Tick-borne borreliosis symptoms and treatment in adults. Atrophic changes in the skin

Lyme disease(or Lyme disease, tick-borne borreliosis, Lymeborreliosis) is an infectious predominantly transmissible disease with a large polymorphism of clinical manifestations and caused by at least three species of bacteria of the genus Borrelia, a type of spirochete. Borrelia burgdorferi dominates as the causative agent of Lyme disease in the United States, while Borrelia afzelii and Borrelia garinii dominate in Europe.
Lyme disease is the most common tick-borne disease in the Northern Hemisphere. The bacteria are transmitted to humans through the bite of infected Ixodes ticks belonging to several species of the genus Ixodes. Early manifestations of the disease may include fever, headaches, fatigue and a characteristic skin rash called erythema migrans. In some cases, in the presence of a genetic predisposition, joint tissue, the heart, as well as the nervous system and eyes are involved in the pathological process. In most cases, symptoms can be relieved with antibiotics, especially if diagnosis and treatment are carried out in the early stages of the disease. Inadequate therapy can lead to the development of “late stage” or chronic Lyme disease, when the disease becomes intractable, causing disability, or leading to death. Differences in opinion regarding the diagnosis, testing and treatment of Lyme disease have led to two different standards of care.

History of the study of Lyme disease, borreliosis

The first report of systemic tick-borne borreliosis appeared in 1975 in the USA, where on November 1 in the state of Connecticut, in the small town of Lyme, cases of this disease were registered. Two women whose children suffered from “juvenile rheumatoid arthritis” contacted the health department. It has been noted that several adults also suffer from this disease. A study conducted by the Centers for Disease Control's Division of Rheumatology and researcher Allen Steere found that 25% of patients had juvenile arthritis. It was noted that the disease occurs after a tick bite, and arthritis was often combined with migratory erythema annulare. This peculiar skin lesion was known in Europe as erythema of Aphrelius.

The incidence of juvenile rheumatoid arthritis ranges from 1 to 15 per 100,000 children (under 16 years of age). The prevalence of juvenile rheumatoid arthritis in different countries is 0.05-0.6%. A. Steer noted that in the state of Connecticut the number of sick children is 100 times higher than this number. The main vector of the pathogen, the ixodes tick (Ixodes damini), was identified in 1977. In 1982, Willy Burgdorfer first isolated spirochete-like microorganisms from ticks, representing a new species of the genus Borrelia, which was subsequently named Borrelia burdorferi.

American researchers also isolated Borrelia burdorferi from the blood and cerebrospinal fluid of those affected by borelliosis, and antibodies to B. burdorferi were found in a number of patients in the same biological environments, which made it possible to completely decipher the etiology and epidemiology of this disease. The disease was named Lyme disease (due to the fact that this was the name of the city where the first patients were seen). Lyme disease is being detected in the United States, where it is currently reported in 25 states. Clinical manifestations of the disease, similar to systemic tick-borne borreliosis, have been noted in the Baltic states, northwestern and central regions of Russia, as well as in the Urals, the Urals, Western Siberia and the Far East. In recent years, cases of Lyme disease have been reported in several European countries.

Classification of Lyme disease, borreliosis

Forms of the disease: latent, manifest.

• With the flow:
  • acute
  • subacute
  • chronic;
• According to clinical signs:
  • Acute and subacute course
    • erythema form
    • non-erythema form

with primary damage to the nervous system, heart, joints

• • Chronic course
    • continuous
    • recurrent

with primary damage to the nervous system, joints, skin, heart

• By severity:
  • heavy
  • moderate severity
  • light
• Signs of infection:
  • seronegative
  • seropositive

The latent form is diagnosed when laboratory confirmation of the diagnosis, but the absence of any signs of the disease. According to the course: acute course - duration of the disease up to 3 months, subacute - from 3 to 6 months, chronic course - more than 6 months. According to clinical signs in acute and subacute course, the following are distinguished: erythema form - in case of development of skin erythema at the site of the tick bite, and non-erythema form - in the presence of fever, intoxication, but without erythema. Each of these forms can occur with symptoms of damage to the nervous system, heart, and joints.

Epidemiology of Lyme disease, borreliosis

In nature, many vertebrates are the natural hosts of the causative agent of Lyme disease: white-tailed deer, rodents, dogs, sheep, birds, cattle. The main vectors of Borrelia are ixodid ticks: Ixodes damini - in the USA, Ixodes ricinus, Ixodes persulcatus - in Europe and our country. It is very difficult to detect the spirochete in mammalian tissues. This microorganism is not only extremely small, forms spore forms, but is also, as a rule, present in tissues in very small quantities. The most reliable method for detecting B. burgdorferi is to treat the sample with specific Borrelia antibodies labeled with fluorescein. Using this method, Borrelia were found in the eyes, kidneys, spleen, liver, testes and brain of various mammals, as well as some species of passerines (judging by the geography of systemic tick-borne borreliosis, Borrelia are spread by migrating birds with infected ticks attached to them). In areas where Lyme disease is highly endemic, borrelia are present in up to 90% of the digestive system of Ixodes ticks, but only a few of them have borrelia in the salivary glands. As it becomes clear from the above, it is ticks that serve as the main reservoir of B. burgdorferi, since their infection continues throughout their lives, and they can transmit it transovarially to their offspring. Ticks are extremely widespread in regions with temperate climates, especially in mixed forests. The life cycle of Ixodes damini usually lasts 2 years. Adult ticks can be found in bushes, about a meter from the ground, from where they can easily move onto large mammals. Only females overwinter; males die soon after mating.

Since Borrelia enters the human body only with the saliva of the tick, during suction, infection of people occurs infrequently. Lyme disease affects people of all genders and ages equally. Several studies have reported spontaneous miscarriages as well as congenital heart defects in fetuses whose mothers were infected with B. burgdorferi during pregnancy. The detection of borrelia in various fetal organs (brain, liver, kidneys) indicates transplacental transmission of the pathogen. However, in none of these cases was there evidence of an inflammatory reaction in the affected tissues, so it is impossible to make a definitive conclusion about the causal relationship between the presence of spirochetes and an unfavorable outcome for the fetus. Although the existence of congenital Lyme borreliosis remains questionable at this time, pregnant women infected with B. burgforferi should be treated with antibiotics. Systemic tick-borne borreliosis is characterized by spring-summer seasonality (May-September), which corresponds to the greatest activity of ticks. The risk of infection increases for those who keep pets. The geographic distribution of systemic tick-borne borreliosis is similar to the area of ​​tick-borne encephalitis, which makes it possible for simultaneous infection by two pathogens and the development of a mixed infection.

Pathogenesis of Lyme disease, borreliosis

The pathogen of systemic tick-borne borreliosis enters the human body with the saliva of the tick. Migrating ring-shaped erythema develops on the skin at the site of tick suction. From the site of introduction, the pathogen enters the internal organs, joints, and lymphatic formations through the lymph and blood flow; perineural, and subsequently rostral, spread with involvement of the meninges in the inflammatory process. When Borrelia die, they release endotoxin, which causes a cascade of immunopathological reactions.

When the pathogen enters various organs and tissues, active irritation of the immune system occurs, which leads to a generalized and local humoral and cellular hyperimmune response. At this stage of the disease, the production of IgM and then IgG antibodies occurs in response to the appearance of the 41-kD flagellar flagellar antigen of Borrelia. An important immunogen in pathogenesis are the surface proteins Osp C, which are characteristic primarily of European strains. In case of disease progression (absence or insufficient treatment), the spectrum of antibodies to spirochete antigens (to polypeptides from 16 to 93 kDa) expands, which leads to long-term production of IgM and IgG. The number of circulating immune complexes increases.

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

The cellular immune response develops as the disease progresses, with the greatest reactivity of mononuclear cells manifesting itself in target tissues. The level of T-helpers and T-suppressors, the index of stimulation of blood lymphocytes, increases. It has been established that the degree of change in the cellular component of the immune system depends on the severity of the disease.

The leading role in the pathogenesis of arthritis is played by liposaccharides that are part of borrelia, which stimulate the secretion of interleukin-1 by cells of the monocyte-macrophage series, some T-lymphocytes, B-lymphocytes, etc. Interleukin-1, in turn, stimulates the secretion of prostaglandins and collagenase by synovial tissue, that is, it activates inflammation in the joints, which leads to bone resorption, destruction of cartilage, and stimulates the formation of pannus.

Of significant importance are the processes associated with the accumulation of specific immune complexes containing spirochete antigens in the synovial membrane of joints, dermis, kidneys, and myocardium. The accumulation of immune complexes attracts neutrophils, which produce various inflammatory mediators, biologically active substances and enzymes that cause inflammatory and dystrophic changes in tissues. The pathogen persists in the body for more than 10 years, apparently in the lymphatic system, but the reasons leading to this are unknown.
A slow immune response associated with relatively late and mild borrelemia, the development of autoimmune reactions and the possibility of intracellular persistence of the pathogen are some of the main reasons for the chronicity of the infection.

