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 has been 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 reach the infectious disease specialist's office.
Lyme disease is reported in Europe, North America, Asia, Australia. There is a tendency to increase the incidence in Russia and Ukraine. Susceptibility to Borrelia in humans is high. So, Lyme disease has been ill with such famous people like Ben Stiller, Christy Turlington, Richard Gere, Avril Lavigne, Ashley Olsen.
Table of contents:Causes
The causative agent of the disease is bacteria of the genus Borrelia (B.burgdorferi, B. afzelii, garinii), belonging to the Spirochaetaceae family. The carrier of Borrelia is ixodid ticks(I.ricinus, I.pacificus, I.damini). An infected tick is contagious at any active stage of its life. life cycle: at the stage of larva, nymph or sexually mature individual.
A person becomes infected with borrelia through the bite of an infected tick, when the saliva of an arthropod enters the wound on the skin. A contamination transmission mechanism is also inherent, when, while combing the skin, a person rubs the contents of a crushed tick into the wound. In addition, precedents for the transmission of infection from mother to child through the placenta are described in medical practice.
The rise in the incidence of Lyme disease is observed in the spring-autumn period, which, of course, is associated with the high activity of ticks in this season. Ixodid ticks live in forests, forested urban areas.
The incubation period averages one to two weeks, but can even increase 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 in 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.
A papule (nodule) appears at the site of the tick bite. Gradually, the area of redness expands along the periphery. The edges of erythema are intensely red, slightly raised above the skin. In the center of erythema, the skin is paler. Spot on appearance resembles a ring, which is why it was called erythema migrans annulare. This symptom occurs in approximately 60-80% of infected people.
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 there is itching, burning in the bite area. The stain persists for several days, then gradually turns pale, leaving pigmentation and peeling.
Some patients develop benign lymphocytoma - a moderately painful red lump on swollen skin. Most often, lymphocytoma is localized in the earlobes, nipples, face, and genitals.
Borrelia from the primary site of the lesion spread 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.
The duration of the first stage varies from three to thirty days. The outcome of this stage can be either recovery (with timely therapy), or a transition to the next stage.
Symptoms of the second stage
Borrelia disseminate into 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 (rarely vomiting), and in some cases, fever.
This stage is characterized by such syndromes:
- meningeal;
- Neurological;
- Cardiology.
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.
Neck stiffness and other typical meningeal signs are recorded.
Also, a person may develop encephalitis or encephalomyelitis, occurring with paraparesis or tetraparesis. Possible neuritis of the cranial nerves, often auditory and oculomotor.
Patients may experience sleep disturbances, emotional lability, anxiety, short-term visual and hearing impairments.
Lyme disease is characterized by lymphocytic meningoradiculoneuritis of Bannawart, characterized by the development of cervicothoracic sciatica, meningitis with lymphocytic pleocytosis.
Cardiac syndrome is often formed on the fifth week of the disease and is manifested by a violation of atrioventricular conduction, slowing or increased heart rate, signs of myocarditis or pericarditis. It should be noted that cardiac involvement is less common than nervous system. In addition, iritis, tonsillitis, splenitis can be observed.
At this stage of the disease, patients may experience joint and muscle pain, but there are no signs of inflammation in the joints yet. Symptoms of the second stage of Lyme disease can occur without previous erythema annulare, which greatly complicates the diagnosis of the disease.
Symptoms of the third stage
Symptoms of this stage appear quite late: several months, and sometimes even years after infection. The most characteristic lesions of the joints (in 60% of patients), skin, heart and nervous system.
In Lyme disease, mainly large joints (elbows, knees) are affected. The affected joints are edematous and painful, there is a limitation of movements. Symmetry of joint damage is characteristic, the process has a recurrent character. Long inflammatory process in joints and cartilage leads to destructive changes in them.
Chronic neurological lesions occur in the form of:
- polyneuropathy;
- dementia;
- Ataxia;
- Memory disorders.
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 clinical picture. It is worth noting that many people do not even notice a tick bite at one time.
To confirm Lyme disease, specific diagnostics are performed. For example, serological methods such as ELISA and ELISA can detect specific antibodies of the IgG and IgM classes in the blood. But at the first stage, in about half of the cases, a serological study turns out to be uninformative. That is why it is necessary to study paired sera with an interval of twenty to thirty days.
