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

Lyme disease(or Lyme's disease, tick-borne borreliosis, Lymeborreliosis) is an infectious predominantly transmissible disease with a large polymorphism of clinical manifestations and is caused by at least three species of bacteria of the genus Borrelia, such as spirochetes. Borrelia burgdorferi is the dominant agent of Lyme disease in the US, while Borrelia afzelii and Borrelia garinii are dominant 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, the tissues of the joints, the heart, as well as the nervous system, and the eyes are involved in the pathological process. In most cases, symptoms can be managed with antibiotics, especially if diagnosed and treated early in the course of the disease. Inadequate therapy can lead to the development of "late stage" or chronic Lyme disease, when the disease becomes difficult to treat, causing disability, or death. Differences in opinion about the diagnosis, testing, and treatment of Lyme disease have led to two different standards of patient care.

History of the study of Lyme disease, borreliosis

For the first time, a message about 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 approached the health department with children suffering from "juvenile rheumatoid arthritis". It has been noted that several adults also suffer from this disease. Studies conducted in the Department of Rheumatology of the Center for Disease Control, and researcher Allen Steer (Eng. Allen Steere) identified 25% of patients with juvenile arthritis. The disease has been noted to occur after a tick bite, arthritis often associated with erythema migrans. This peculiar skin lesion was known in Europe as Aphrelius erythema.

The incidence of juvenile rheumatoid arthritis is 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 carrier of the causative agent of the disease, the Ixodes tick (Ixodes damini), was established in 1977. In 1982, Willy Burgdorfer was the first to isolate spirochete-like microorganisms from mites, representing a new species from 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 borreliosis, and antibodies to B. burdorferi were found in a number of patients in the same biological media, which made it possible to fully 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 found in the United States, where it is currently reported in 25 states. Clinical manifestations of the disease, similar to systemic tick-borne borreliosis, were 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 published in a number of 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-erythematous form

with a primary lesion of the nervous system, heart, joints

• • chronic course
    • continuous
    • recurrent

with a primary lesion of the nervous system, joints, skin, heart

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

The latent form is diagnosed with laboratory confirmation of the diagnosis, but the absence of any signs of the disease. According to the course: acute course - the duration of the disease is 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 is distinguished: erythema form - in case of development of skin erythema at the site of a tick bite, and non-erythemic 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, 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 Ixodes ticks: Ixodes damini - in the USA, Ixodes ricinus, Ixodes persulcatus - in Europe and our country. It is very difficult to detect a spirochete in mammalian tissues. This microorganism is not only extremely small, forms spore forms, but, as a rule, is present in tissues in very small quantities. The most reliable method for detecting B. burgdorferi is to treat the sample with fluorescein-labeled specific antibodies to Borrelia. Using this method, Borrelia have been found in the eyes, kidneys, spleen, liver, testicles and brain of various mammals, as well as some species of passerine birds (judging by the geography of systemic tick-borne borreliosis, Borrelia are spread by migratory birds with infected ticks attached to them). In areas highly endemic for Lyme disease, Borrelia are present in the digestive system of ticks of the genus Ixodes up to 90%, but only a few of them have Borrelia in the salivary glands. As it becomes clear from the above, it is the mites that serve as the main reservoir of B. burgdorferi, since the infection in them lasts a lifetime, and they can transmit it transovarially to offspring. Ticks are extremely widespread in temperate regions, especially in mixed forests. The life cycle of Ixodes damini usually lasts 2 years. Adult ticks can be found in the bush, about a meter from the ground, from where it is easy for them to move on large mammals. Only females hibernate; males die shortly after mating.

Since Borrelia enter 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 organs of the fetus (brain, liver, kidneys) indicates transplacental transmission of the pathogen. However, in none of these cases there were signs of an inflammatory reaction in the affected tissues, thus, it is impossible to draw an unambiguous conclusion about the causal relationship between the presence of spirochetes and an unfavorable outcome for the fetus. Although the existence of congenital Lyme borreliosis is currently questionable, pregnant women infected with B. burgforferi should be treated with antibiotics. Systemic tick-borne borreliosis is characterized by spring-summer seasonality (May-September), corresponding to the greatest activity of ticks. The risk of infection increases for those who keep pets. The geographical distribution of systemic tick-borne borreliosis is similar to the area of ​​tick-borne encephalitis, which leads to the possibility of simultaneous infection with two pathogens and the development of a mixed infection.

