Borreliosis in adults. Stage of early disseminated infection

Tick-borne borreliosis (aka Lyme borreliosis and Lyme disease) is a contagious disease of a natural focal nature, characterized by a violation of various metabolic reactions. The cause of the disease are three types of Borrelia. About what constitutes tick-borne borreliosis, what is its nature, symptoms and methods of treatment, we will describe below.

Causes of tick-borne borreliosis

Scientists have found that the causative agents of the disease are three categories of Borrelia: Borrelia burgdorferi; Borrelia garinii; Borrelia afzelii. The last two types of bacteria are more common in Europe, and the first type is in America, it has already been identified in more than 25 US states.

The carriers of the causative agent of tick-borne borreliosis are Ixodes ticks. They are able to migrate by attaching themselves to the bodies of migratory birds or dogs. Bacteria are coiled and very small. In addition to dogs and birds, in the natural environment, the following animals are their reservoirs:

rodents;
horses;
cows;
goats;
deer and others.

Tick-carriers become infected with borreliosis by sucking the blood of sick animals and capable of transmitting Borrelia to their offspring. Such mites are mainly found in temperate climatic zones, in mixed forests. Endemic zones of tick-borne borreliosis in the world are:

Northwest and center of Russia.
Ural.
Western Siberia.
Far East.
Partially Europe.

In these regions, tick infestation is up to 60 percent. The peak of this disease is the end of spring and the beginning of summer, when there is an increased activity of ticks, and a person has high susceptibility to Borrelia, respectively, is at great risk of contracting tick-borne borreliosis.

The course of the disease

A person becomes infected with tick-borne borreliosis through a tick bite. Together with saliva, the pathogen passes into the skin and begins to multiply. Then it enters the lymph nodes and reproduction continues again.

A few days later, Borrelia pass into the bloodstream throughout the body through the bloodstream. They enter the following organs:

Heart.
Muscles.
Joints.

There they can stay for a very long time and multiply again. Against Borrelia, the immune system produces antibodies, but even this does not help to completely get rid of the causative agent of tick-borne borreliosis.

And the immune complexes that appear as a result of it, start the autoimmune process. This becomes the cause of the chronic course of the disease, and the pathogen dies, which is accompanied by the release of toxic substances, from this the human condition becomes worse. However, it is not contagious to others.

Symptoms of tick-borne borreliosis

Often even doctors confuse this disease with the following diseases: myocarditis; meningitis; arthritis; neuritis. The key symptoms of the disease are as follows:

Stages of tick-borne borreliosis

This disease includes several stages:

The incubation period (from the moment of infection to the first symptoms) is from 3 to 32 days.
The first stage is the period of reproduction of Borrelia in the areas of penetration and lymph nodes.
The second stage is the time of spread of the pathogen throughout the body along with the blood.
The third stage is the chronic stage. At this time, a certain system of the body (nervous or musculoskeletal) is mainly affected.

The first two stages are the early period of infection, and the third is the late one, respectively. The division between them is conditional.

Description of the first stage of tick-borne borreliosis

During this period, local and general manifestations of tick-borne borreliosis are noted. Common symptoms are:

Rarely seen pain and sore throat, slight cough and runny nose. Local symptoms look like this:

the appearance of swelling at the site of the bite;
painful sensations;
redness;

Erythema

A specific symptom of tick-borne borreliosis is erythema annulare, which occurs in 70 percent of cases. Also, a papule is formed at the site of the bite - a dense formation that expands over time and has a ring shape.

In the middle of it is the bite site, which is very pale, and the rim is more red and rises above the unaffected area of the skin.

The zone of redness is oval or rounded, has a diameter of about 10-60 cm, often there are small rings inside the ring, especially if the erythema is large. Most of the time it doesn't hurt, but it can bake or itch. Quite often, erythema is the first manifestation of tick-borne borreliosis and has no reactions. Further, new erythema may appear, even where there were no bites.

Erythema lasts for about a month, sometimes it can be several days, and sometimes several months. Then she disappears and leaves behind pigmentation and flaking. Rashes like hives or conjunctivitis can also often appear on the skin.

Other local symptoms of the first stage include:

Enlargement and pain in the area of the lymph nodes.
Temperature increase.
Rigidity of the neck muscles.
Joint muscle pain.

Often in the first stage of the disease, the symptoms disappear even without treatment.

The second stage of the disease

This stage of tick-borne borreliosis is accompanied by such features: damage to the joints and skin; heart and nervous system.

The stage can last from several days to a month, during which time all manifestations of the first stage disappear. In some cases, tick-borne borreliosis begins immediately from the second stage, while there is no general infectious syndrome and annular erythema.

The defeat of the nervous system is manifested through serous meningitis, the cranial nerves and roots of the spinal nerves are affected.

Serous meningitis is defined as inflammation of the meninges. It manifests itself in the form of a moderate headache, fear of light, increased sensitivity to stimuli, tension in the occipital muscles and severe fatigue.

This type of meningitis may be asymptomatic, but may include:

emotional disorders;
insomnia;
problems with attention and memory;
an increase in the amount of protein and lymphocytes in the cerebrospinal fluid.

Other symptoms of the second stage

Often the cranial nerves are affected, especially the facial one, which manifests itself in the form of paralysis of the facial muscles: the face is distorted; may not completely close the eyes; food may fall out of the mouth while eating.