Congenital Lyme borreliosis

As with other spirochetoses, immunity in Lyme disease is non-sterile. Those who have recovered may be re-infected after 5-7 years.

Clinical picture of Lyme disease, borreliosis

Incubation period of borreliosis (Lyme disease)

The incubation period from infection to the onset of symptoms is usually 1-2 weeks, but it can be much shorter (several days) or longer (months to years). Symptoms typically appear from May to September, as tick nymphs develop during this time, causing most infestations. Asymptomatic infections do occur, but statistically account for less than 7% of Lyme disease infections in the United States. The asymptomatic course of the disease is more typical for European countries.

By stage, Lyme disease is divided into 2 stages:

• Early period
  • Stage I
  • Stage II
• Late period
  • Stage III

Stage Iborreliosis (Lyme disease)

characterized by acute or subacute onset. The first manifestations of the disease are nonspecific: chills, fever, headache, muscle aches, severe weakness and fatigue. Stiffness of the neck muscles is characteristic. Some patients experience nausea and vomiting, and in some cases there may be catarrhal symptoms: sore throat, dry cough, runny nose. At the site of tick suction, a spreading ring-shaped redness appears - migratory ring-shaped erythema, which occurs in 60-80% of patients. Sometimes erythema is the first symptom of the disease and precedes the general infectious syndrome. In such cases, patients first turn to an allergist or dermatologist, who diagnoses an “allergic reaction to a tick bite.” First, a macula or papule appears at the site of the bite within 1-7 days, and then over the course of several days or weeks the area of ​​redness expands (migrates) in all directions. Its edges are intensely red and slightly raised above the unaffected skin in the form of a ring, and in the center the erythema is slightly paler. Sometimes migrating annular erythema is accompanied by regional lymphadenopathy. The erythema is usually oval or round, with a diameter of 10-20 cm, sometimes up to 60 cm. Within such a large area there may be individual ring-shaped elements. In some patients, the entire affected area is uniformly red; in others, vesicles and areas of necrosis appear against the background of erythema. Most patients indicate discomfort in the area of ​​erythema, a minority experience severe burning, itching and pain. Migratory ring-shaped erythema is most often localized on the legs, less often on the lower part of the body (abdomen, lower back), in the axillary and groin areas, and on the neck. In some patients, along with primary skin lesions at the site of tick suction, multiple ring-shaped rashes appear within a few days, resembling migratory erythema, but they are usually smaller in size than the primary lesion. The mark left by a tick can remain visible for several weeks in the form of a black crust or bright red spot. Other skin symptoms have been noted: utricarial rash on the face, urticaria, small transient red dotted and ring-shaped rashes, and conjunctivitis. In approximately 5-8% of patients, already in the acute period, signs of damage to the soft membranes of the brain appear, manifested by general cerebral symptoms (headache, nausea, repeated vomiting, hyperesthesia, photophobia, the appearance of meningeal symptoms). During lumbar puncture in such patients, increased cerebrospinal fluid pressure (250-300 mm water column), as well as moderate lymphocytic pleocytosis, increased protein and glucose levels are recorded. In some cases, the composition of the cerebrospinal fluid does not change, which is regarded as a manifestation of meningism. Patients often experience myalgia and arthralgia. In the acute period of the disease, some patients exhibit signs of anicteric hepatitis, which manifest themselves in the form of anorexia, nausea, vomiting, pain in the liver, and an increase in its size. The activity of transaminases and lactate dehydrogenase in the blood serum increases. Migrating annular erythema is a constant symptom of stage I of the disease, other symptoms of the acute period are changeable and transient. In approximately 20% of cases, cutaneous manifestations are the only manifestation of stage I Lyme disease. In some patients, erythema goes unnoticed or is absent. In such cases, in stage I only fever and general infectious symptoms are observed. In 6-8% of cases, a subclinical course of infection is possible, with no clinical manifestations of the disease.

The absence of symptoms of the disease does not exclude the development of subsequent stages II and III of the disease. As a rule, stage I lasts from 3 to 30 days. The outcome of stage I may be recovery, the likelihood of which increases significantly with adequate antibacterial treatment. Otherwise, even with normalization of body temperature and disappearance of erythema, the disease gradually passes into the so-called late period, including stages II and III.

Stage II borreliosis (Lyme disease)

characterized by dissemination of the pathogen through the blood and lymph flow throughout the body. True, stage II does not occur in all patients. The timing of its onset varies, but most often, 10-15% of patients develop neurological and cardiac symptoms 1-3 months after the onset of the disease. Neurological symptoms may include meningitis, meningoencephalitis with lymphocytic cerebrospinal fluid pleocytosis, cranial nerve palsy and peripheral radiculopathy. This combination of symptoms is quite specific to Lyme disease. Characterized by throbbing headache, stiff neck, photophobia, fever is usually absent; Patients, as a rule, are bothered by significant fatigue and weakness. Sometimes there is moderate encephalopathy, consisting of disorders of sleep and memory, concentration, and severe emotional lability. Of the cranial nerves, the facial one is most often affected, and isolated paralysis of any cranial nerve may be the only manifestation of Lyme disease. With this disease (as with sarcoidosis and Guillain-Barré syndrome), bilateral facial paralysis is observed. Damage to the facial nerve can occur without impairment of sensitivity, hearing, or lacrimation.

Without antibiotic therapy, meningitis can last from several weeks to several months. A characteristic feature of systemic tick-borne borreliosis is the combination of meningitis (meningoencephalitis) with neuritis of the cranial nerves and radiculoneuritis. In Europe, among neurological lesions, the most common lymphocytic meningoradiculoneuritis of Bannawart, in which intense radicular pain appears (cervicothoracic radiculitis is more common), changes in the cerebrospinal fluid, indicating serous meningitis, although in some cases meningeal symptoms are mild or absent. Neuritis of the oculomotor, optic and auditory nerves is possible. In children, meningeal syndrome usually predominates; in adults, the peripheral nervous system is more often affected. Patients with Lyme disease may have more severe and prolonged manifestations of the nervous system: encephalitis, myelitis, chorea, cerebral ataxia. In stage II of the disease, the cardiovascular system also continues, which, however, is observed less frequently than damage to the nervous system and does not have characteristic features. Typically, 1-3 months after erythema migrans annulare, 4-10% of patients experience cardiac abnormalities. The most common symptom is conduction disturbances such as atrioventricular block, including complete transverse block, which, although rare, is a typical manifestation of systemic tick-borne borreliosis. It is difficult to document transient block due to its transient nature, but an ECG is desirable in all patients with erythema annulare migrans because complete transverse block is usually preceded by less severe arrhythmias. With Lyme disease, pericarditis and myocarditis may develop. Patients experience palpitations, shortness of breath, chest pain, and dizziness. Sometimes cardiac damage is detected on an ECG only by prolongation of the PQ interval. Conduction disturbances usually go away on their own within 2-3 weeks, but complete atrioventricular block requires the intervention of cardiologists and cardiac surgeons. In the early years of studying the clinical picture of Lyme disease, it was believed that stage II was characterized mainly by neurological and cardiac manifestations. However, in recent years, evidence has accumulated indicating that this stage has very clear clinical polymorphism, due to the ability of Borrelia to penetrate any organs and tissues and cause mono- and multi-organ lesions. Thus, skin lesions can occur with secondary ring-shaped elements, an erythematous rash on the palms of the capillary type, diffuse erythema and utricarial rash, and benign skin lymphocytoma. Along with erythema annular migrans, benign cutaneous lymphocytoma is considered one of the few manifestations of Lyme disease. Clinically, benign skin lymphocytoma is characterized by the appearance of a single infiltrate or nodule or disseminated plaques. The most commonly affected areas are the earlobes, nipples and areolas of the mammary glands, which look swollen, bright crimson and slightly painful on palpation. The face, genitals and groin areas are also affected. The duration of the course (wavy) is from several months to several years. The disease can be combined with any other manifestations of systemic tick-borne borreliosis. The clinical picture of benign cutaneous lymphocytoma has been well studied thanks to the research of Grosshan, who proved the spirochetal etiology of this condition even before the discovery of Lyme disease. At the dissemination stage of Lyme disease, various nonspecific clinical manifestations also occur: conjunctivitis, iritis, choriretinitis, panophthalmos, tonsillitis, bronchitis, hepatitis, splenitis, orchitis, microhematuria or proteinuria, as well as severe weakness and fatigue.

I II stage borreliosis (Lyme disease)

is formed in 10% of patients 6 months - 2 years after the acute period. The most studied in this period are joint lesions (chronic Lyme arthritis), skin lesions (atrophic acrodermatitis), as well as chronic neurological syndromes resembling the tertiary period of neurosyphilis in terms of development. Currently, a number of etiologically undeciphered diseases are presumably associated with borreliosis infection, for example, progressive encephalopathy, recurrent meningitis, multiple mononeuritis, some psychoses, convulsive conditions, transverse myelitis, cerebral vasculitis.

In stage III, there are 3 types of joint damage:

• Arthralgia;
• Benign recurrent arthritis;
• Chronic progressive arthritis.