The pathogenesis of Lyme disease, borreliosis

With tick saliva, the pathogen of systemic tick-borne borreliosis enters the human body. On the skin, at the site of tick suction, migrating annular erythema develops. From the place of introduction with the current of lymph and blood, the pathogen enters the internal organs, joints, lymphatic formations; perineural, and later on the rostral route of distribution with the involvement of the meninges in the inflammatory process. Dying, Borrelia secrete endotoxin, which causes a cascade of immunopathological reactions.

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

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

The cellular immune response is formed as the disease progresses, with the greatest reactivity of mononuclear cells manifested in the 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 link of the immune system depends on the severity of the course of the disease.

The leading role in the pathogenesis of arthritis is played by liposaccharides, which 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, cartilage destruction, 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 the 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 degenerative changes in tissues. The causative agent persists for more than 10 years in the body, apparently in the lymphatic system, but the reasons leading to this are unknown.
A slow immune response associated with a relatively late and mild borrelia, the development of autoimmune reactions and the possibility of intracellular persistence of the pathogen are among the main causes of chronic infection.

Congenital Lyme borreliosis

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

Clinical picture of Lyme disease, borreliosis

Incubation period of borreliosis (Lyme disease)

The incubation period from infection to symptom onset is usually 1–2 weeks, but it can be much shorter (a few days) or longer (months to years). Typically, symptoms appear from May to September, as this is when tick nymphs develop and are the cause of most infections. Asymptomatic infections do occur, but are statistically less than 7% of Lyme disease infections in the United States. The asymptomatic course of the disease is more typical for European countries.

Lyme disease is divided into 2 stages:

• Early period
  • I stage
  • II stage
• Late period
  • III stage

I stageborreliosis (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 develop nausea and vomiting, in some cases there may be catarrhal phenomena: sore throat, dry cough, runny nose. At the site of tick suction, a spreading annular redness appears - migrating annular 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." Initially, a macula or papule appears at the site of the bite within 1-7 days, and then within a few days or weeks, the area of ​​redness expands (migrates) in all directions. Its edges are intensely red and slightly rise above the unaffected skin in the form of a ring, and in the center of the erythema is slightly paler. Sometimes migrating annular erythema is accompanied by regional lymphadenopathy. Erythema is usually oval or round, with a diameter of 10-20 cm, sometimes up to 60 cm. Inside such a large area there may be separate annular elements. In some patients, the entire affected area has a uniformly red color, 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. Migrating annular erythema is localized most often on the legs, less often on the lower part of the body (abdomen, lower back), in the axillary and inguinal regions, 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 migrating erythema, but they are usually smaller than the primary focus. The bite mark may remain visible for several weeks as a black crust or bright red spot. Other skin symptoms are also noted: utricle rash on the face, urticaria, small transient red dot and ring-shaped rashes, as well as conjunctivitis. Approximately 5-8% of patients already in the acute period show signs of damage to the soft membranes of the brain, manifested by cerebral symptoms (headache, nausea, repeated vomiting, hyperesthesia, photophobia, the appearance of meningeal symptoms). During lumbar puncture in such patients, an increased pressure of the cerebrospinal fluid (250-300 mm of water column) is recorded, as well as moderate lymphocytic pleocytosis, an increased content of protein, glucose. In some cases, the composition of cerebrospinal fluid does not change, which is regarded as a manifestation of meningism. Often patients have myalgia and arthralgia. In the acute period of the disease, some patients show 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. Erythema migrans annulare is a constant symptom of the first stage of the disease, other symptoms of the acute period are variable and transient. In about 20% of cases, skin 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, while there are no clinical manifestations of the disease.

The absence of symptoms of the disease does not exclude the development in the subsequent II and III stages 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 the normalization of body temperature and the disappearance of erythema, the disease gradually passes into the so-called late period, which includes stages II and III.

II stage borreliosis (Lyme disease)