Sometimes one side is affected, sometimes both. But it is worth saying that with tick-borne borreliosis, the facial nerve is affected, but this gives rise to recovery. Can often be seen hearing and vision impairment develops strabismus and impaired eye movement.

The roots of the spinal nerves are affected, which is expressed in shooting pains. In the torso, the pains can be girdle in nature, and in the limbs they go from top to bottom. After a few days or weeks muscles are affected, which manifests itself in the form of paresis, the general sensitivity increases or decreases, tendon reflexes fall out.

Often the affected nervous system with tick-borne borreliosis is accompanied by the following symptoms:

Speech disorder.
Instability.
involuntary movements.
Trembling of limbs.
Swallowing problems.
epileptic seizures.

All this can occur in 10 percent of cases of the disease. Joints are affected in the form recurrent monoarthritis or oligoarthritis. This applies to the hip joints, ankle and knee, elbow. There are pains and mobility is limited.

The heart can be affected in different forms:

The conduction of the heart is impaired.
Myocarditis and pericarditis appear.
The heartbeat is disturbed.
Shortness of breath appears.
The appearance of pain behind the sternum.
Heart failure.

Skin disorders at this stage can also be different: a rash as with urticaria and lymphocytoma; secondary annular erythema.

Lymphocytoma is a specific symptom of tick-borne borreliosis and manifests itself as a red nodule ranging in size from a few millimeters to centimeters, which protrudes above the level of the skin. Often it appears in the groin, on the nipple or earlobe.

In the second stage of tick-borne borreliosis, other organs and systems are also affected, but not so often:

bronchi;
kidneys;
liver;
testicles;
eyes.

Characteristics of the third stage of the disease

The third stage of tick-borne borreliosis can begin several months and even years after the onset of the disease. It can manifest as chronic arthritis; atrophic skin lesions; nervous system lesions.

Quite often, the disease can affect one or another system, either the joints, or the nervous system or the skin are affected. There is also a combined lesion.

In chronic arthritis, both large and small joints can be affected. Often the disease is accompanied by relapses, gradually joints begin to deform, cartilage tissue becomes thinner and osteoporosis develops. Often this is accompanied by chronic myositis.

With atrophic acrodermatitis, there may appear bluish red spots on the extensions of the knees and elbows, as well as in the back of the hands and on the soles. The skin in these places thickens and swells, with relapses and duration of the disease, the skin becomes like tissue paper.

In the third stage of tick-borne borreliosis, the nervous system is affected in different ways:

in the form of a paresis.
Sensitivity increase.
Balance disorders.
Problems with memory and thinking.

Happen often epileptic seizures, hearing and vision are impaired, problems with the pelvic organs appear. There is weakness, lethargy, depression. If tick-borne borreliosis is not treated in any way, then over time it passes into the chronic stage, which is accompanied by recurrence.

Tests for tick-borne borreliosis

Such a diagnosis as tick-borne borreliosis is made on the basis of clinical data in the form of a tick bite and the presence of erythema annulare, as well as laboratory methods. Often a tick bite goes unnoticed and there is no erythema, manifestations of the disease occur only in the second stage, so the disease can be detected only by laboratory method.

Borrelia are very difficult to identify, they can be seen in the affected fluids or tissues. A biopsy is often performed, but the effectiveness is not too high, therefore, indirect methods for diagnosing this disease are often used: the polymerase chain reaction method; serological diagnosis.

Often used in diagnosis search for DNA fragments, and it is more accurate than the use of serological tests, which give false readings in the presence of syphilis, infectious mononucleosis, or rheumatic diseases.

There are seronegative variants of tick-borne borreliosis, but in the early stages, in half of the cases, a serological study does not confirm the presence of the disease. Research therefore needs to be carried out in dynamics.

How to treat borreliosis

Features of the treatment of tick-borne borreliosis depend on the stage of the disease. There are two directions of treatment: etiotropic - has an effect on the causative agent of the disease; symptomatic and pathogenetic, when the affected organs and systems are treated.

At the first stage of tick-borne borreliosis as an etiotropic treatment prescribe antibiotics to the patient inside. Among them:

Tetracycline.
Doxycycline.
Amoxicillin.
Cefuroxime.

The time of taking antibiotics is about two weeks. The dosage should never be reduced or the duration of their intake shortened, because in this case, part of the Borrelia survives and they begin to multiply again.

In the second stage, parenteral antibiotic treatment is prescribed, prescribed penicillin and ceftriaxone. In this case, antibiotics are taken for 14 to 21 days, and this provides a cure for the disease in most cases.

In the third stage of the disease, the recommended duration of antibiotic use is at least 28 days. For this purpose, appoint penicillin antibiotics, during this time the patient is given 224 injections and a prolonged form of the drug is used.

If there is no effect from the use of one or another antibiotic or there is no positive dynamics during the study of the cerebrospinal fluid, then the antibiotic must be changed.

Through antibiotics preventive therapy, it is prescribed to those who seek medical help within 5 days after a tick bite and when the tick was brought with them or was removed by the doctor, and also if Borrelia were found under a microscope. In such cases, the doctor prescribes:

Tetracycline.
Doxycycline.
Amoxiclav.
Retarpen.

In most cases, such prevention helps to get rid of the disease. Is there some more pathogenetic and symptomatic treatment which involves the use of drugs of this kind:

antipyretic;
anti-inflammatory;
detoxification;
restorative;
cardiac;
vitamin.