With the help of PCR, laboratory doctors manage to determine Borrelia DNA in skin biopsy, 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 with the use of various antibiotics. So, at the first stage of the disease in the presence of erythema and without lesions internal organs prescribe orally tetracyclines, aminopenicillins. , started in the first stage of the disease, will prevent further progression of Lyme disease.
With damage to the internal organs, patients are prescribed parenterally penicillins and cephalosporins (second or third generation). In the chronic form of infection, third-generation cephalosporins and penicillins are prescribed.
Pathogenetic therapy is based on the existing concomitant lesions of the internal organs. So, with damage to the heart, with disorders that are not eliminated by taking antibiotics, protracted meningitis, meningoencephalitis, corticosteroids are prescribed. In 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 administered parenterally.
Prevention
When visiting a forest area (park area), general prevention is reduced to the use of repellents, wearing clothes that cover the body as much as possible. In case of a tick bite, you should immediately contact the clinic, where it will be correctly removed, the bite site examined and further health monitoring provided. If a person is often on his own suburban area, it will not be superfluous to carry out acaricidal measures. After walking with the dog, you should carefully examine the pet for the presence of a tick on the body. 
After a tick bite in an endemic region, long-acting antibiotics are prescribed as an emergency prophylaxis (for example, bicillin-5 once intramuscularly at a dosage of 1500 thousand units).
Grigorova Valeria, medical commentator
The acute form of borreliosis, which occurs in the form of erythema on the skin, has a mild course and 90% curability, and does not leave any complications behind. If these first symptoms of the disease go unnoticed and if left untreated, Lyme disease can become chronic, which can persist for many years, have hidden form and not show any symptoms.
However, at some point, the disease may suddenly begin to attack again, but not the skin, but the heart or central nervous system. This type of borreliosis can leave behind very serious complications.
Consequences of borreliosis
If the bacterium is not killed when the disease spreads only to the skin, it can enter through the blood or lymph into almost all organs of our body. That is why the treatment of borreliosis in the early stages of infection is so important. Of course, before the bacterium reaches the brain or heart, it should take a little time - it can be weeks, months, or even years.
Late symptoms of borreliosis are not very characteristic, and, in addition, develop long after infection, which creates additional difficulties for the diagnosis of Lyme disease. Sometimes, before a pathogen is found, i.e. Borrelii the disease can be very developed, and its consequences will become irreversible.
Brain complications of borreliosis
The most serious complications arise if the disease covers the central nervous system. Disease in the nervous system can occur as a mild form of inflammation of the meninges, and sometimes can also involve cranial or peripheral nerves. However, properly treated neuroborreliosis does not leave behind long-term complications.
Erythema migrans...
Consequence inflammation of the facial nerve it may be damaged, which is associated with paresis of the nerves of this side of the face. As a result of the lesion, the appearance of the patient's face changes - the corner of the mouth drops, the skin between the nose and cheek and the skin of the forehead are smoothed. Such a patient is unable to bare his teeth or move his cheeks.
Eyelid regurgitation may also occur, causing the eyeball to dry out and become more susceptible to infections. With neuroborreliosis associated with inflammation of the peripheral nerves, complications may develop in the form of colic in specific parts of the body, severe neuropathy, or fatigue of the arms or legs.
The most dangerous form of neuroborreliosis is chronic brain inflammation. After such a disease, paralysis of all muscles may appear, not only of the limbs or trunk, but also of the sphincters. This can lead to permanent damage to the cranial nerves.
Inflammation of the brain as a result of infection with borreliosis can also lead to changes in the human psyche. They may develop psychosis, dementia, impaired concentration and attention. There are also depressions, the cause of which, most likely, is inflammation of the brain.
A bacterial disease of the brain can also lead to the formation of areas of cerebral ischemia, which can affect its work and the functioning of the body in different ways. It happens that there is a weakening or impairment of hearing and vision.
Cardiac complications of Lyme disease
Chronic bacterial infection Borrelii may result in heart problems. The disease affects the heart muscle, and also causes endocarditis and pericarditis. This can lead to disturbances in the functioning of the heart and, in particular, disturbances in the conduction of nerve impulses that are responsible for the correct contraction of the heart muscle.
