the disease.
And in 1948, the Swedish microbiologist Karl Lennhoff discovered spirochetes in samples of skin affected by migratory erythema.
The community of all these diseases was discovered relatively recently, after doctors diagnosed suddenly two “juvenile rheumatoid arthritis” in two children at once on November 1, 1975 in the town of Lyme (Connecticut, USA).
Then, the same complaints (pain in the joints and characteristic migrating spots on the skin) were made by several adults.
In 1977, rheumatologist Allen Stear and employees of the Center for Disease Control and Prevention conducted a survey and found that in the city of Lyme, 25% of residents made a diagnosis of juvenile rheumatoid arthritis. They also found that the disease occurs after a tick bite.
The causative agent of Lyme disease was isolated in 1982 by microbiologists Willy Burgdorfer (Switzerland) and Alan Barbour (USA). In honor of the Swiss scientist and named this variety of Borrelia - Borrelia burgdorferi.
The fact that the syndrome described by Garin, Bujado and Bannwart, and Lyme disease - borreliosis are of a common nature, was established in 1984. In our country, the infection was first serologically verified in 1985 in patients in the Northwest region.
Etiology or cause of borreliosis
The causative agents of Lyme borreliosis are spirochetes of the genus Borrelia (mobile gram-negative bacteria in the form of a left- or dextrorotatory spiral). These are chemoorganotrophic anaerobes, obligate parasites with predominantly intracellular persistence.
For humans, the pathogenicity of three of the thirteen genes of borrelia has been proven: B. burgdorferi sensu stricto, B. garinii and B. afzelii.
Borrelia is named after their discoverer, the French microbiologist Amedey Borrel (1867–1936), who studied this genus of spirochetes in the early twentieth century.
Epidemiology
Lyme borreliosis is a natural focal zoonosis with a transmissible mechanism of transmission of pathogens. In nature, Borrelia circulate between ticks and wild animals.
Cases of the disease are widespread in the forest and forest-steppe zones. On average, the incidence of Lyme borreliosis in Russia is 5.5% (up to 11.5% in the Northwest region).
In Russia, the infection of ticks Ixodes persulcatus and I. ricinus with borrelia is 10–70%. In 15% of cases, ticks, in addition to borrelia, are infected with pathogens of tick-borne encephalitis and / or ehrlichiosis, which causes the occurrence of mixed infections. Also, 7-9% of ticks can be infected simultaneously by several genes of Borrelia.
Despite the fact that borreliosis is historically a fairly new group of infectious diseases, one should not assume that the disease itself appeared only recently.
For example, in an article published on the website of the nature science information portal February 28, 2012, fragments of the B. burgdorferi genome were found in material extracted from the remains of a person who died in the Alps 5300 years ago.
Pathogenesis and clinical presentation
Most often, infection of a person occurs as a result of sucking a tick in places with thin skin and abundant blood supply (neck, chest, axillary cavities, inguinal folds).
The incubation period is from 2 to 30 days (most often - 2 weeks). There are 3 stages of development of lime borreliosis, although a clinically clear boundary between them is impossible to draw.
Stage of local infection
Borrelia entering the skin are absorbed by macrophages and cause the development of a local inflammatory reaction due to the activation of bacteriophages, and directly, due to the production of exotoxins and the release of endotoxins. Sometimes incomplete phagocytosis is observed, and conditions are created for the subsequent persistence of microorganisms.
At the site of initial accumulation, Borrelia is actively affected by inflammation factors, loses mobility, their number decreases, local inflammation phenomena decrease, and “enlightenment” forms in the center of erythema. The spot size is 5-15 cm.
The formation of new rings or spots of hyperemia is associated with new generations of borrelia, capable of independent translational movement to neighboring areas, where the concentration of inflammatory factors is still low.
Sometimes migratory erythema with borreliosis does not develop at all, and the disease manifests itself with symptoms of general intoxication - clinical manifestations of the second phase.
Dissemination Stage
At 4-6 weeks, as pathogens accumulate in the primary focus, they spread throughout the body with a blood stream, lymph, and also due to their own mobility.
Clinically, generalization of infection is accompanied by symptoms of general intoxication and damage to various organs. In 5-10% of patients, of those in whom the disease manifested by migratory erythema, daughter skin foci form at this phase. They are very similar to the primary focus, but are usually smaller in size.
Stage organ lesions
It develops as a result of prolonged exposure to pathogens on organs and systems. Skin, central and peripheral parts of the nervous system, musculoskeletal system, heart, etc. may be affected.
The humoral (antibodies and complement system) and cellular (activated T-lymphocytes) immune responses come to the fore. The antigenic spectrum of borrelia is very variable and different not only in different genovidov, but also among isolates of the same genovidov.
They activate macrophages and T and B lymphocytes. Moreover, the antibodies produced have cross-immunological activity against both Borrelia antigens and tissue proteins (axonal tissue proteins, synovial membrane proteins, etc.).
As a result, over time, autoimmune mechanisms begin to play a leading role in pathogenesis, and borreliosis infection acts as a trigger.
B. burgdorferi, in addition, synthesize an exotoxin called Bbtox1. Its action is similar to botulinum toxin C2 and determines the effect of borrelia on the nervous system.