The use of this or that drug depends on the stage and form of tick-borne borreliosis.

Consequences of the disease

If tick-borne borreliosis was detected at the first stage and treatment was carried out in full, then full recovery occurs. In the second stage, the disease is cured in most cases without consequences.

If the diagnosis was made late, the course of treatment was incomplete, or there were defects in the immune response, then the disease can go into the third or chronic stage. With such forms, and even with repeated courses of therapy and treatment, the patient does not fully recover.

His condition may improve, but will functional disorders that can cause disability:

Reduced muscle strength in the arms or legs.
Sensitivity is broken.
The face is deformed due to damage to the facial nerve.
Vision and hearing are impaired.
There is unsteadiness when walking.
Seizures of epilepsy.
Joints are deformed and their functions are disturbed.
Arrhythmia.
Heart failure.

Not always in the third stage of the disease or its chronic form, all these symptoms are observed. And an improvement in the condition can be observed even in advanced cases, and even slow recovery occurs.

Preventive measures for tick-borne borreliosis

From tick-borne borreliosis there is no special vaccine and there is no special prevention. As a preventive measure for this disease, you must follow the elementary precautionary rules in places where insects and ticks accumulate:

Tick-borne borreliosis is dangerous disease infectious nature, which often develops imperceptibly, especially if the person did not notice the bite. Initially, ring-shaped erythema appears, and various organs are affected, and the disease is confirmed by laboratory methods.

it disease can be cured if antibiotics are used early. Otherwise, the disease becomes chronic and can provoke irreversible disorders.

Tick-borne borreliosis or Lyme disease is a natural focal infection that is transmitted by insect bites (ticks) and a special type of spirochetes entering the human body with their saliva.

Borreliosis often has a relapsing or chronic course, affecting the nervous system, skin, heart and skeleton.

On average, 2-3 people per 100,000 of the population are sick, it is especially difficult for adults or the elderly, but no mortality from borreliosis has been recorded.

The reasons

Borreliosis is caused by special microbes related to spirochetes. They are called Borrelia. Borrelia vectors are ixodid ticks. The reservoir of infection are warm-blooded animals, the main food for ticks.

Borreliosis is widely distributed, it is often noted in the Urals, the Far East, southern Siberia, as well as in the Kaliningrad, Leningrad, Tyumen, Yaroslavl, Tver, Perm and Kostroma regions.

European and taiga ticks are considered carriers of borreliosis; according to epidemiologists, at least a third of all ticks have borreliosis. A person with borreliosis is not dangerous in terms of epidemics; he cannot infect others.

Mechanism of infection

The process of getting Borrelia into the body occurs when a tick bites. In the process of sucking blood, the tick releases saliva infected with the pathogen into the wound. Borrelia penetrate the skin, and begin to actively multiply at the site of the bite. As their number increases, they spread through the skin and penetrate into the internal organs - the area of \u200b\u200bthe joints, nervous tissue or heart tissue.

Borreliosis can last for years, periodically giving exacerbations or relapses. Chronization of the process occurs after a long time.

Symptoms of borreliosis

On average, the incubation period lasts from two days to a month, the average incubation time is two weeks.

The course of borreliosis is divided into several periods:

First stage

Early localized course. The first and typical sign of borreliosis is the formation of ring-shaped redness of the skin at the site of a tick bite.

As the disease progresses, the redness increases its diameter along the peripheral edge, averaging from 1-2 cm at the beginning to 10 or more cm by the end of the period. Mostly the spots are round or ovoid. The edges of the ring rise slightly above the level of healthy skin.

In the center, the skin turns pale and becomes bluish in color. In the place where the bite itself was, a spot appears, on it a crust and then a scar. Without treatment, the stain lasts up to three weeks, gradually disappearing.

Second stage

Early disseminated or widespread, begins after a couple of months. There are signs of damage to the heart, nervous system and joints. Arthritis, muscle pain, heart rhythm problems and myocarditis, neuritis, encephalitis, polyradiculoneuritis occur.

Third stage

Begins to form in the absence of treatment. Stage of chronic infection with progressive damage to the nervous system with multiple sclerosis, polyarthritis, dermatitis with skin atrophy and other symptoms.

Diagnostics

Borreliosis can be suspected by the characteristic annular erythema of the skin with a crust in the center. To confirm the diagnosis, a laboratory blood test and the detection of antibodies to Borrelia are performed. It is necessary to take an analysis for borreliosis 2 weeks after a tick bite.

In parallel with it, a study is being carried out on tick-borne encephalitis, since tick bites can carry both diseases at once.

An X-ray of the joints and their examination, an ECG and an ultrasound of the heart, an examination by a neurologist and a neurological examination, if necessary, a puncture with obtaining cerebrospinal fluid for analysis, are necessary.

It is necessary to differentiate borreliosis from rheumatoid arthritis, infectious arthritis, tick-borne encephalitis.

Treatment of borreliosis

If tick-borne borreliosis is suspected, it is necessary to hospitalize the patient in an infectious diseases hospital. In the hospital, complex therapy will be carried out to destroy borreliosis and restore the functions of organs affected by the infection. Without proper therapy, the disease can lead to the formation of disability.

The basis of the treatment of borreliosis is the effect on the pathogen by the use of antibiotics, to which borreliosis is sensitive. In addition, pathogenetic treatment is necessary, based on the stage of the disease, the leading symptoms and the presence of complications.