Rhythm disturbances can be very dangerous to health and even human life. The patient feels an uneven heartbeat. As a rule, heart problems disappear within 6 weeks, but 5% of people may have irreversible consequences in the form of heart failure.
Complications on the joints after Lyme disease
Sometimes, though rarely, Lyme disease leaves behind permanent inflammation in the joints. Pain can appear simultaneously with skin changes or even two years after infection with a bacterium. Usually the knees are affected.
The disease proceeds spasmodically - asymptomatic periods alternate with periods of exacerbations. As a rule, arthritis resolves after the use of antibiotic therapy and does not leave long-term consequences. However, if the treatment is not implemented at the right time, it can lead to joint deformities.
Unfortunately, Lyme disease, if it does not manifest itself as skin changes, becomes very difficult to diagnose, due to the fact that the internal forms of this disease have completely uncharacteristic symptoms.
Often the key to staying healthy and alive is self-examination at the time of a potential tick attack. However, if this does not happen, symptoms of organ damage may appear many years after the bite and are difficult to associate with borreliosis. In such a situation, the main thing is the intuition and experience of the doctor.
Lyme disease (synonyms: Lyme borreliosis, Lyme borreliosis, tick-borne ixodid borreliosis, Lyme disease) is an infectious pathology that occurs in acute or chronic form with skin lesions, musculoskeletal system, nervous, cardiovascular system, etc. It refers to natural focal infections, carriers are ixodid ticks.Lyme borreliosis is widely found in the habitat of ixodid ticks, namely in the northern hemisphere. In our country, about 8 thousand new cases of the disease are registered annually, all age categories are ill, but more than 10% of the cases are children. Ixodid ticks can be carriers of several infections at the same time, so when bitten by one tick, a person is at risk of contracting several infections.
What is this disease?
Lyme disease (tick-borne borreliosis) is an infectious natural focal transmissible disease that is caused by spirochetes and transmitted by ticks and has a tendency to recurrent and chronic course and predominantly affects the skin, nervous system, heart and musculoskeletal system.
Causes of Lyme Disease
The causative agent of the disease are several types of Borrelia - B. garinii, B. burgdorferi and B. afzelii. These are gram-negative spirochetes that grow on media containing amino acids, animal sera, and vitamins.
- The natural hosts of Borrelia are rodents, deer, and birds. When bloodsucking, Borrelia find themselves in the intestines of the tick (their reproduction occurs there), and then they are excreted with feces. The circulation of the pathogen in natural foci occurs according to the scheme: ticks - wild birds and animals - ticks.
- Infection with human Lyme disease occurs in natural foci of borreliosis through a tick bite. But there is a possibility of infection in case of contact with the skin of the feces of the tick during its subsequent combing. If the tick is not properly removed, if it ruptures, Borrelia can get into the wound. An alimentary route of transmission of the pathogen is also possible - with the use of raw cow or goat milk.
Infection with Lyme disease (borreliosis) occurs when visiting the forest, forest park areas inside cities, when removing ticks from pets.
The peak incidence of borreliosis falls on the period from May to June.
What happens in the human body
The causative agent of tick-borne borreliosis enters the body with the saliva of the tick. From the site of the Borrelia bite, blood and lymph flow into the internal organs, lymph nodes, and joints. The pathogen spreads along the nerve pathways with the involvement of the meninges in the pathological process.
The death of bacteria is accompanied by the release of endotoxin, which triggers immunopathological reactions. Irritation of the immune system activates the general and local humoral and cellular response. Directly the production of IgM antibodies, and a little later IgG occurs in response to the appearance of the flagellar flagellar antigen of bacteria.
As the disease progresses, the set of antibodies to Borrelia antigens expands, which leads to prolonged production of IgM and IgG. The proportion of circulating immune complexes increases. These complexes are formed in the affected tissues and activate inflammatory factors. The disease is characterized by the formation of lymphoplasmic infiltrates in the lymph nodes, skin, subcutaneous tissue, spleen, brain, peripheral ganglia.