Most often, it is precisely the nervous system that is affected: serous meningitis or meningoencephalitis, cranial nerve neuritis, radiculoneuritis.
With the development of meningitis, headache, nausea, vomiting, photophobia, hypersensitivity to sound and light stimuli, soreness when moving eyeballs appear.
There is moderate stiff neck, a decrease or absence of abdominal reflexes. The cerebrospinal fluid is clear, its pressure is within normal limits, moderate lymphocytic pleocytosis (100-300 cells in 1 μl) is often observed against a background of high protein content (up to 0.66-1.0 g / l) and normal or slightly increased glucose concentration.
A third of patients have sleep disturbance, distraction, memory loss, increased irritability, emotional instability, anxiety (signs of astheno-neurotic syndrome).
Cranial nerve neuritis occurs in about half of patients with neurological disorders. The most frequently affected is the VII pair (paresis of the facial muscles without disturbing skin sensitivity).
If V pair is involved in the pathological process, the patient feels numb and tingling of the affected half of the face, pain in the ear and lower jaw.
The oculomotor nerves with impaired convergence, the visual ones with visual impairment, the auditory ones with hearing impairment, and less often the glossopharyngeal and vagus nerves, can also be affected.
Disturbances from the spinal nerves are observed in a third of patients with neurological symptoms. If the disorders develop according to the sensitive type, patients complain of severe pain in the cervical region, shoulder girdle or lower back, radiating to one or both corresponding limbs, as well as numbness or other unpleasant sensations in this area.
Actually, Bannwart syndrome is a combination of all these lesions of the nervous system. Migratory erythema is observed in only 40% of such patients.
Other target organs of borreliosis infection are the heart, joints, and skin.With heart damage, myopericarditis develops, joints - reactive arthritis (in 2-10% of patients with Lyme borreliosis), and skin - benign lymphocytoma.
Diagnosis of Borreliosis
In addition to the characteristic clinical manifestations, an epidemiological history is important (being in endemic areas, sucking a tick in the last 10-14 days).
In laboratory diagnostics, microscopy of various materials (blood, cerebrospinal fluid, lymph, intraarticular fluid, tissue biopsies, etc.) is most often used.
If the symptoms of general intoxication syndrome prevail in the clinical picture, a differential diagnosis must be made with acute respiratory infections.
In the presence of erythema - with an erythema form of erysipelas and an allergic reaction to an insect bite. In the case of non-erythema forms in the presence of a tick bite in the history - with tick-borne encephalitis.
If in the acute period meningial syndrome is leading, then the differential diagnosis is carried out with serous meningitis of another etiology.
Tick borreliosis treatment and prognosis
Patients with moderate and severe degree of borreliosis are subject to hospitalization in the infectious department. In mild forms, outpatient treatment is possible.
As an etiotropic therapy, tetracycline antibiotics or semisynthetic penicillins (oral or parenteral) are prescribed.
In chronic forms or relapses, 3rd-4th generation cephalosporins (e.g. ceftriaxone) are the drugs of choice.
Pathogenetic therapy depends on which syndromes prevail in the clinical picture. With high fever and severe phenomena of meningitis, parenteral administration of glucose-salt isotonic solutions is prescribed to reduce intoxication and correct the acid-base state.
To improve microcirculation in tissues and accelerate remyelination processes - vascular agents, antioxidants, as well as drugs that stimulate metabolic processes in the nervous tissue, non-steroidal anti-inflammatory drugs (indomethacin, piroxicam), analgesics (paracetamol, tramal), drugs that improve neuromuscular conduction ( proserin, oxazyl, ubretide).
Neurological symptoms during treatment usually completely disappear after a few months. Astheno-neurotic syndrome can persist for up to 12 months.
Erythema usually disappears after 3-4 weeks (less commonly after a few months). In its place, peeling of the skin, hyperpigmentation is observed, and the patient will note itching, tingling and a decrease in pain sensitivity.
In the absence of treatment or irrational therapy, Bannwart syndrome takes a chronic course, in which progressive inflammation over time leads to atrophic and degenerative changes in the nervous system.
In patients with this, sleep disturbances, distraction, memory loss, emotional instability, anxiety are observed.
Since the pathogenesis at this stage is demyelination of nerve fibers, progressive encephalomyelitis often mimics multiple sclerosis, epileptiform seizures, encephalopathy can also develop.
Cranial nerves are often affected, especially the vestibulocochlear (15–80% of cases), followed by the visual (5–10%).
If the auditory branch of the VIII pair suffers, patients note tinnitus, hearing loss; if vestibular - dizziness arising from a sharp turn of the head or body.
In case of defeat of the second pair, the visual acuity of one or both eyes decreases, the visual fields change, scotomas appear, the brightness or contrast of the vision decreases, the colors are distorted.
In 40-60% of cases, the chronic course of neuroborreliosis is combined with skin lesions, resulting in the development of chronic atrophic acrodermatitis. And in 30-35% of cases - with reactive arthritis.
Prevention
In the United States, in 1998, two monovalent recombinant vaccines were licensed with an efficiency of about 65-80%. In Russia, work on the development of a vaccine against Lyme borreliosis has not yet been conducted.
But emergency antibiotic therapy is actively used - in those cases when it was precisely established that the sucking tick was infected with Borrelia.
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