The easiest way to cure borreliosis in the first stage - then you can prevent the development of neurological symptoms, joint damage and heart problems.

Doxycycline, tetracycline or amoxicillin is used for up to 20-30 days, with the development of complications, injections of antibiotics are indicated. Cephalosporins, erythromycin, or sumamed may be used.

With the development of arthritis, non-steroidal anti-inflammatory drugs, physiotherapy drugs and painkillers are used. In order to reduce the risk of allergies with a massive intake of antibiotics, antihistamines are used.

At the stage of recovery, vitamins and immunotherapy are indicated.

Complications and prognosis

Forecasts for life are favorable, complications occur with untreated borreliosis - arthritis, carditis and multiple sclerosis are formed. This leads to disability and a decrease in the quality of life.

A disease with a large number of external clinical manifestations. It is caused by bacteria of the genus Borrelia, of which more than 10 species are known today.

The geography of Lyme disease is extensive, it is common everywhere except Antarctica. The areas of Tyumen, Kostroma, Leningrad, Perm, Tver, Kaliningrad, Yaroslavl regions and the Ural, Far East and West Siberian regions are considered to be infected with borreliosis ticks in Russia. Accordingly, people who often visit mixed forests in these areas fall into the risk group. But not only forests, even in a garden plot or in a city park, you can pick up such a tick.

Statistics show a high level of childhood morbidity (10-14 years old) and an active adult population (24-46 years old). These are seasonal infections, they coincide with periods of tick activity - from mid-April to October, reaching a maximum in May, June and July (depending on geography).

How is a person infected with borreliosis?

Borrelia hosts are birds, domestic and wild animals, humans, and the carrier is. Most often, ticks get on human clothes or animal hair in the forest from grass, branches of low trees or shrubs, but they can be brought into the house with a bouquet of flowers, firewood, brooms.

The tick does not dig in immediately, usually after 1-2 hours. In children, it is quite often the scalp, in adults - the neck, chest, inguinal folds, armpits, where the skin is thinner.

The very process of infection occurs as follows: the tick digs under the skin, squirting saliva with borrelia, while he himself does not get sick. Where do borrelia come from in the tick's body? They enter his body when bitten by a sick person, and the ixodid tick then becomes a lifelong spreader of Lyme disease, and anyone it bites is highly likely to be infected.

From the bite of Borrelia, they enter the lymph and blood, due to which they spread to all organs, joints, nerve fibers and lymph nodes.

It is possible to become infected with borreliosis not only by a tick bite, but also by drinking raw goat's milk. Cases of intrauterine infection with Lyme disease are known.

No cases of infection from a sick person have been identified.

Symptoms, stages and forms of Lyme disease

There are three stages of Lyme disease: acute, subacute and chronic. And two forms: latent and manifest.

When do symptoms of tick-borne borreliosis appear?

Symptoms may appear within a month after a tick bite. The incubation period lasts from 2 to 50 days. Setting the time of the bite can be difficult, 30% of patients simply do not remember the bite.

The manifest form has signs and symptoms of the disease.
The latent form is characterized by the absence of signs of the disease, but a positive diagnosis for borelli.

Often, patients complain about the first symptoms of infection: itching and pain of inflamed skin appear, inflammation may develop that looks like erysipelas. Some patients develop secondary erythema. But often erythema looks like just a red spot. Other manifestations are possible - rash, urticaria, conjunctivitis.

Acute stage

There are signs characteristic of a flu-like condition: chills, fever, headache, weakness, aches all over the body, drowsiness. There is nausea and vomiting, sometimes it hurts to swallow, dry cough, runny nose.

Symptoms of anicteric hepatitis are sometimes observed: nausea, an increase in the size of the liver, pain in the liver, an aversion to food.

There are erythema and non-erythema forms.

erythema form

After 3-30 days (on average 7), a nodule (papule) or just redness forms at the site of the bite, then the area of redness expands and erythema forms - a red ring on the skin, and its edges are somewhat raised above the rest of the skin. The size of erythema is different - from a centimeter to tens of centimeters.

Erythematous form

At the site of the bite - just a black crust and a small speck may form.

In the event of erythema, the patient usually goes to the doctor and receives treatment. With an erythematous form - the symptoms are attributed to influenza, the necessary time is missed. One of the reasons for the high incidence of childhood morbidity is the inability to recognize the disease at an early stage. Especially when several children from the same group fall ill. For parents, everything is logical - they contracted SARS.

At this stage, the symptoms disappear even without treatment for borreliosis after a couple of weeks.

subacute stage

It is characterized by the spread of borrelia from the bite site to the organs. In the case of an erythema-free form, the disease begins with signs of dissemination and is more difficult than with erythema.

In a few weeks, the nervous system is affected (meningoencephalitis, mononeuritis, serous meningitis, myelitis and other diseases of the nervous system).

Possible manifestations of heart damage (development of atrioventricular blockade, there may be various cardiac arrhythmias, less common lesions of the myocardium and pericardium). The patient complains of palpitations, constricting pain in the chest and behind the sternum, dizziness, shortness of breath.

There are complaints of pain in the joints.

chronic stage

A chronic disease is considered to be a disease that lasts from six months to several years. At this stage, joints are affected, oligoarthritis of large structures is typical, but lesions of small joints are also seen. Changes characteristic of chronic diseases are observed in the joints: osteoporosis, thinning of cartilaginous tissue, usura in the area of the metacarpophalangeal and middle interphalangeal joints of the hands, arthritis of the fingers and hands, the appearance of osteophytes of the hip, knee and carpal joints.