Classification
In the clinical course of Lyme disease, an early period is distinguished ( Stages I-II) and late period (Stage III):
- I - stage of local infection (erythemal and non-erythemic forms)
- II - stage of dissemination (course options - febrile, neuritic, meningeal, cardiac, mixed)
- III - stage of persistence (chronic Lyme arthritis, chronic atrophic acrodermatitis, etc.).
According to the severity of pathological reactions, Lyme disease can occur in mild, moderate, severe and extremely severe forms.
Symptoms
The incubation period for Lyme disease from infection to symptom onset is usually 1 to 2 weeks, but it can be much shorter (a few days) or longer (months to years).
Symptoms typically appear from May to September, as this is when tick nymphs develop and are the cause of most infestations. Asymptomatic infection occurs but is statistically less than 7% of Lyme disease infections in the United States. The asymptomatic course of the disease is more typical for European countries.
The first symptoms of Lyme disease are nonspecific: fever, headache, chills, muscle aches, weakness. characteristic feature is the stiffness of the neck muscles. An annular redness (migratory annular erythema) develops at the site of the tick bite. In the first 1-7 days, a macula or papule appears, then within a few days or weeks, the 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 the redness is somewhat paler. Erythema is round in shape, 10–20 cm in diameter (up to 60 cm), localized more often on the legs, less often on the lower back, abdomen, neck, axillary, inguinal areas. In the acute period, symptoms of damage to the soft meninges (nausea, headache, frequent vomiting, photophobia, hyperesthesia, meningeal symptoms) may appear. Pain in muscles and joints is often noted.
After 1-3 months, stage II may begin, which is characterized by neurological, cardiac symptoms. Systemic tick-borne borreliosis is characterized by a combination of meningitis with neuritis of the cranial nerves, radiculoneuritis.
The most common cardiac symptom is atrioventricular blockade, the development of myocarditis, pericarditis is possible. There is shortness of breath, palpitations, constricting pains in the chest. 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.
What does Lyme disease look like: photo
The photo below shows how the disease manifests itself in humans.
Click to view
[hide]
Chronic symptoms
If the disease is treated ineffectively or not treated at all, then a chronic form of the disease may develop. This stage is characterized by alternating remissions and relapses, but in some cases the disease has a continuously relapsing character. The most common syndrome is arthritis, which recurred over several years and acquired a chronic course through the destruction of bones and cartilage.
There are changes such as osteoporosis, thinning and loss of cartilage, less often - degenerative changes.
Among the skin lesions, there is a benign lymphocytoma, which has the appearance of a dense, edematous, raspberry-colored nodule (infiltrate) and causes pain on palpation. A typical syndrome is atrophic acrodermatitis, which causes skin atrophy.
Diagnosis of Lyme disease
A thorough history taking is critical to the diagnosis of Lyme disease. It is important not to miss the facts indicating the possibility of infection with tick-borne borreliosis (country walks, tourist trips, etc.). Also, experts pay attention to the presence of primary signs of the disease: skin erythema and general intoxication.
Depending on the stage at which the disease develops, various serological and immunological laboratory tests are used (PCR, RIF, ELISA, microscopic studies, etc.). In order to identify structural disorders of various organs and tissues, apply additional methods research, prescribing fluoroscopy, puncture followed by a laboratory study of the material, an electrocardiogram, a biopsy of epidermal tissues, etc.
A differential diagnosis should be made with such diseases as: encephalitis, rheumatoid arthritis, dermatitis of various origins, neuritis, rheumatism, Reiter's disease and others with similar symptoms. In patients suffering from syphilis and various autoimmune diseases (infectious mononucleosis or rheumatism), serological reactions are false positive, which requires additional confirmation of the diagnosis.
See photo
[hide]
Complications
Among the likely negative consequences of borreliosis, irreversible changes in the nervous system, heart, and inflammatory diseases of the joints should be highlighted, which, if not properly treated, lead to disability, and in severe cases, cause death.
Lyme Disease Treatment
Upon detection characteristic symptoms Lyme disease undergoes complex treatment in the hospital of the infectious diseases hospital.