Migrating arthralgia is observed quite often - in 20-50% of cases, accompanied by myalgia, especially intense in the neck, as well as tenosynovitis, and occasionally, quickly passing monoarthritis. Objective signs of inflammation are usually absent even with high intensity arthralgia, which sometimes immobilizes patients. As a rule, joint pain is intermittent, lasting for several days, combined with weakness, fatigue, and headache. Pain in the joints of very significant severity can be repeated several times, but goes away on its own. In the second type of joint damage, arthritis develops, often chronologically associated with a tick bite or the development of migratory cutaneous erythema. Patients are bothered by abdominal pain, headaches, and polyadenitis is detected. Other nonspecific symptoms of intoxication are also recorded. This variant of joint damage develops from several weeks to several months after the onset of migratory cutaneous erythema. The most common is asymmetric monooligoarthritis involving the knee joints; less typical are the development of Baker's cysts (protrusion of the knee joint bursa during an exudative inflammatory process) and damage to small joints. Joint pain can bother patients from 7-14 days to several weeks, and can be repeated several times, with the intervals between relapses ranging from several weeks to several months. Subsequently, the frequency of relapses decreases, attacks become increasingly rare and then stop completely. It is believed that this benign variant of arthritis, which occurs as an infectious-allergic type, does not last longer than 5 years. A significant number of patients may have only 1-2 episodes of arthritis. The third type of joint damage - chronic arthritis - usually does not develop in all patients (10%), and after a period of intermittent oligoarthritis or migratory polyarthritis. The articular syndrome becomes chronic, accompanied by the formation of pannus (inflammation of the cornea of ​​the eyes) and cartilage erosions; sometimes morphologically indistinguishable from rheumatoid arthritis. In chronic Lyme arthritis, not only the synovial membrane is affected, but also other joint structures, such as periarticular tissues (bursitis, ligamentitis, enthesopathies). In later stages, changes typical of chronic inflammation are revealed in the joints: osteoporosis, thinning and loss of cartilage, cortical and marginal lesions (disappearance of a limited part of the organ), less often degenerative changes: osteophytosis (layering of loose young mass on the bone), subarticular sclerosis.

The clinical course of Lyme arthritis may be similar to that of rheumatoid arthritis, ankylosing spondylitis and other seronegative spondyloarthritis. The late period of Lyme disease is characterized by much less pronounced clinical polymorphism, and the leading ones, in addition to joint damage, are considered to be peculiar lesions of the nervous system (chronic encephalomyelitis, spastic paraparesis, some memory disorders, dementia, chronic axonal polyradiculopathy). Late-stage skin lesions include atrophic acrodermatitis and focal scleroderma. Acrodermatitis atrophicum occurs at any age. The onset of the disease is gradual and is characterized by the appearance of cyanotic-red spots on the extensor surfaces of the extremities (knees, elbows, dorsum of the hands, soles). Inflammatory infiltrates often appear, but nodules of fibrous consistency, swelling of the skin, and regional lymphadenopathy may be observed. The extremities are usually affected, but other areas of the trunk may also be involved. The inflammatory (infiltrative) phase develops over a long period of time, persisting for many years, and turns into a sclerotic one. The skin at this stage atrophies and resembles crumpled tissue paper. Some patients (1/3) have simultaneous damage to bones and joints, 45% have sensory and, less commonly, motor disorders. The latent period before the development of acrodermatitis atrophica ranges from 1 year to 8 years or more. After the first stage of Lyme disease, a number of researchers isolated the pathogen from the skin of patients with acrodermatitis atrophica with a disease duration of 2.5 years and 10 years. Borreliosis infection negatively affects pregnancy. Despite the fact that pregnancy in women with Lyme disease can proceed normally and result in the birth of a healthy child, there is the possibility of intrauterine infection and the occurrence of congenital borreliosis, similar to congenital syphilis. Cases of death in newborns a few hours after birth due to serious congenital heart pathology (aortic valve stenosis, coarctation of the aorta, endocardial fibroelastosis), cerebral hemorrhage, etc. have been described. At autopsy, borrelia are found in the brain, heart, liver, and lungs. Cases of stillbirth and intrauterine fetal death have been observed. It is believed that borreliosis may be the cause of toxicosis in pregnant women. In the blood with systemic tick-borne borreliosis, an increase in the number of leukocytes and ESR is detected. Gross hematuria may be detected in the urine. Biochemical studies in some cases reveal an increase in aspartate aminotransferase activity. Not every patient experiences all stages of the disease.

Chronic symptoms of borreliosis (Lyme disease)

If the disease is treated ineffectively, or not treated at all, 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 nature. The most common syndrome is arthritis, which recurred over several years and acquired a chronic course through the destruction of bones and cartilage.

Changes such as osteoporosis, thinning and loss of cartilage, and less commonly degenerative changes are observed.

Among the skin lesions there is a benign lymphocytoma, which has the appearance of a dense, edematous, crimson nodule (infiltrate) and causes pain on palpation. A typical syndrome is acrodermatitis atrophica, which causes atrophy of the skin.

Diagnosis of borreliosis (Lyme disease)

Lyme disease is diagnosed based on an epidemiological history (visiting a forest, sucking a tick), taking into account the time of year (summer, early autumn), as well as the clinical picture: the appearance of migratory annular erythema. Subsequently, neurological, articular and cardiac symptoms join the skin lesions. It should be borne in mind that some patients do not notice or forget that they removed the tick from the skin. In these cases, the presence of clinical stages of the disease, as well as laboratory data, is of diagnostic importance. Borrelia can be isolated in pure culture from affected tissues and biological fluids of a sick person (marginal zone of migrating annular erythema, skin biopsies for benign skin lymphocytoma and chronic atrophic acrodermatitis). Since the number of spirochetes in tissues and body fluids is insignificant, the direct release of the causative agent of Lyme disease varies widely. For example, the isolation of Borrelia from the marginal zone of migratory annular erythema ranges from 6-45%. The results of isolating Borrelia from cerebrospinal fluid and blood are even lower and depend on the stage of the disease. Spirochetes can be seen under a microscope after silver impregnation using the Warthin-Starry method. Very important to confirm the diagnosis is a serological study, which is based on the detection of antibodies to Borrelia in blood serum, cerebrospinal and synovial fluids, using the indirect immunofluorescence reaction (IRIF), enzyme-linked immunosorbent assay (ELISA) and immunoblotting. In these reactions, both whole microbial cells and ultrasonic disruptors of B.burgdorferi are used as antigen. RNIF usually uses whole microbial cells. A titer of 1:64 or higher is considered diagnostically significant. Less commonly used for diagnosis are the indirect agglutination reaction and immunofluorometry. Laboratory diagnostic methods are essential in establishing the diagnosis of erased, subclinical forms and in later stages. It should be noted that in the early stages of Lyme disease, serological testing is uninformative in approximately 50% of cases, so it is important to study paired sera with an interval of 20-30 days. Late stages of the disease are characterized by a significant increase in antibody titers, especially in acrodermatitis atrophicus (100% of cases). In chronic arthritis, the isolation of Borrelia from the blood at low antibody titers in the serum has been described. False-positive serological reactions are observed in patients with syphilis, relapsing fever, other spirochetoses, as well as in rheumatic diseases and infectious mononucleosis.

Differential diagnosis of Lyme disease

The differential diagnosis of Lyme disease depends on the stage of its development. It is necessary to differentiate systemic tick-borne borreliosis from tick-borne encephalitis, erysipelas, erysepeloid, cellulite, etc. Borreliosis must be differentiated from the listed diseases in stage I. In stage II, differential diagnosis must be made with various forms of tick-borne encephalitis, rheumocarditis and cardiopathy. In stage III, differential diagnosis must be made with rheumatism, rheumatoid arthritis, reactive arthritis, and Reiter's disease. Morphological studies of the synovium help in differential diagnosis.

Treatment of borreliosis (Lyme disease)

Treatment of Lyme disease should be comprehensive and include adequate etiotropic and pathogenetic agents. The stage of the disease must be taken into account.

If treatment with antibacterial drugs is started already at stage I, provided there are no signs of damage to the nervous system, heart, joints, then the likelihood of developing neurological, cardiac and arthralgic complications is significantly reduced. In the early stages, tetracycline is considered the drug of choice at a dose of 1.0-1.5 g/day for 10-14 days. Untreated migrating annular erythema can disappear spontaneously, on average after 1 month (from 1 day to 14 months), however, antibacterial treatment helps the erythema disappear in a shorter period of time, and most importantly, can prevent the transition to stages II and III of the disease.

Along with tetracycline, doxycycline (vibramycin) is also effective for Lyme disease, which must be prescribed to patients with skin manifestations of the disease (erythema migrans annulare, benign skin lymphoma) - 0.1 g 2 times a day, the course of treatment is 10 days. Children under 8 years of age are prescribed amoxicillin (Amoxil, Flemoxin) orally 30-40 mg/(kg day) in 3 doses or parenterally 50-100 mg/(kg day) in 4 injections. It is impossible to reduce the single dose of the drug and reduce the frequency of dosing, since in order to obtain a therapeutic effect it is necessary to constantly maintain a sufficient bacteriostatic concentration of the antibiotic in the patient’s body. If signs of damage to the nervous system, heart, and joints are detected in patients (in patients with acute and subacute course), it is not advisable to prescribe tetracycline drugs, since in some patients, after the course of treatment, relapses, late complications occurred, and the disease became chronic. When identifying neurological, cardiac and articular lesions, penicillin or cefotaxime, ceftriaxone are usually used.