Damage to the nervous system (PNS) is accompanied by high fatigue, headaches, partial hearing loss, and memory impairment. Children notice a lag in growth and sexual development. There are manifestations of chronic encephalomyelitis, polyneuropathy, spastic paraparesis.

At this stage, there are skin lesions in the form of atrophic acrodermatitis, dermatitis.

When the chronic stage of this disease is put, three factors are usually considered:

the duration of the disease (the period in which a violation of immunity is noticeable);
prolonged persistent neurological relapses - meningitis, encephalopathy and others, or developing manifestations of arthritis;
Borrelia activity.

The division into stages of Lyme disease is conditional, the disease can manifest itself at any stage.

Signs and symptoms of borreliosis

Lyme disease is characterized by the following symptoms:

The initial symptoms are similar to those of the flu or other viral infections.
At the second stage (desimination) - the defeat of several organs.
Migrating pains - first the elbow hurts, then the pain occurs in the knee, then this pain goes away, but the head starts to hurt.
Stiffness and clicking of the joints.
An increase in temperature to 37.2 degrees in the middle of the day, which is often not noticed, reddening of the face.
Drowsiness and increased fatigue.
Four-week cycles of symptoms are noted, increasing and decreasing during the cycle (cycles of Borrelia activity).
Slow response to treatment, with occasional worsening of symptoms. Relapses and remissions follow each other, and if the treatment is ended too soon, the symptoms will return.

Diagnosis of borreliosis

Lyme disease is diagnosed based on the presence of a bite and examination of the tick itself, the appearance of erythema, and primary symptoms. The tick is examined by PCR, which allows you to determine whether the tick is a carrier of the infection. This is the best option, since it is almost impossible to detect Borrelia in the human body in the first days of infection. They are isolated from the marginal zone of erythema, but the scatter of data is very large. Serological studies at an early stage of the disease are not informative.

Chemiluminescent immunoassay - a method for detecting antibodies to Borrelia (the main serological method in Russia). Analysis accuracy up to 95%. In some cases, immunoblot is used to avoid errors.

Immunoblot - to clarify the diagnosis in patients with symptoms of Lyme disease, but with a negative immunoassay. Examines 10 Borrelia antigens. A few weeks later, the diagnosis is repeated.

PCR with real-time detection - examine joint and cerebrospinal fluid. This method is used if the immunoassay is not informative (either at the onset of the disease or during treatment). This method complements other assays.

Differential diagnosis is carried out by a large group of diseases due to the similarity of symptoms with Lyme disease.

Treatment of tick-borne Lyme borreliosis

If a laboratory study showed that the pulled out tick was infected with borreliosis, the infectious disease doctor prescribes treatment immediately, even without primary symptoms. Usually this is taking antibiotics: tetracycline or doxycycline, children up to 8 years old - amoxicillin or flemoxyl in tablets or injections. The early stage of Lyme disease is very well and quickly cured, with little to no consequences.

The chronic stage of the disease differs from the early one, due to the peculiarities of the effect of Borrelia on the body's immune system. All co-infections are exacerbated, even many latent infections that were present before infection may be exacerbated. The immune system cannot cope with the enemy, individual pathogens become strong and active enough to cause pathologies, it is these pathologies that must be treated.

For the treatment of tick-borne Lyme borreliosis, antibiotics are mainly used: tetracyclines, penicillins and cephalosporins. The choice of drug depends on its effect on Borrelia in a particular patient.

Together with antibiotics, pathogenetic treatment is used, aimed at normalizing and mobilizing immunity, as well as for better penetration of antibiotics into tissues and organs.

Currently, the relevance of the treatment of patients with borreliosis is increasing due to the improvement in the diagnosis of this disease in patients of neurological, therapeutic, dermatological clinics.

Many doctors deal with Lyme disease - infectious disease specialists, neurologists, immunologists, cardiologists, rheumatologists.

Dangerous consequences of running berreliosis

Infection with borreliosis in Russia is growing year by year. This is a very dangerous and insidious disease. The non-erythemic form of the disease is especially dangerous.

A few years later, when health problems arise and a person goes to be treated by a doctor according to the profile of the disease - a neurologist, rheumatologist, surgeon, cardiologist and doctors treat the disease that has arisen, ascertain how these diseases have “rejuvenated”, and do not remember Borrelia. The cause remains and the disease progresses.

Lyme disease (ixodid tick-borne borreliosis, systemic tick-borne borreliosis, Lyme borreliosis) is a natural focal infectious disease with a transmissible pathogen transmission mechanism, characterized by a predominant lesion of the skin, nervous system, heart, joints and a tendency to chronic course.

ICD codes -10

A69.2. Lyme disease. Chronic erythema migrans caused by Borrelia burgdorferi.
L90.4. Acrodermatitis chronic atrophic.
M01.2. Arthritis in Lyme disease.

Etiology (causes) of Lyme disease

Pathogen- Gram-negative spirochete complex Borrelia burgdorferi sensu lato of the family Spirochaetaceae of the genus Borreliae. B. burgdorferi is the largest of the Borrelia: its length is 10–30 µm, its diameter is about 0.2–0.25 µm.