At stage I, antibiotic therapy is indicated for 2-3 weeks:
- Doxycycline 100 mg 2 r / day
- Amoxicillin 500 mg 3 r / day (children 25-100 mg / kg / day) orally
- Antibiotic reserve - ceftriaxone 2.0 g / m 1 r / day
Against the background of antibiotic therapy, the development of the Jarisch-Herxheimer reaction (fever, intoxication against the background of mass death of borrelias) is possible. In this case, antibiotics are canceled for a short time, and then the reception is resumed at a lower dose.
In stage II Lyme disease, antibiotic therapy is prescribed for 3-4 weeks:
- In the absence of changes in the cerebrospinal fluid, doxycycline 100 mg 2 r / day or amoxicillin 500 mg 3 r / day orally are indicated
- If there are changes in the cerebrospinal fluid - ceftriaxone 2 g 1 r / day, cefotaxime 2 g every 8 hours or benzylpenicillin (sodium salt) 20-24 million units / day IV
Stage III uses:
- Doxycycline 100 mg 2 times a day or amoxicillin 500 mg 3 times a day by mouth for 4 weeks
- If there is no effect, ceftriaxone 2 g 1 r / day, cefotaxime 2 g every 8 hours or benzylpenicillin (sodium salt) 20-24 million units / day IV for 2-3 weeks.
Early initiation of treatment, as a rule, leads to a complete recovery of the person. Chronic stages can lead to disability and death (irreversible changes in the nervous and cardiovascular systems). After the end of treatment, regardless of its effectiveness, a person is registered with an infectious disease specialist and narrow specialists.
Prevention
When visiting a forest area (park area), general prevention is reduced to the use of repellents, wearing clothes that cover the body as much as possible. In case of a tick bite, you should immediately contact the clinic, where it will be correctly removed, the bite site examined and further health monitoring provided.
If a person is often in his own summer cottage, it will not be superfluous to carry out acaricidal measures. After walking with the dog, you should carefully examine the pet for the presence of a tick on the body.
Tick-borne borreliosis (Lyme disease)- an infectious transmissible natural focal disease caused by spirochetes and transmitted by ticks, with a tendency to chronic and recurrent course and predominant damage to the skin, nervous system, musculoskeletal system and heart.For the first time, the study of the disease began in 1975 in the town of Lyme (USA).
The cause of the disease is tick-borne borreliosis (Lyme disease). The causative agents of tick-borne borreliosis are spirochetes of the Borrelia genus. The pathogen is closely related to ixodid ticks and their natural hosts. The commonality of carriers for pathogens of ixodid tick-borne borreliosis and tick-borne encephalitis viruses causes the presence of ticks, and therefore in patients, cases of mixed infection.
Geographic distribution tick-borne borreliosis (Lyme disease) extensively, it is found on all continents (except Antarctica). Considered to be highly endemic (constant occurrence this disease in a certain area) Leningrad, Tver, Yaroslavl, Kostroma, Kaliningrad, Tyumen regions, Perm region, as well as the Ural, West Siberian and Far Eastern regions for ixodid tick-borne borreliosis. In the territory Leningrad region The main keepers and carriers of Borrelia are the taiga and European forest ticks. Infection by causative agents of Lyme disease of ticks - vectors in different natural foci can vary in a wide range (from 5-10 to 70-90%).
A patient with tick-borne borreliosis (Lyme disease) is not contagious to others.
The developmental process of Lyme disease. Infection with tick-borne borreliosis occurs when bitten by an infected tick. Borrelia with tick saliva enter the skin and multiply within a few days, after which they spread to other areas of the skin and internal organs (heart, brain, joints, etc.). Borrelia can persist in the human body for a long time (years), causing a chronic and relapsing course of the disease. The chronic course of the disease may develop after a long period of time. The process of development of the disease in borreliosis is similar to the process of development of 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 in 70% of cases is the appearance of reddening of the skin at the site of a tick bite. The red spot gradually increases along the periphery, reaching 1-10 cm in diameter, sometimes up to 60 cm or more. The shape of the spot is round or oval, less often irregular. The outer edge of the inflamed skin is more intensely red, slightly elevated above the level of the skin. Over time, the central part of the spot turns pale or acquires a bluish tint, a ring shape is created. At the site 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.
Recognizing Lyme disease. The appearance of a red spot at the site of a tick bite gives reason to think primarily about Lyme disease. A blood test is done to confirm the diagnosis.