Penicillin is prescribed to patients with systemic tick-borne borreliosis with lesions of the nervous system in stage II, and in stage I for myalgia and fixed arthralgia. High doses of penicillin are used - 20,000 units/kg per day intramuscularly or in combination with intravenous administration. However, ampicillin in a daily dose of 100 mg/kg for 10-30 days has recently been considered more effective. From the group of cephalosporins, the most effective antibiotic for Lyme disease is ceftriaxone, which is recommended for early and late neurological disorders, high degrees of atrioventricular block, and arthritis (including chronic). The drug is administered intravenously at 100 mg/kg/day for 2 weeks. Of the macrolides, erythromycin is used, which is prescribed to patients with intolerance to other antibiotics and in the early stages of the disease at a dose of 30 ml/kg per day for 10-30 days. In recent years, reports have been received on the effectiveness of sumamed, used in patients with migratory erythema annulare for 5-10 days.

The risk of developing chronic forms of borreliosis infection is associated both with the severity of the clinical manifestations of the acute period of the disease and the multiorgan involvement of the disease, as well as with the adequacy of the chosen antibiotic, its duration and dose. In this regard, the development of new treatment regimens for early borreliosis in children using new generation antibacterial drugs that are highly effective against the pathogen is quite timely.

In the new approach, in case of localized form, in addition to 14-day oral courses of known antibacterial drugs, it is proposed to use benzylpenicillin (penicillin G) intramuscularly for 14 days, and in case of dissemination of the pathogen, it is recommended to prescribe third-generation cephalosporins intramuscularly for up to 14 days. However, the disadvantage of the described method is that after the use of penicillin G, the frequency of chronicity is up to 40-50%, and treatment of forms with damage to internal organs with a 14-day course of third-generation cephalosporins seems insufficient to eliminate the pathogen, which is characterized by intracellular persistence in the reticuloendothelial system of the macroorganism, which leads to relapses of the disease and transition to a chronic course. The technical result of this treatment method is to prevent the development of the chronic course of ixodid tick-borne borreliosis in children and reduce the duration of hospital treatment. This result is achieved by the fact that when using antibacterial therapy according to the invention, depending on the form and severity of the disease in erythema and non-erythema forms, cephobid is prescribed intramuscularly 2 times a day for 10 days at a daily dose of 100 mg per 1 kg of body weight, followed by administration at erythemal form of benzathine benzylpenicillin intramuscularly once a month for three months at a dose of 50 mg per 1 kg of body weight; for the non-erythema form - intramuscularly once a month for six months at a dose of 50 mg per 1 kg of body weight; if internal organs and systems are affected, cephobid is prescribed intramuscularly for 14 days 2-3 times a day at a daily dose of 200-300 mg per 1 kg of body weight, followed by benzathine benzylpenicillin intramuscularly once every 2 weeks for three months at a dose of 50 mg per 1 kg of body weight and then once a month for another three months at a dose of 50 mg per 1 kg of body weight.

Cefobid (cefoperazone) is a semisynthetic cephalosporin antibiotic of the third generation with a broad spectrum of action, intended only for parenteral administration. The bactericidal effect of the drug is due to inhibition of bacterial wall synthesis. High therapeutic levels of cephobid are achieved in all tissues and fluids, which is necessary to destroy Borrelia at the site of primary penetration and during the development of dissemination in the body. The course duration of 10 days is determined by the rapid regression of clinical symptoms during treatment with cephobid. A daily dose of 100 mg per 1 kg of body weight is determined by the pharmacokinetics of the drug and is sufficient for the penetration of the substance into tissues and fluids with intact biological barriers.

The administration of benzathine benzylpenicillin (retarpen, extensillin), a long-acting drug that has a bactericidal effect on sensitive reproducing microorganisms by suppressing the synthesis of cell wall mucopeptides, is intended to consolidate the effect of the main course and contribute to the destruction of the pathogen that persists in biological fluids and tissues of the macroorganism. The timing of the prescription of benzathine benzylpenicillin (3-6 months) is due to the fact that the highest frequency of relapses and the development of a chronic course of the disease are observed in the period of 3-6 months. The dose of the drug is maximum in children, and after intramuscular administration, absorption of the active substance occurs over a long period of time (21-28 days). Increasing the dose does not affect the effectiveness of the antibiotic. In the non-erythema form, the course of therapy with benzathine benzylpenicillin is extended to 6 months, since in this form, after the introduction of borrelia into the skin, they penetrate into regional lymph nodes, disseminate the pathogen and often develop chronicity of the disease. In case of damage to internal organs and systems, cephobid is prescribed for a course of 14 days in maximum doses in order to achieve penetration of the antibiotic through damaged biological barriers. The subsequent course of benzathine benzylpenicillin is proposed to be carried out once every 2 weeks for the first 3 months, then once every 1 month for another 3 months in order to increase the duration of action of the antibiotic on the persistent intracellular microorganism. The course duration of 6 months is determined by the fact that this is the most common period of development of chronicity of the disease.

In case of a chronic course of the disease, the course of treatment with penicillin according to the same regimen lasts 28 days. It seems promising to use long-acting penicillin antibiotics - extensillin (retarpen) in single doses of 2.4 million units once a week for 3 weeks.

In cases of mixed infection (Lyme disease and tick-borne encephalitis), anti-tick gamma globulin is used along with antibiotics. Preventive treatment of victims of a Borrelia-infected tick bite (the intestinal contents and tick hemolymph are examined using dark-field microscopy) is carried out with tetracycline 0.5 g 4 times a day for 5 days. Also for these purposes, retarpen (extensillin) is used with good results at a dose of 2.4 million units intramuscularly once, doxycycline 0.1 g 2 times a day for 10 days, amoxiclav 0.375 g 4 times a day for 5 days. Treatment is carried out no later than the 5th day from the moment of the bite. The risk of developing the disease is reduced by up to 80%.

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

For Lyme arthritis, non-steroidal anti-inflammatory drugs (plaquinil, naproxin, indomethacin, chlotazole), analgesics, and physiotherapy are more often used.

To reduce allergic manifestations, desensitizing drugs are used in normal dosages.

Often, with the use of antibacterial drugs, as in the treatment of other spirochetoses, a pronounced exacerbation of the symptoms of the disease is observed (the Jarisch-Gersheimer reaction, first described in the 16th century in patients with syphilis). These phenomena are caused by the mass death of spirochetes and the release of endotoxins into the blood.

During the period of convalescence, patients are prescribed general restoratives and adaptogens, vitamins A, B and C.

Forecast of borreliosis (Lyme disease)

A favorable outcome of the disease largely depends on the timeliness and adequacy of etiotropic therapy carried out during the acute period of the disease. Sometimes, even without treatment, systemic tick-borne borreliosis stops at an early stage, leaving behind a “serological tail.” The prognostic factor for recovery is the persistence of high titers of IgG antibodies to the pathogen. In these cases, regardless of the clinical manifestations of the disease, it is recommended to carry out a second course of antibiotic therapy in combination with symptomatic treatment. In some cases, the disease gradually passes into the tertiary period, which may be due to a defect in the specific immune response or factors of nonspecific resistance of the body. In the case of neurological and articular lesions, the prognosis for complete recovery is unfavorable. After an illness, it is recommended that patients undergo clinical observation in a clinical medical facility for a year (with a clinical and laboratory examination after 2-3 weeks, 3 months, 6 months, 1 year). If skin, neurological or rheumatic manifestations persist, the patient is referred to the appropriate specialists, indicating the etiology of the disease. Issues of further ability to work are resolved with the participation of an infectious disease specialist at the clinic’s VKK.

Prevention of borreliosis (Lyme disease)

Specific prevention of BL has not currently been developed. Nonspecific prevention measures are similar to those for tick-borne encephalitis. The most effective measures to prevent bites from ticks attached to the body are the use of protective clothing (long-sleeved shirts, high-necked shirts, long pants, hats and gloves) and insect repellents. If a tick is found that has settled on any part of the skin, it must be carefully removed slowly, preferably with gloved hands using tweezers. If possible, you need to hold the tick by the head and pull it out with a twisting motion. If you pull vertically, there is a high risk that the proboscis and head will remain in the wound. Do not crush the tick, as infection can occur through intact skin. After washing the wound, you need to wash your hands with soap. Since ticks are very small, it is important to look for them carefully, preferably using a flashlight. Ticks often attach themselves to pets, so during tick season you should check them after they return from a walk.

Not all ticks are sources of disease, bearing a provocative bite pattern. Ixodid tick-borne borreliosis occurs only in those ticks that have managed to become infected with Borrelia from an infected animal that it bit before attacking a person. An infected person after a tick bite is not dangerous to other people; he is not able to carry the infection.