She is able to actively move with the help of flagella. A microbial cell consists of a protoplasmic cylinder, which is surrounded by a three-layer cell membrane containing a thermostable LPS with endotoxin properties. There are three groups of Borrelia antigens: surface (OspA, OspB, OspD, OspE and OspF), flagellar and cytoplasmic.

Borrelia are grown on a specially created liquid nutrient medium enriched with amino acids, vitamins, bovine and rabbit serum albumin and other substances (BSK medium).

Based on the methods of molecular genetics, more than ten genomic groups of Borrelia belonging to the Borrelia burgdorferi sensu lato complex have been identified. B. burgdorferi sensu stricto, B. garinii and B. afzelii are pathogenic for humans. The division of the pathogen into genomic groups is of clinical importance. Thus, B. burgdorferi sensu striсto is associated with a predominant lesion of the joints, B. garinii - with the development of meningoradiculitis, B. afzelii - with skin lesions.

Borrelia are unstable in the environment: they die when dried; well preserved at low temperatures; at a temperature of 50 °C they die within 10 minutes; die under the influence of ultraviolet radiation.

Epidemiology of Lyme Disease

The geographical distribution of Lyme disease is similar to the area of tick-borne encephalitis, which can lead to simultaneous infection with two pathogens and the development of mixed infection.

Pathogen reservoir - mouse-like rodents, wild and domestic animals; birds spreading infected ticks during migratory flights. The transmission of Borrelia to humans is carried out through the bites of ixodid ticks: I. ricinus, I. persulcatus - in Europe and Asia; I. scapularis, I. pacificus - in North America.

Ticks can attack humans at all stages of the life cycle: larva → nymph → adult. The possibility of transovarial and transphasic transmission of the pathogen in ticks has been established.

Stages of development of the ixodid tick

The spring-summer seasonality of the disease is due to the period of activity of ticks (May-September). The natural susceptibility of people is close to absolute. Cases of the disease are recorded among all age groups. More often the adult working-age population is ill.

Post-infectious immunity non-sterile; re-infection is possible.

The pathogenesis of Lyme disease

From the site of the bite with the saliva of the tick, Borrelia penetrate the skin, causing the development of migrating annular erythema. After the reproduction of the pathogen in the area of the entrance gate, hematogenous and lymphogenous dissemination occurs in the lymph nodes, internal organs, joints, and the central nervous system. In this case, there is a partial death of Borrelia with the release of endotoxin, which causes intoxication phenomena (malaise, headache, lack of appetite, fever).

B. burgdorferi stimulate the production of various inflammatory mediators (IL-1, IL-6, TNF-α) involved in the development of Lyme arthritis. In the pathogenesis of neuroborreliosis, the participation of autoimmune reactions is assumed. Of significant importance are the processes associated with the accumulation of specific immune complexes containing spirochete antigens in the synovial membrane of the joints, dermis, kidneys, and myocardium. The immune response in patients is relatively weak. In the early stages of the disease, IgM begins to be produced, the content of which reaches a maximum level at the 3–6th week of the disease. IgG are detected later; their concentration increases 1.5–3 months after the onset of the disease.

Clinical picture (symptoms) of Lyme disease

The incubation period is 5–30, more often 10–14 days.

There is no single classification for Lyme disease. The most common clinical classification (Table 17-42).

Table 17-42. Clinical classification of Lyme disease

The most common variant is the subclinical course of the infection. The fact of infection is confirmed by an increase in the titer of specific antibodies in paired sera. The acute course (from several weeks to 6 months) includes two successive stages - early localized infection and early disseminated infection.

The chronic form of the disease can last for life.

The main clinical manifestations of Lyme disease depending on the stage of the disease are presented in Table. 17-43.

Table 17-43. Clinical manifestations of Lyme disease at different stages of the infectious process

Damage to organs and systems	Early localized infection	Early disseminated infection	chronic infection
General infectious manifestations	flu-like syndrome	Weakness, malaise	chronic fatigue syndrome
lymphatic system	Regional lymphadenitis	Generalized lymphadenopathy	–
Leather	migrating erythema	Secondary erythema and exanthema	Benign lymphocytoma of the skin; chronic atrophic acrodermatitis
The cardiovascular system	–	atrioventricular block; myocarditis	–
Nervous system	–	Meningitis; meningoencephalitis; neuritis of the cranial nerves; radiculoneuritis; bannwart syndrome	Encephalomyelitis; radiculopathy; cerebral vasculitis
Musculoskeletal system	Myalgia	Migrating pains in bones, joints, muscles; first attacks of arthritis	Chronic polyarthritis

Stage of early localized infection

The onset of the disease is acute or subacute. The first symptoms of the disease are nonspecific: fatigue, chills, fever, fever, headache, dizziness, weakness, muscle aches, bone and joint pain. Often, against the background of intoxication, catarrhal phenomena occur (sore throat, dry cough, etc.), which are the cause of diagnostic errors.

The main manifestation of the early localized stage of Lyme disease is .

Erythema migrans

Within a few days, the area of redness expands (migrate) in all directions. Other symptoms of the acute period are variable and transient. Possible urticarial rash, small transient red dotted and ring-shaped rashes and conjunctivitis. In one third of patients, an increase in lymph nodes close to the entrance gate of infection is noted. In some patients, erythema is absent, then only fever and a general infectious syndrome are observed in the clinical picture.