Treatment of tick-borne borreliosis should be carried out in an infectious diseases hospital, where, first of all, therapy is carried out aimed at the destruction of borrelias. Without such treatment, the disease progresses, becomes chronic, and in some cases leads to disability.
Treatment of tick-borne borreliosis (Lyme disease). With an increase in the titer of specific antibodies and the absence of clinical manifestations diseases after the bite of an infected tick, antibiotic therapy is not carried out. In case of early infection (in the presence of migrating erythema), doxycycline (0.1 g 2 times a day orally) or amoxicillin (0.5-1 g orally 3 times a day) are used, the duration of therapy is 20-30 days. With the development of carditis, meningitis, antibiotics are administered parenterally (ceftriaxone IV 2 g 1 time per day, benzylpenicillin IV 20 million units per day in 4 injections); the duration of therapy is 14-30 days.
The prognosis for life is favorable, but disability is possible due to damage to the nervous system and joints.
Those who have been ill are under medical supervision for 2 years and are examined after 3, 6, 12 months and after 2 years.
Prevention of Lyme disease. The fight against ticks plays a leading role in the prevention of Lyme disease, where both indirect measures (protective) and their direct extermination in nature are used.
Protection in endemic foci can be achieved with the help of special anti-tick suits with rubber cuffs, zippers, etc. For these purposes, ordinary clothes can be adapted by tucking a shirt and trousers, the latter into boots, tightly fitting cuffs, etc. From the attack of ticks on open areas of the body for 3-4 hours, various repellents - repellents can protect.
When bitten by a tick as soon as possible - better the next day, you should go to the infectious diseases hospital with the tick removed to examine it for the presence of Borrelia. In order to prevent Lyme disease after a bite 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 years of age are not prescribed).
Test for tick-borne borreliosis (Lyme disease)- the test is quite simple, it can be carried out in the doctor's office without resorting to the services of a laboratory, and in an hour you get the result, approved by the Food and Drug Administration / FDA / USA.
Test" Preview"based on a drug that the company manufactures" Chembio Diagnostic Systems The test "recognizes" the antigens produced by Borrelia burgdorferi, the bacterium that causes the infection, in a timely manner to detect the presence of an infection and make a correct diagnosis, the FDA said in a statement.
Tick-borne borreliosis, or Lyme disease, has many features in common with tick-borne encephalitis. In Russia, in 1999, Lyme disease was detected in 89 large administrative territories, writes AiF. Health. This means that a significant or possibly even large part of the global range of infections that now appear under common name "tick-borne borreliosis"are located within Russia.
The incidence of Lyme disease in the Russian Federation is 1.7-3.5 per 100 thousand population. You can get Lyme disease at any age. Adult ixodid ticks infect humans with Borrelia. The incidence of Lyme disease is much higher than tick-borne encephalitis. Lyme disease dangerous because it is much more likely than tick-borne encephalitis, gives chronic forms. Adults and the elderly are more severely ill, due to the presence of concomitant chronic pathology (atherosclerosis, hypertension). No deaths from Lyme disease have been reported to date.
Lyme disease is a transmissible disease caused by pathogenic bacteria of the genus Borrelia.
It is very difficult to talk about the prevalence of pathology, which in many sources is called the "great imitator". This name is due to the polymorphism of the clinical manifestations of Lyme disease, in connection with which patients experience symptoms that make them turn to neuropathologists, dermatologists or rheumatologists, and not to infectious disease specialists.
Lyme disease is very common in Europe, North America, Australia and Asia. AT last years the number of patients with this diagnosis is also increasing in Russia and Ukraine. This is due to the high sensitivity of the human body to Borrelia. Many famous people have been ill with this disease - Avril Lavigne, Ashley Olsen, Richard Gere and others.
Causes
The causative agent of the disease are bacteria of the genus Borrelia from the Spirochaetaceae family. Carriers of pathogens are ixodid ticks (I.ricinus, I.pacificus, I.damini). An infected tick is contagious at any stage of its development. This means that both larvae, and nymphs, and adults of arthropods are quite capable of leading to human infection with borrelia with the further development of Lyme disease.