Borreliosis

Within 7 days after being infected by a tick, people may notice redness (erythema) on their skin, increasing to an impressive size. The inner part of the erythema becomes lighter, taking on a rounded shape, and the bite site is healed. In the absence of proper treatment, after 3 weeks the spot will disappear on its own, and the disease will take a chronic form.

Clinical picture

A tick bite itself is not felt on the body. When an infection enters the bloodstream, it spreads through the bloodstream throughout the body. In the organs of the heart, muscles, joints, central nervous system, borreliosis can persist for a long time, which provokes a chronic form of the disease.

The body's immune system tries to fight harmful microorganisms, but it is not strong enough. The disease can occur in several forms.

1. The first stage is the reproduction of borrelia, penetration to the lymph nodes.
2. The second stage is infection of the body by spreading through the blood.
3. The third stage is damage to the nervous or musculoskeletal system (chronic form).

First stage of the disease

The first stage continues from the first day and lasts for 35 days, if we take the average duration, then it is 7 days. The course of the disease begins acutely, accompanied by an elevated temperature of up to 39 degrees. Patients complain of headaches, painful sensations in the muscles, throat during swallowing, and joints. Symptoms of berryliosis may affect the enlargement of the liver and spleen.

Within a week from the onset of infection, a papule forms, which quickly turns into annular erythema. Often the bite site can be the neck, thighs, wrist, or torso. An increase in the size of the erythema can reach a diameter of more than 20 cm, while it has a regular shape; in some cases, the erythema occupies most of the body, sometimes with the appearance of stripes.

The edges of the erythema are red, swollen, inflamed, and rise above the surface of the skin. The center of inflammatory erythema is marked by a bluish color and looks like an eye. In some cases, a gradual increase in the infiltrate is possible, and the lymph nodes become enlarged with painful sensations. A quarter of patients complain of the occurrence of repeated ring-shaped elements and an urticarial, papular rash.

The disease is in the first stage and continues for a long time. The affected skin atrophies over time, becoming thin, unattractive, and dry as paper. At this stage of the disease, the manifestation of iritis, iridocyclitis with pathology of the visual organs is possible. Phlebectasia may develop. Most often, this form of illness lasts about a month.
The symptoms accompanying the first stage of the disease look like this: pain near the bite site, redness, itching, swelling. Most often, the symptoms of the first form of the disease go away on their own without drug therapy.

Second stage

The second stage is reflected in disorders of a neurological and cardiac nature. Pathologies become noticeable 40 days after the onset of the disease, the duration is several months.

Three areas of impairment are most commonly noted. Nervous system – meningitis (serous), radiculitis, damage to the intracranial nerve. The sign of serous meningitis resembles the meningeal form of tick-borne encephalitis. Lymphocytic pleocytosis is noted in the cerospinal fluid with an increase in the amount of protein.

Symptoms similar to encephalitis, encephalomyelitis are often observed; oculomotor paresis, paralysis and tetraparesis of the facial and intracranial nerve are possible. Perhaps a typical manifestation of paralysis of the 4th pair of cranial nerves (Bell's palsy), the pathology of neuralgia.

A tick bite after manifestations of erythema is manifested by pain. The occurrence of polyradiculoneuritis or meningoradiculoneuritis leads to disruption of the sensitivity of the thoracic region and the motor functions of the spinal nerve roots.

Possible changes in heart function appear at 5 weeks. They are characterized by pathology of anterior ventricular (atrioventricular) conduction, in rare cases, heart block, cardiac arrhythmia, sometimes with signs of myocarditis, pericarditis, accompanied by an enlargement of the heart organ. Left ventricular heart failure may develop. The duration of the pathological condition of the heart can last from 7 to 45 days.

Third stage of the disease

The third stage (arthritic borreliosis) can develop several months and sometimes years after the onset of the disease. In medicine, several typical manifestations of this disease are known.

• nervous system disorder (polyneuropathy, encephalomyelitis, encephalopathy);
• chronic arthritis;
• acrodermatitis of the atrophic type (skin lesions);

Most often, the disease manifests itself in one of the body systems. For example, in the joints, skin or nervous system, but after a while complex damage is possible.
Chronic arthritis can affect both small and large joints; due to relapse of the disease, the joints become deformed. The cartilage becomes thinner and gradually destroyed, osteoporosis begins to develop in the bone structure, the process affects the neighboring muscles, which lies at the source of the development of chronic myositis.

Acrodermatitis of the atrophic type is manifested by bluish spots in the extensor areas of the elbows, soles, hands, and knees. The skin thickens and swells. Relapses of the process and the duration of the existing disease lead to atrophy (thinning) of the skin.

When the nervous system is damaged in the third stage, the process is very diverse. Pain of various kinds, loss or decrease in sensitivity, impaired concentration of movements, mental abilities, loss of hearing and vision. Epilepsy attacks, stressful conditions, depression, and increased emotionality are possible. When taking a blood test, leukocytosis, hyperleukocytosis, and an increase in ESR are possible. Recurrent polyarthritis is noted.

The incubation period for tick-borne berryliosis with symptoms lasts about a month. The manifestation of symptoms depends on the course and pathological process of the disease; the stage of development also plays an important role.

Possible consequences and complications

The development of this disease has serious consequences for the heart, nervous system, and joints. It is necessary to take tick attacks seriously, recognize the disease in a timely manner, consult a specialist, and undergo clinical tests. If the diagnosis is confirmed, you need to undergo the recommended treatment, it is better to do this in a specialized infectious diseases department.

In a medical institution, therapy will be comprehensive, focused on the destruction of Borrelia. The absence of the correct course of therapy will lead to the disease becoming chronic, sometimes with disability.

Detection of the disease in the first stage allows for adequate therapy, which guarantees complete recovery. Borreliosis of the second degree with selected treatment in most cases is cured without a trace. The most difficult and lengthy treatment occurs when a chronic type of disease is identified, which has functional consequences, even after a course of therapy.

• arrhythmia;
• decreased muscle strength in the legs and arms;
• heart failure;
• impaired sensitivity;
• damage to the facial nerve with visible deformation;
• deterioration of vision and hearing;
• impaired joint function and deformation;
• epileptic seizures;

The good news is that these consequences are not always observed in patients with the third or chronic form of borreliosis. Often, even an advanced stage after a course of treatment has a significant improvement with slow recovery.

Treatment of borreliosis

For adequate treatment of this disease, a complex of pathogenetic and etiotropic agents is required. It is necessary to take into account the stage of the disease process.
When therapy for tick-borne borreliosis is started with antibacterial agents. In the first form of the course, this makes it possible to reduce the likely provocation of cardiac and neurological arthralgic consequences.

Early infection with migratory erythremia is treated with Doxycycline (0.1 twice a day orally), Amoxycycline (0.5 three times a day). The course of therapy is at least 3 weeks. During the development of carditis and meningitis, parenteral administration of antibiotics is recommended: Ceftriaxone intravenously 2 g once every 24 hours. Benzylpenicillin intravenously 20 ml 4 times a day. The course of therapy is from two weeks to a month.

The photo shows erythema migrans

At the onset of the disease, treatment with Tetracycline 1.0-1.5 g per day for two weeks is possible. Erythema can disappear on its own without the use of medications, but bacterial therapy promotes disappearance in a shorter time. What is important about bacterial therapy is that it helps prevent the disease from progressing to the second and third stages, which is the main goal.

In combination with Tetracycline, Doxycycline is effective, which is prescribed to patients with migratory, ring-shaped erythema, and benign skin lymphoma. The course of therapy is designed for 2-4 weeks, 200 mg each.

Penicillin is prescribed for patients with systemic borreliosis, in cases of damage to the nervous system in the second stage. In the first stage of myalgia, fixed arthralgia, a high dose of the drug of 20,000,000 units is recommended. per day intramuscularly, or in combination with i.v. Recently, doctors have given preference to treatment with Ampicillin, 1.5-2.0 g per 24 hours. The course of therapy is 2-4 weeks.

Cephalosporins are the most effective and highly effective antibiotics. For Lyme disease, Ceftriaxone is prescribed in both early and late stages, as well as for atrioventricular block, arthritis, and neurological disorders. The medicine is recommended to be administered intravenously 2 g once a day for 14 days. If patients are intolerant to various types of antibiotics, doctors may prescribe Erythromycin, a group of macrolides.

Among the types of modern treatment, the drug Sumamed received positive reviews. The course of therapy is from 5 to 10 days. Lyme arthritis is treated with non-steroidal anti-inflammatory drugs: Naproxin, Chlotazol, Plaquinil, Indomethacin. Additional physiotherapy and analgesics are prescribed.

To reduce allergic manifestations, it is recommended to take desensitizing medications. Sometimes the use of antibacterial agents causes severe aggravated symptoms, just as in the treatment of spirochetosis. A Jarisch-Gersheimer reaction is possible. Mass death of spirochetes occurs with the release of toxins into the bloodstream.
General strengthening drugs with adaptogens and vitamin complex (A, B, C) are recommended.