The outcome of stage I can be a complete recovery, the likelihood of which increases significantly with adequate antibiotic therapy. Otherwise, even with the normalization of temperature and the disappearance of erythema, the disease passes into the stage of disseminated infection.

Stage of early disseminated infection

It develops several weeks or months after the end of the stage of early localized infection. Hematogenous spread of infection is most often accompanied by changes in the nervous and cardiovascular systems, skin. Damage to the nervous system usually occurs at 4–10 weeks of illness and is expressed in the development of cranial neuritis, meningitis, radiculoneuritis, lymphocytic meningoradiculoneuritis (Bannwart's syndrome). Bannwart's syndrome is a variant of neuroborreliosis common in Western Europe. It is characterized by a sluggish course, pronounced radicular (mainly nocturnal) pain, lymphocytic pleocytosis in the CSF.

Heart lesions in Lyme borreliosis are quite diverse: these are conduction disturbances (for example, atrioventricular block - from I degree to complete transverse block), rhythm, myocarditis, pericarditis.

During this period, patients experience transient multiple erythematous skin lesions. Parotitis, eye lesions (conjunctivitis, iritis, choroiditis, retinitis, panophthalmitis), respiratory organs (pharyngitis, tracheobronchitis), genitourinary system (orchitis, etc.) are less commonly found.

Stage of chronic infection

The chronic course of Lyme disease is characterized by a predominant lesion of the joints, skin and nervous system.

Usually, patients experience progressive arthralgia, followed by chronic polyarthritis. Most patients experience arthritis relapses over a number of years.

In some cases, chronic infection occurs in the form of benign skin lymphocytoma and chronic atrophic acrodermatitis.

Benign lymphocytoma of the skin is characterized by nodular elements, tumors, or indistinctly demarcated infiltrates. Chronic atrophic acrodermatitis is characterized by skin atrophy, which develops after the previous inflammatory-infiltrative stage.

In chronic infection, nervous system disorders develop between one and ten years after the onset of the disease. Late lesions of the nervous system include chronic encephalomyelitis, polyneuropathy, spastic paraparesis, ataxia, chronic axonal radiculopathy, memory disorders, and dementia.

The chronic course of Lyme disease is characterized by alternating periods of remissions and exacerbations, after which other organs and systems are involved in the infectious process.

Diagnosis of Lyme disease

When taking an anamnesis and examining a patient, pay attention to:

seasonality (April-August);
visits to endemic areas, forests, tick attacks;
fever
The presence of a rash on the body, erythema at the site of a tick bite;
stiffness of the muscles of the neck;
signs of inflammation of the joints.

Laboratory methods for suspected Lyme disease

In the acute period of the disease, a general blood test is characterized by an increase in ESR, leukocytosis. In the presence of nausea, vomiting, stiff neck muscles, positive Kernig's symptom, spinal puncture with microscopic examination of the CSF is indicated (Gram stain; counting of formed elements, bacteriological examination, determination of glucose and protein concentrations).

Instrumental research methods

With damage to the nervous system:
- methods of neuroimaging (MRI, CT) - with prolonged neuritis of the cranial nerves;
- ENMG - to assess the dynamics of the disease.
Arthritis - X-ray examination of the affected joints.
With damage to the heart - ECG, EchoCG.

The absence of erythema in the acute period of the disease complicates the clinical diagnosis of Lyme disease, therefore, in such cases, specific diagnosis plays an important role (Fig. 17-8).

Specific Laboratory Diagnosis of Lyme Disease

For laboratory diagnostics, the following methods are used: the detection of DNA fragments in PCR and the determination of antibodies to Borrelia.

Currently, the effectiveness of PCR diagnostics at different stages of the disease is being studied, methods for studying various biological substrates (blood, urine, CSF, synovial fluid, skin biopsies) are being developed.

In this regard, PCR is not yet included in the standard for diagnosing Lyme borreliosis, but is used for scientific purposes.

The basis of the diagnostic algorithm for Lyme disease is serological diagnostics (ELISA, RNIF). Immunoblotting is used as a confirmatory test to exclude false positive reactions. Studies for the presence of antibodies to Borrelia should preferably be carried out in dynamics in paired sera taken at intervals of 2–4 weeks.

Differential diagnosis of Lyme disease

Erythema migrans is a pathognomonic symptom of Lyme borreliosis, the detection of which is sufficient for a definitive diagnosis (even without laboratory confirmation). Difficulties in diagnosis are caused by forms of the disease that occur without erythema, as well as chronic lesions of the cardiovascular, nervous, musculoskeletal system and skin.

Differential diagnosis is carried out with other vector-borne diseases with a similar distribution area (see Tables 18-47 on p. 903).

Isolated joint damage must be differentiated from infectious arthritis, reactive polyarthritis, and, in combination with skin pathology, from collagenosis. In some cases, Lyme disease is differentiated from acute rheumatism, with neurological disorders - from other inflammatory diseases of the peripheral and central nervous system. With the development of myocarditis, AV blockade, infectious myocarditis of another etiology should be excluded. The basis of differential diagnosis in these cases is serological studies for the presence of antibodies to Borrelia.

Rice. 17-8. Algorithm for clinical and laboratory diagnosis of Lyme borreliosis.

Indications for consulting other specialists

Neurologist - with damage to the central nervous system and peripheral nervous system.
Cardiologist - with hypotension, shortness of breath, heart rhythm disturbances, changes in the ECG.
Dermatologist - for exanthema and inflammatory-proliferative skin diseases.
Rheumatologist - with edema, pain in the joints.