Infection of a person occurs when the saliva of a tick comes into contact with damaged areas of the skin. Another route of infection is also possible - contamination, when the contents of a crushed tick are rubbed into the skin while combing itchy areas. In addition, cases of transmission of pathology by the placental route are known. A surge in pathology is observed in the spring-autumn period.
Stages of the course of the disease
Conventionally, Lyme disease is divided into 3 stages:
- The first stage continues for 30 days after the tick bite. At this time, the patient has a general malaise, flu-like symptoms are observed. During the crescent, the patient's body temperature may rise to 40 degrees. Sometimes there may be signs of intoxication of the body. During this period, you can notice an increase in the spot at the site of the tick bite. Timely treatment helps to get rid of the stain in a few days. If therapy has not been carried out, it can remain on the body for up to 2 months.
- The disease passes to the second stage of development in the absence of treatment. After a few weeks or months, damage to the nervous system occurs, the patient develops a skin rash (like hives), and heart pain occurs. At this stage, angina often occurs, kidney, liver and eye pathologies develop. Bronchitis may recur.
- The third stage of Lyme disease develops approximately 2-3 (or 5-6) months after the end of phases 1 and 2. At this time, the pathology enters the chronic phase. The patient complains of constant fatigue and loss of strength, sleep disturbance and depressive states. At this stage, the process of damage to various internal organs and systems continues.
Lyme disease symptoms
The incubation period of the disease is 1-2 weeks. The first symptoms of Lyme disease do not have specific features, and they are expressed:
- an increase in body temperature;
- cephalgia;
- chills;
- aching joints;
- muscle weakness;
- general malaise and weakness.
Neck stiffness is one of the typical symptoms of Lyme disease. A ring-shaped redness forms at the bite site, which is the main manifestation of erythema migrans. During the first days, a small macula or papule forms, and then the erythema begins to spread, affecting large areas of the skin. At the edges, the redness has a bright shade, it rises slightly above the epidermis. In the middle, the ring is paler.
Round erythema can reach 10-2 cm in diameter. It is often localized on the legs, less often in the lumbar region, neck, abdomen, armpits or inguinal zone.
In the acute period of the course of the disease, the appearance of:
- headaches;
- nausea with vomiting;
- photophobia;
- hyperesthesia;
- pain in muscles and joints;
- meningeal symptoms.
After 1-3 months, the disease can move to stage 2 of development. At this time, neuralgic and cardiac symptoms appear.
Systemic tick-borne borreliosis is accompanied by the development of meningitis in combination with cranial neuritis and radiculoneuritis. Among the most frequent cardiac symptoms is atrioventricular block. Myocarditis and pericarditis may develop.
Over time, the onset and increase of shortness of breath, increased heart rate, pain in chest. The last, 3rd, stage of development of Lyme disease is extremely rare. It comes in about 6 months, or 1-2 years. With its development, the joints are affected (chronic Lyme arthritis), the skin (atrophic acrodermatitis), the nervous system (chronic neurological syndrome).
Signs of a chronic form
One of the most common symptoms of borreliosis is the development of arthritis, which can be accompanied by other chronic processes in the patient's body. In particular, this applies to the development of osteoporosis, thinning of cartilage, and sometimes their complete loss, less often (in more severe cases) degenerative changes.
Often there is a skin lesion, accompanied by the formation of a benign nodule - lymphocytoma, which has a crimson hue and a convex, rounded shape. When pressing on its surface, the tumor-like growth can become painful.
The most common locations for such an infiltrate are the nipple of the mammary gland and the earlobe. Lymphocytoma can persist on the human body for several months, or even years.
Atrophic acrodermatitis is characterized by the appearance of cyanotic red spots in the extensor areas of the arms and legs. They are prone to peripheral enlargement and fusion. This, in turn, can lead to the development of systemic inflammation.
Over time, the skin in the area of spots atrophies and becomes similar to papyrus. The development of such a pathological process can continue for several months or years.
Lyme disease - photo
The photos below show what Lyme disease looks like.
Diagnostics
The diagnosis is made on the basis of a carefully collected anamnesis and analysis of the clinical picture observed in the patient. Since the peddler of pathology is a tick, the patient must remember whether there was a visit to the forest, forest belts, parks in the recent past. However, not all people notice a tick bite, so a timely visit to a doctor is a rare phenomenon.