The prognosis after undergoing courses of medical therapy is mostly positive, but in some cases disability is possible due to damage to the central nervous system and joints.
Patients who have had borriliosis must be registered with a doctor to undergo quarterly examinations for two years.

Preventive measures

Prevention of tick-borne borreliosis is carried out both by direct extermination of the tick in nature and by protective measures.

Good to know

For protection in endemic areas, special anti-tick suits are required, however, you can use other ordinary clothing. The shirt must be tucked into the pants, the trousers must be tucked into closed high shoes. The cuffs and collar must fit snugly to the body, and a headdress is mandatory equipment.

After visiting public gardens and parks, returning from hunting or fishing, or perhaps just from the forest, you need to carefully examine your body and clothing for the presence of ticks.

The suit has 100% protection against bloodsuckers. Manufactured by a domestic manufacturer, which is guaranteed to have well-deserved recognition along with foreign samples. Using the Bio Stop suit, there is no need to use repellents or frequently inspect clothing and body.
If there is no need to purchase such a suit, then you can protect your clothes with the help of repellents.

Infections affect virtually all systems of the body and have a progressive course, which is why they are so dangerous. Tick-borne borreliosis (Lyme disease, spirachetosis) belongs to this group of diseases and is transmitted through insect bites, namely ixodid ticks. The infection is caused by bacteria called Barrelia, a type of spirachete. In a disease such as borreliosis, the symptoms and consequences are interrelated, because if you do not start a course of therapy when the first signs appear, the pathology will worsen. To do this, you need to undergo examination on time. In this case, detection of Lyme disease will be timely and after treatment you can remain without any complications.

A tick bite causes the development, but initially the bacteria that cause the disease are found in their natural reservoir, namely in animals. Blood-sucking insects pick up barrels from them and become carriers of infection, which can be transmitted to a new generation of beetles.

Ixodid ticks are common in forests located in areas with a temperate climate. Such places are localized in the USA, Russia (Siberia, the Urals) and in some European countries. According to statistics, in such areas every second tick is a carrier of infection, so the spread of spirochetosis in these areas is quite wide.

Blood-sucking insects begin to bite most actively towards the end of spring. In turn, people are too susceptible to bacteria, so the chance of becoming infected is very high.

Development of pathology

Anyone bitten by an ixodid tick should know how the infection develops. After a bite, the bacteria enter the skin through the insect's saliva. Next, the infection penetrates the nearest lymph nodes and actively multiplies, and after 2-3 days it spreads through the bloodstream throughout the body. In this way, borreliosis infection after a tick bite enters the cardiovascular and nervous system, as well as muscle tissue and joints.

The immune system of an infected person will try with all its might to synthesize antibodies to eliminate bacteria, but this will not be enough. With prolonged exposure to barrels, an autoimmune process may begin to develop in the body. It is a malfunction in the immune system, due to which the antibodies produced destroy healthy cells. This factor often leads to chronic Lyme disease. The main harm from the infection comes from the dangerous toxin produced by the barrels, so a long course of the disease worsens the general condition of the patient.

Finding an infected tick on a person does not make that person a carrier of the disease. The same applies to pregnant women, as well as women during lactation (breastfeeding). Infection in adults and children occurs in the same way, namely due to a tick bite.

Symptoms

Lyme disease has several stages of development, namely:

• Incubation period. It lasts from the moment of an insect bite until the first signs of borreliosis, namely from 5-10 days to 1 month;
• 1st period. It refers to the basic moment of development, when the infection began to actively multiply at the site of the bite and in the lymph nodes;
• 2nd period. This stage is characterized by the time when bacteria began to actively spread through the bloodstream;
• 3rd period. It is characterized by damage to a certain system of the body (nervous, musculoskeletal, etc.). Over time, this stage can become chronic.

All these divisions are conditional, since it is impossible to accurately draw a line between them. However, the first 2 stages are early and respond well to treatment, and the last is already considered an advanced form of the disease.

First period of development

Symptoms of stage 1 tick-borne borreliosis are mostly common with local manifestations. Most often, the following general signs of infection are observed at an early stage:

• Elevated temperature up to 38°;
• General weakness;
• Nausea;
• Pain in muscles and joints;
• Signs of illness (cough, rhinitis, sore throat).

In the first stage of Lyme borreliosis, symptoms often appear only at the site of the insect bite, namely:

• Pain;
• Swelling;
• Redness.

The first symptoms of borreliosis are often difficult to detect, and they are attributed to a cold.

The main sign that can confirm the presence of the disease is erythema.

It is a redness caused by dilation of capillaries. After 3-4 days, the center of the bite becomes lighter, but the edges remain red and expand in size. Such a ring can be more than half a meter in diameter. In rare cases, small circles appear inside it.

Basically, erythema does not manifest itself in any way, but sometimes it begins to itch and even burn. This skin manifestation lasts on average 1 month, but in some people it subsides in 2-3 days. In its place, the skin begins to peel off a little.

Borreliosis also causes other skin manifestations, such as urticaria. Sometimes infection causes the development of conjunctivitis.

Gradually, other signs of pathology begin to appear:

• Pain and swollen lymph nodes;
• Hardening of muscle tissue in the neck area.

Sometimes, stage 1 Lyme disease symptoms can go away completely without medication. The infection will proceed without manifestations until the patient’s condition becomes significantly worse.

Second period of development

The second stage is characterized by the spread of infection through the bloodstream and damage to nerve fibers, muscles, joints, the cardiovascular system and the skin. This stage usually lasts from 5-7 days to 2-3 months. Local symptoms have actually disappeared and instead of them signs characteristic of such pathological processes appear:

• Meningitis;
• Damage to cranial nerve fibers;
• Damage to the nerve roots in the spinal cord.

The first pathology is characterized by the following symptoms:

• Excessive sensitivity to external stimuli (fear of light, increased perception of sound, etc.);
• Hardening of the occipital muscle tissue;
• Fast fatiguability;
• Outbursts of emotions;
• Sleep disorders;
• Deterioration of memory and concentration;
• Increased concentration of protein and lymphocytes in the cerebrospinal fluid (CSF).

Among the group of cranial nerves, it is the facial (trigeminal) that is most often damaged, and much less frequently the visual, oculomotor and auditory nerves. This process is manifested by the following symptoms:

• Distorted face;
• Loss of food from the mouth during meals;
• Inability to close the entire eye;
• Deterioration of visual acuity;
• Hearing loss (hearing impairment);
• Strabismus;
• Disturbances during eye movement.

Often, damage to the cranial nerves is bilateral. In more rare cases, one side is first damaged by infection, and only after 5-7 days the other.

Barrel damage to the spinal nerves is usually accompanied by the following symptoms:

• Painful sensations of shooting type;
• Weakness (paresis) in muscle tissue;
• Sensitivity surges;
• Decreased tendon reflexes.

In addition to the manifestation of signs of certain syndromes, borreliosis sometimes causes neurological symptoms that arise due to damage to the nervous system:

• Incoherent speech;
• Movement coordination disorder;
• Unsteady gait;
• Involuntary movements;
• Trembling in the limbs (tremor);
• Problems with swallowing;
• Epileptic seizures.

Due to infection, arthritis gradually develops and affects mainly the following joints:

• Ankle;
• Hip;
• Knees;
• Elbows.

It can affect either one joint or several at once. This manifests itself in the form of pain and the inability to carry out full movements.

When the heart is damaged, signs of the following forms of disease most often appear:

• Myocarditis;
• Antiventricular block;
• Pericarditis.

Such pathologies mainly manifest themselves as follows:

• Cardiopalmus;
• Heart failure;
• Dyspnea;
• Chest pain.

On the skin, stage 2 infection is manifested by the following symptoms:

• Hives;
• Small ring erythema of secondary type;
• Lymphodenosis (lymphocytoma)

Lymphodenosis is an accumulation of cells (lymphatic) and looks like a small red elevation above the skin. Its size usually varies from 2-3 mm to 2 cm. This formation is localized in the nipple area, in the groin area and closer to the earlobe.

With borreliosis, other body systems are most often not affected. However, the infection is carried through the bloodstream, which means it can end up in any part of the body.

Third period of development

Sometimes it takes 1-2 years from the first manifestations of Lyme disease to the development of stage 3. At this stage, the following pathological processes are most pronounced:

• Chronic arthritis;
• Damage to the nervous system with the possible development of polyneuropathy, encephalomyelitis and encephalopathy;
• Chronic atrophic acrodermatitis (CAD).

At this stage, the infection is most expressed in one of the systems, for example, the nervous system, or affects joints, skin, etc. As borreliosis develops, manifestations can be combined with each other.

Arthritis at this stage becomes chronic and affects both small and large joints. The pathology manifests itself in periodic relapses, due to which gradual deformation of the cartilage tissue occurs, and the bones become hollow, as in osteoporosis. Most often, the problem also affects nearby skeletal muscles and chronic myositis develops.

Atrophic acrodermatitis has a chronic course and appears as red and blue spots. They are localized on the extensor sides of the lower and upper extremities, as well as on the back of the hands and feet. In these places, the skin hardens and swelling appears on it. Over time, the skin begins to atrophy and feels and looks like paper.