Diagnosis example

A69.2. Lyme disease, acute course, stage of early localized infection. Migrating erythema of moderate severity.

Indications for hospitalization

Patients with Lyme borreliosis do not pose an epidemic danger. The following categories of patients are subject to hospitalization:

with moderate and severe course of the disease;
in case of suspected mixed infection with tick-borne encephalitis virus;
in the absence of erythema (for differential diagnosis).

Lyme Disease Treatment

Mode. Diet

The patient's activity mode is determined by the severity of the course of the disease:

ward regime - with mild, moderate course of the disease;
bed rest - with severe course, myocarditis, cardiac arrhythmias, meningoencephalitis, polyarthritis.

A special diet for patients is not required (table number 15).

Medical treatment for Lyme disease

The basis of treatment is antibacterial drugs, the doses and duration of which are determined by the stage and form of the disease (Tables 17-44).

Timely started treatment promotes rapid recovery and prevents chronicity of the process.

Table 17-44. Antibiotic regimens for Lyme disease

The nature of the flow	The form	A drug	single dose	Method of administration	Multiplicity of reception	Duration, days
Acute	Stage of early localized infection	The main drug is doxycycline	0.1 g	inside	2	10
		Drugs of choice
		Amoxicillin	0.5 g	inside	3	10
		Cefixime	0.4 g	inside	1	10
		Azithromycin	0.5 g	inside	1	10
		Amoxiclav	0.375 g	inside	3	10
Acute	Stage of early disseminated infection		2 g	Intramuscular	1	14
		Alternative drugs
		Cefotaxime	2 g	Intramuscular	3	14
		Penicillin	0.5–2 million units	Intramuscular	8	14
		Doxycycline	0.2 g	inside	1	14
		Amoxicillin	0.5 g	inside	3	14
chronic course	–	The main drug is ceftriaxone	2 g	Intramuscular	1	21
		Drugs of choice
		Cefotaxime	2 g	Intramuscular	3	21
		Penicillin	2–3 million units	Intramuscular, intravenous	6–8	21

In cases of mixed infection (lyme borreliosis and tick-borne encephalitis), along with antibiotics, immunoglobulin against tick-borne encephalitis is used in calculated doses.

Detoxification therapy is carried out according to general principles. According to individual indications, vascular agents and antioxidants are used.

During the rehabilitation period, hyperbaric oxygen therapy, exercise therapy, and massage are carried out. Sanatorium-and-spa treatment is indicated for patients in remission with a chronic course with damage to the osteoarticular and nervous systems.

Forecast

The prognosis for life is favorable. With late or inadequate therapy, the disease progresses, becomes chronic and often leads to disability.

Approximate periods of incapacity for work

Acute course, stage of early localized infection - 7-10 days.
Acute course, stage of early disseminated infection - 15-30 days.

Clinical examination

Dispensary observation in a polyclinic is carried out by a general practitioner or an infectious disease specialist for 2 years. In the case of a mixed infection with tick-borne encephalitis, the period of dispensary observation is increased to 3 years.

When examining patients, special attention is paid to the condition of the skin, osteoarticular, cardiovascular and nervous systems. In the absence of complaints and a drop in antibody titers to B. burgdorferi, patients are removed from the dispensary.

Reminder for the patient with Lyme disease

Infection with Lyme disease occurs only when bitten by an infected tick. All people are susceptible to tick-borne borreliosis, regardless of age and gender. The incubation period is 10–14 days. The course of the disease is varied. At the first stage of the disease, which lasts up to one month, malaise, fever, and muscle pain are possible. The main symptom is reddening of the skin at the site of a tick bite, gradually increasing in size and reaching 60 cm in diameter. The second stage (1–6 months) is characterized by the development of neurological and cardiovascular complications. At a late stage of the disease (more than 6 months), articular, skin and other inflammatory processes develop. The main means of treating the disease at all stages is antibiotics.

Prevention of Lyme disease

Specific prophylaxis has not been developed.

Measures to prevent infection:

· acaricidal treatment of forest park areas, places of mass recreation of people, local treatment of the most visited forest areas;
wearing protective clothing when walking in the forest;
individual application of repellents;
self- and mutual examinations after visiting the forest;
Immediate removal of the detected tick and treatment of the bite site with iodine tincture;
examination of the tick for the presence of Borrelia and tick-borne encephalitis virus in the laboratory;
Contacting a doctor upon detection of the first signs of the disease (fever, redness of the skin at the site of the bite).

For emergency prevention, antibiotics of various groups are used: doxycycline, bicillin-3, amoxicillin, amoxicillin trihydrate + clavulanic acid.

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 of tick-borne borreliosis (Lyme disease) extensively, it is found on all continents (except Antarctica). Consider very endemic (constant manifestation of this disease in a certain area) Leningrad, Tver, Yaroslavl, Kostroma, Kaliningrad, Perm, Tyumen regions, as well as the Ural, West Siberian and Far Eastern regions for ixodid tick-borne borreliosis. On the territory of the 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 of the disease 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 leading role in the prevention of Lyme disease is the fight against ticks, 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 come 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 worldwide range of infections that now appear under the general 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, which is explained by the presence of concomitant chronic pathology (atherosclerosis, hypertension). No deaths from Lyme disease have been reported to date.