To confirm or refute the diagnosis of Lyme disease, a specific diagnosis is carried out, which consists in the use of serological blood tests - ELISA and ELISA. Performing such diagnostic manipulations helps to identify immunoglobulins (antibodies) of the IgG and IgM classes in the patient's biomaterial.
However, in the first phase of the development of the disease, serological research methods are uninformative in 50% of cases. For this reason, a second study of blood serum is carried out after 20-30 days.
Through PCR, it is possible to accurately detect Borrelia DNA in a sample of skin tissue, cerebrospinal fluid, or blood.
Differential Diagnosis
It is important to differentiate Lyme disease from diseases with similar symptoms. This list includes:
- erizepeloid, etc.
It is necessary to distinguish borreliosis from these diseases at the 1st stage of development. In the second phase, differential diagnosis should be carried out in order to exclude different forms tick-borne encephalitis, rheumatic heart disease or cardiopathy. At stage 3 progression, pathology should be differentiated from rheumatoid arthritis, rheumatism, Reiter's disease and reactive arthritis. To conduct such a diagnosis, synovial fluid is used for further morphological studies.
Lyme Disease Treatment
Patients with this diagnosis are necessarily hospitalized in the hospital of the infectious diseases department. Pharmacological drugs are prescribed taking into account the phase of the pathology.
Sick with mild degree Borreliosis is prescribed, as a rule, antibiotics of the tetracycline series (Doxycillin). Medicines are taken for 14 days. If necessary, Amoxicillin may be prescribed.
The transition of Lyme disease to stages 2 and 3 of development, accompanied by damage to the joints, nervous system and heart, requires the use of antibiotics of the cephalosporin or penicillin series. The course of therapy lasts from 3 to 4 weeks.
During the passage of antibiotic therapy, the patient may experience or worsen the symptoms of spirochetosis. This is due to the process of death and excretion of Borrelia from the body, as a result of which endotoxins begin to be actively released into the blood. Under such circumstances, antibiotics are stopped for a while, after which they are resumed.
Treatment for Lyme disease also depends on the associated symptoms. So, with damage to the joints, analgesics are used, and courses of physiotherapy are also conducted. If general infectious signs occur, detoxification therapy is carried out, and in case of meningitis, dehydration treatment is used. If there is a development of severe systemic inflammation, the patient is prescribed GCS for oral administration, or intra-articular injections are made (with the development of synovitis).
Complications
Lyme disease can lead to:
- Brain complications. The most severe course is characterized by pathological processes that affected the central nervous system. Inflammation of the meninges, peripheral or cranial nerve fibers may develop.
- cardiac complications. Untreated borreliosis is fraught with the development of endocarditis or pericarditis.
- Articular complications, in particular, their inflammation.
Prevention
To date, there are no specific measures for the prevention of Lyme disease. Therefore, it is important to be careful in places where a person is most susceptible to tick bites.
When leaving for forest park zones, forest belts or forests, it is necessary to carefully protect the body. The easiest way is to wear a long sleeve shirt with a high collar and long pants. If a tick has been found on the body, it must be carefully removed. This should be done with gloves, using pre-disinfected tweezers. If the manipulation was successful, the tick must be clamped behind the head and removed with twisting movements.
Do not crush the tick - this can lead to the ingress of its pathological contents onto healthy areas of the skin. After the procedure, the wound must be washed with an antiseptic, and then wash your hands thoroughly.
If there are pets in the house, they should be inspected after each walk, since ticks often attach to animals.
Forecast
A favorable prognosis is possible only with timely detection and treatment of the disease. There are cases when systemic tick-borne borreliosis stopped at an early stage of development, leaving behind the so-called "serological tail".
The prognosis is unfavorable in patients who have abnormally high titers of immunoglobulin IgG for a long time. In this case, repeated antibiotic therapy is indicated along with symptomatic treatment. Patients who have undergone pathology should be under dispensary observation in the conditions of the coronary heart disease during the year. During this time, clinical diagnostic studies are mandatory every 14-21 days, 3, 6 and 12 months.
If skin, neurological or rheumatic symptoms persist, the patient is referred to specialized medical specialists. Further studies are carried out taking into account the patient's history.