With borreliosis, the nervous system suffers the most and is manifested by the following symptoms:

• Weakening of muscles (paresis);
• Impaired sensitivity, manifested in the form of pain of various types and symptoms of paresthesia (numbness, tingling and goose bumps);
• Failures in coordination of movements;
• Problems with mental abilities, namely memory, intelligence and intelligence;
• Disruption of the pelvic organs.

In addition to the listed symptoms, the patient has increased problems with hearing and vision, and epileptic seizures become more frequent. The symptoms characteristic of the previous stages worsen, and outbursts of emotions occur more often and the general condition worsens.

Chronic course of Borreliosis

As borreliosis develops, it becomes chronic and is characterized by relapses. The patient's condition gradually becomes worse, and pathological changes in the body continue. In a chronic course, symptoms of such disorders appear:

• Multiple lesions of the nervous system;
• Damage to joints;
• Lymphocytomas.

Diagnostics

Diagnosis of borreliosis is carried out using a serological test, as well as by visible symptoms. Barrelia are detected using electron microscopy. If their concentration is low enough, then polymerase chain reaction (PCR) is used for determination.

After 3-4 weeks, the body begins to produce antibodies to the bacteria, which causes an increase in the amount of class M immunoglobulins (IgM). After another 2-3 weeks, the IgG level increases. It is the decrease in their number that indicates that the person has begun to recover and vice versa.

Separately, it is worth noting that the development of tick-borne encephalitis and borreliosis is not related. They are 2 independent diseases and the only thing they have in common is their mode of transmission (through a tick bite). Sometimes a person can catch two infections at the same time, and this fact must be taken into account when diagnosing.

A course of treatment

The course of therapy consists of several stages, but the main goal is to destroy bacteria in the body. If this is not done in the first two stages, then it will be extremely difficult to completely get rid of the infection and you may remain disabled.

To eliminate the cause of the disease, the following drugs are usually used:

• Treatment of stages 1-3 borreliosis involves the use of tetracycline antibiotics such as Doxycycline. It must be used strictly as directed by a doctor, as you can get an overdose or not cure the disease;
• The chronic form of borreliosis can be eliminated with the help of penicillin medications, for example, Amoxicillin;
• If a patient is diagnosed with tick-borne encephalitis and borreliosis, then gamma globulin is used.

With borreliosis, many systems of the body suffer and to maintain them it will be necessary to include the following methods in the course of therapy:

• Treatments and medications used for detoxification will help relieve symptoms of fever;
• For meningitis, dehydration is performed;
• Non-steroidal anti-inflammatory medications and physical therapy will help relieve pain and inflammation;
• Special medications are used to normalize heart function. They are selected based on clinical manifestations;
• Desensitizing therapy, which serves to reduce sensitivity to the allergen, will help eliminate allergies.
• Vitamin complexes and immunostimulants will help strengthen the immune system and improve general condition.

Consequences

Consequences of tick-borne borreliosis arise in cases where patients do not undergo a course of therapy and the disease progresses to stage 3 or even to a chronic course. The disease gradually progresses and internal deformations in places where bacteria accumulate are worsened. If the disease is not treated, the person may die or become disabled.

The most common consequences are:

• Dementia;
• Blindness;
• Deafness;
• Paralysis of individual muscle groups;
• Severe cardiac dysfunction;
• Multiple arthritis;
• Benign neoplasms that appear on the skin near the site of the bite.

Ixodid tick-borne borreliosis is an infectious disease that can be easily eliminated in the early stages. At more advanced stages of development, it is no longer so easy to recover from the disease and consequences may remain. That is why doctors advise to be careful when going out into nature and to examine your body after arriving home.

Once, while performing on stage (singing is my hobby), I felt my neck involuntarily deviate to the right. I didn’t attach much importance to this, I thought, you never know where there was a leak.

After two or three weeks, my head began to constantly move to the side, and my sleep was disturbed. However, the district neurologist did not find any abnormalities in my health. Another specialist suggested that I had Parkinson’s disease and prescribed medications... Another one suspected epilepsy and prescribed much stronger pills.

They also offered me Botox blockades - I shrugged them off for a whole year. And in May 2014, an article by the region’s chief infectious disease specialist appeared in the regional newspaper about the severe consequences of tick bites and that this can lead to spastic torticollis. I immediately remembered that in May - June 2012, after a vacation on our Curonian Spit, I found a tick on my left side at home. He pulled it out and threw it away...

I took the tests again and 10 days later I received the diagnosis: tick-borne borreliosis, Lyme disease. I was admitted to the regional infectious diseases hospital, where I was treated. Upon discharge, le
The attending doctor threw up her hands sympathetically: “Your disease is incurable, adapt to life as best you can.”

At the district clinic, I was injected with antibiotics for another six months, I also went through six courses of Botox blockades, the result was zero. Another blood test showed that the virus had not gone away.

The district infectious disease specialist said that I am now a chronic patient and that I will take antibiotics for the rest of my life. With that we parted.

Taking advantage of the short respite, I began searching for treatment. I was interested in an article about herbal medicine by the eminent herbalist, academician Karp Abramovich Treskunov.

A 42-year-old resident of Perm turned to the doctor for help, saying that she had tick-borne borreliosis, which gave complications to the central nervous system, heart, joints. Karp Abramovich advised taking two preparations - antistaphylococcal and antifungal. The course of treatment is at least 3 months. He immediately listed the collection of herbs. There are many of them, but I have noted everything in detail.

So, in antistaphylococcal collection included: yarrow grass - 8 parts by weight; large burdock leaves - 5 parts by weight; herb St. John's wort, sweet clover, oregano, leaves of stinging nettle and great plantain - 3 parts by weight; coltsfoot grass, knotweed, cinnamon rose hips, grass and roots of cinquefoil erecta, dandelion, calendula flowers, tansy - 2 parts by weight; chamomile flowers, horsetail herb - 1 part by weight.

Grind and mix all components, 1 tbsp. I poured 0.5 liters of boiling water into a spoonful of the mixture and let it sit for 1 hour. After straining, I drank 0.5 glasses 2 times a day 30 minutes before meals.

In the second, antifungal collection included: yarrow grass - 9 parts by weight; birch leaves - 7 parts by weight; wormwood herb - 5 parts by weight; Veronica officinalis herb and tricolor violet - 4 parts by weight; marshweed grass - 3 parts by weight; flowers of chamomile and calendula officinalis - 2 parts by weight; tansy flowers,
meadow clover - 1 part by weight.

1 tbsp. I poured 0.5 liters of boiling water into a spoonful of the mixture and let it sit for 1 hour. After straining, I drank 0.5 cups 2 times a day 30 minutes before meals.

According to Karp Abramovich, antifungal collection has antifungal, antibacterial, enveloping, astringent, regenerating, immunostimulating, anti-inflammatory effects. Indicated for fungal and viral diseases, giardiasis, chlamydia, helicobacteriosis, as well as gastritis, duodenitis, and peptic ulcers.

After being treated for three months without missing a single day, I took the test again. The study showed: there is no dangerous virus in the blood! Not believing in such a happy outcome, after some time I donated blood again. The result is negative!

The chief infectious disease specialist at the military hospital did not believe in my healing either, and suggested conducting an in-depth analysis. I was not diagnosed with Lyme disease.

Now I am closely involved in the treatment of my spastic torticollis. I know: this process is long, but what are my years! Only 78! The main thing is not to give up, but to search, apply, believe.

Gluskin Garry Aronovich for the newspaper ZOZH

Lyme borreliosis is a human disease, the main causative agent of which is the specific microorganism Borrelia. The disease is transmitted through the bite of an ixodid tick.

borreliosis mite

According to statistics, this disease is the most common among all those spread through these insects in the Northern Hemisphere. Its main feature remains the polymorphism of the clinical picture.

If a person is bitten by a tick, borreliosis can manifest itself in different ways, which causes certain difficulties in the timely diagnosis of the disease. That is why it is very important to consult a doctor even with ordinary bites of these insects.

Features of transmission of borreliosis ticks

As has already become clear, the microorganism enters the human body through a tick bite. However, natural reservoirs for its storage are mammals. Borrelia can infect the internal organs of deer, foxes, squirrels or other animals living in the corresponding geographical area.

When the ixodid tick bites mammals, it sucks in blood that contains microbial particles. After this, they begin the process of their development, but already in the insect’s body.

How is the disease transmitted?

This is the most suitable place for long-term storage of bacteria. After all, it is known that ticks can live even for decades while remaining dormant. All this time, the microbe retains the ability to spread.

A person becomes infected when an infected tick bites him. With the insect's saliva, microbial bodies enter the bloodstream, which begin to actively multiply and spread throughout the body.

The symptoms and consequences of the borreliosis tick, or rather its bite, largely depend on the individual resistance of the human immune system and the general condition of the body.

Features of pathogenesis

Once in the human body, Borrelia spreads through the blood and lymph flow to various organs and systems. A number of characteristic reactions occur in them, which determine the development of the corresponding symptoms.

The entire cascade of reactions can be represented in the following sequence:

1. With the blood, the microbe spreads throughout the body to the brain, internal organs and muscles. A ring-shaped erythema forms at the site of the bite.
2. After Borrelia dies, it provokes a cascade of humoral reactions that cause further progression of the disease.
3. In response to the appearance of specific pathogen antigens in the body, the immune system begins to actively produce antibodies - IgM and IgG. They are sent to places with the largest concentrations of foreign organisms.
4. In specific organs and systems where antigen-antibody interaction occurs, local inflammatory reactions progress with the release of large amounts of mediators, histamine and other rather aggressive compounds.
5. All this leads to the formation of microinfiltrates and disruption of the normal functioning of specific organs.
6. A special substance interleukin-1 is also released, which remains one of the most powerful mediators of inflammation. Under its influence, immune complexes penetrate bones, joints, and tissues of internal organs, gradually destroying them.

After a barial tick bites, symptoms begin to develop under the influence of the body’s response to foreign bodies.

The main thing in this situation is to seek qualified help. Otherwise, the pathological process will only progress, which can lead to disability of the patient or even death. Lyme borreliosis is a very insidious and multifaceted disease with a complex clinical picture.

Symptoms of the presence of borreliosis mites and their bites of 1st degree

The incubation period for this disease ranges from 7-14 days. However, there may be earlier manifestations of the disease or its delayed manifestations. Most often, disease activity occurs between late spring and early autumn. During this period, nymphs mature - forms of ticks that are mainly the cause of human infection.

tick bite on hand

In the process of development of the clinical picture, 2 periods are conventionally distinguished:

1. Early, including the first and second stages.
2. Late, including the third stage.

Depending on the number of bacteria that have entered the human body and the general health of the patient, the manifestations of the pathological process may differ slightly.

The first stage begins acutely or subacutely.

Borreliosis tick symptoms in the initial stages show nonspecific:

• General weakness.
• Body aches.
• Temperature increase.
• Nausea, vomiting.
• Chills.

Catarrhal symptoms (nasal congestion, cough, etc.) may often appear.

However, the main symptom of the disease at this stage remains a special ring-shaped erythema that develops at the site of the tick bite. It looks like a characteristic round or oval redness in the place where there was contact with the insect.

Its size can vary from 5 to 60 cm. Basically, it does not protrude above the surface of the skin, however, there are cases when it takes on the appearance of a kind of roller. Other ring-shaped elements may be present within the circle.

The main symptom of the disease is ring-shaped erythema

The patient's sensations range from the complete absence of any discomfort to active itching and mild pain in the affected area. A brown crust may remain at the site of the bite for a long time.

Ring-shaped erythema is the most common symptom of stage 1 borreliosis. It is observed in 60-80% of patients. It also demonstrates the ability to migrate. The edges of the affected area tend to expand and move to new areas of the skin. Often this phenomenon is accompanied by regional lymphadenopathy due to the pathogen entering the corresponding vessels.

Symptoms of borreliosis after a tick bite may also manifest as other intermittent signs.

These include:

• Rash on the face and other areas of the skin.
• Conjunctivitis.
• Damage to the meninges with the development of characteristic manifestations (headache, vomiting, photophobia, and others).
• Liver damage with the development of a pathological condition such as hepatitis. It is characterized by the progression of dyspeptic symptoms (nausea, vomiting), abnormalities in laboratory tests and an increase in liver size.

There are cases when Lyme disease is subclinical. In such cases, it is often confused with ordinary viral diseases due to the non-specificity of the clinical picture. The main fact that should alert any doctor is the presence of a tick bite in the anamnesis.

However, the most inconvenient is borreliosis, which occurs without the manifestation of symptoms in the first stage. However, the absence of signs of the disease does not mean that it is not developing. The disease simply “quietly” goes straight into the second stage of the pathological process.

Symptoms of stage II of the disease

The second stage of the disease may not occur. It all depends on the timely start of antibacterial treatment of the disease. However, if you ignore the pathology, then after about 1-3 months, annular erythema progresses into a number of other clinical manifestations.

At the moment, the two most common forms of the 2nd stage of borreliosis are traditionally distinguished:

1. Neuralgic.
2. Cardiac.

In the first case, the human nervous system takes the main blow. With the flow of blood and lymph, microorganisms penetrate the meninges, where they continue their negative impact on the body. The most common symptoms of meningitis, meningismus and encephalitis develop.

the second stage of the disease is characterized by headaches and nausea. insomnia

Accordingly, the following symptoms appear:

• Headache.
• Photophobia.
• Sleep rhythm disturbance.
• Irritability.
• Nausea and vomiting that is not relieved by conventional medications.
• Movement disorders.
• General weakness and decreased muscle strength.

Intracranial pressure also increases. A feature of damage to the human central nervous system in Lyme borreliosis remains the effect on the cranial nerves. As a result, symmetrical paresis and paralysis often progress. The facial nerve is most often affected. Therefore, it is important to carry out differential diagnosis with other diseases that could potentially cause similar symptoms.

The cardiac form of manifestation of the disease is characterized by damage to the heart. It occurs comparatively less frequently than neuralgia. The most common symptom in this case is heart rhythm disturbance.

First, single ventricular extrasystoles develop, however, they quickly progress into episodes of atrioventricular block. Sometimes a complete transverse block may occur. This happens extremely rarely, but you need to remember it.

In addition to heart rhythm disturbances, pathology can provoke the development of myocarditis and pericarditis. The first is characterized by a decrease in the contractile function of the heart, which can cause insufficient provision of nutrients to the entire body.

there are problems with the cardiac system

Pericarditis is manifested by characteristic pain in the heart area, which patients can sometimes confuse with angina pectoris. It is important to properly diagnose these diseases.

Despite the prevalence of the two previous forms of the disease in the second stage, borreliosis is distinguished by the polymorphism of its symptoms. It can penetrate almost any internal organ and cause disruption in its functioning. Therefore, you need to be very careful about any disorders of the functioning of the body if you have a history of a tick bite.

Symptoms of stage III disease from borreliosis mites

The last phase of the development of Lyme borreliosis is possible in the absence of appropriate treatment for this disease. It develops 6-24 months after the onset of ring-shaped erythema. It is characterized by the polymorphism of its manifestations.

However, at the moment it is customary to talk about the three most studied forms of pathology at this stage:

1. With joint damage.
2. With skin lesions.
3. With the development of chronic neuralgic symptoms.

The first variant of the disease can occur as arthralgia, recurrent arthritis or its chronic form. The main symptoms of the disease are joint damage with degeneration of cartilage tissue. Pain occurs spontaneously.

They can range from normal discomfort to severe sensations that make any activity impossible. The knees and small joints of the palms are mainly affected. The pain goes away as spontaneously as it appears.

The chronic version of the articular syndrome is in many ways similar to rheumatoid arthritis. There is almost the same deformation in the arms, the pain occurs mainly in the morning. It is important to carry out appropriate differential diagnosis.

Skin lesions with borreliosis manifest themselves in the form of atrophy or local scleroderma. In the first case, the body cover locally takes on the appearance of tissue paper. Itching and discomfort are often observed in areas of the former annular erythema.

Regular moisturizing creams and ointments do not help. If the disease progresses like scleroderma, then skin thickening is recorded in certain areas. It doesn't fold. Sometimes this interferes with normal movements.

If chronic neurogenic symptoms develop, they manifest themselves as constant pain in the neck and muscles. Muscular stiffness in the cervical region progresses. Often a person cannot bend his head or turn it to the side. Symptoms of meningitis and encephalitis intensify. Laboratory diagnostics reveal characteristic changes in the cerebrospinal fluid.

Features of treatment of borreliosis after a tick bite

Therapy for a patient with this disease should be complex and multifaceted. An important role is played by the patient’s stay at a specific stage of the disease. The approach to therapy also depends on the manifestation of symptoms.

When a person is bitten by a barial tick, treatment should first begin with taking antibacterial agents. Erythema annulare may disappear spontaneously within 1 month. However, with appropriate therapy, these periods are significantly reduced, and most importantly, the transition of the disease to the next stage is blocked.

The drugs of choice for Lyme borreliosis are:

• Tetracycline at a dose of one to one and a half grams per day for 2 weeks. This medicine is especially effective in the early stages of the disease. However, with the progression of neurological and cardiac symptoms, it loses some of its relevance.
• Doxycycline. It has proven itself to be effective in patients with skin manifestations of the disease. You need to take 0.1 g of this antibiotic 2 times a day for 10 days.
• Treatment of borreliosis after a tick bite in children under 8 years of age begins with taking Amoxicillin at a dose of 30 mg/kg body weight per day. The duration of treatment is similar to that for adults.

In parallel with antibacterial therapy, symptomatic therapy is carried out. Drugs are used to relieve cardiac manifestations of pathology. Desensitizing medications must be used to suppress the immunological manifestations of the disease.

One way or another, Lyme borreliosis is a serious disease that is sometimes difficult to diagnose. It is important to promptly determine its presence and begin appropriate treatment. In this case, the disease can be defeated.