characterized by dissemination of the pathogen with the blood and lymph throughout the body. True, stage II does not occur in all patients. The timing of its occurrence varies, but most often in 10-15% of patients 1-3 months after the onset of the disease, neurological and cardiac symptoms develop. Neurological symptoms can manifest as meningitis, meningoencephalitis with lymphocytic cerebrospinal fluid pleocytosis, cranial nerve palsy, and peripheral radiculopathy. This combination of symptoms is quite specific to Lyme disease. Throbbing headache, neck stiffness, photophobia, and fever are usually absent; patients, as a rule, are concerned about significant fatigue and weakness. Sometimes there is a moderate encephalopathy, which consists in sleep and memory disorders, concentration of attention, and severe emotional lability. Of the cranial nerves, the facial is most often affected, and isolated paralysis of a cranial nerve may be the only manifestation of Lyme disease. With this disease (as with sarcoidosis and Guillain-Barré syndrome), bilateral facial paralysis is noted. Damage to the facial nerve can occur without impaired sensitivity, hearing and 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 cranial neuritis and radiculoneuritis. In Europe, among neurological lesions, Bannawart's lymphocytic meningoradiculoneuritis is most common, 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. Possible neuritis of the oculomotor, optic and auditory nerves. 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 less common than damage to the nervous system, and has no characteristic features. Usually, 1-3 months after migrating annular erythema, 4-10% of patients develop cardiac disorders. The most common symptom is a conduction disturbance of the type of atrioventricular blockade, including a complete transverse blockade, which, although rare, is a typical manifestation of systemic tick-borne borreliosis. Recording a transient block is difficult due to its transient nature, but an ECG is desirable in all patients with erythema migrans, as a complete transverse block is usually preceded by less severe arrhythmias. In Lyme disease, pericarditis and myocarditis may develop. Patients feel palpitations, shortness of breath, constricting chest pains, dizziness. Sometimes heart damage is detected on the ECG only by prolongation of the PQ interval. Conduction disorders usually resolve on their own in 2-3 weeks, but complete atrioventricular blockade 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 a very pronounced clinical polymorphism due to the ability of Borrelia to penetrate into any organs and tissues and cause mono- and multiple organ damage. So, skin lesions can occur with secondary annular elements, an erythematous rash on the palms of the type of capillaritis, diffuse erythema and utricle rash, benign lymphocytoma of the skin. Along with erythema migrans, benign cutaneous lymphocytoma is considered one of the few manifestations of Lyme disease. Clinically benign lymphocytoma of the skin 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 appear edematous, bright crimson, and are slightly painful on palpation. The face, genitals, and groin areas are also affected. The duration of the course (wave-like) 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 lymphocytoma of the skin is well understood thanks to the research of Grosshan, who proved the spirochetal etiology of this condition even before the discovery of Lyme disease. At the stage of dissemination of Lyme disease, there are also various non-specific clinical manifestations: 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)

formed in 10% of patients after 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, 3 variants of joint damage are distinguished:

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

Migrating arthralgias are noted quite often - in 20-50% of cases, they are accompanied by myalgias, especially intense in the neck, as well as tendovaginitis, and occasionally quickly passing monoarthritis. Objective signs of inflammation are usually absent even with a high intensity of arthralgia, which sometimes immobilize patients. As a rule, joint pains are intermittent in nature, lasting for several days, combined with weakness, fatigue, and headache. Pain in the joints of very significant strength can be repeated several times, but pass on its own. In the second variant of joint damage, arthritis develops, often chronologically associated with a tick bite or the development of migrating skin erythema. Patients are concerned about pain in the abdomen, headaches, polyadenitis is detected. Other nonspecific symptoms of intoxication are also recorded. This variant of joint involvement develops weeks to months after the onset of erythema migrans. The most common is asymmetric monooligoarthritis involving the knee joints; less typical are the development of Baker's cysts (protrusion of the bag of the knee joint with an exudative inflammatory process), damage to small joints. Pain in the joints can disturb patients from 7-14 days to several weeks, can be repeated several times, and the intervals between relapses range from several weeks to several months. In the future, the frequency of relapses decreases, the attacks become more and more rare and then completely stop. It is believed that this benign variant of arthritis, proceeding according to the type of infectious-allergic, does not last longer than 5 years. A significant number of patients may have only 1-2 episodes of arthritis. The third variant 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 erosion; sometimes morphologically indistinguishable from rheumatoid arthritis. In chronic Lyme arthritis, not only the synovial membrane is affected, but also other structures of the joint, such as periarticular tissues (bursitis, ligamentitis, enthesopathy). In the later stages, changes typical of chronic inflammation are revealed in the joints: osteoporosis, thinning and loss of cartilage, cortical and marginal usura (disappearance of a limited part of the organ), less often degenerative changes: osteophytosis (layering of a 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, in addition to joint damage, peculiar lesions of the nervous system (chronic encephalomyelitis, spastic paraparesis, some memory disorders, dementia, chronic axonal polyradiculopathy) are considered to be the leading ones. Skin lesions of the late period include atrophic acrodermatitis and focal scleroderma. Atrophic acrodermatitis 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 limbs (knees, elbows, back of the hands, soles). Inflammatory infiltrates often appear, but nodules of fibrous consistency, swelling of the skin, and regional lymphadenopathy can be observed. The extremities are usually affected, but other areas of the skin of the trunk may also be involved. The inflammatory (infiltrative) phase develops for a long time, persisting for many years, and passes into the sclerotic one. The skin in this stage atrophies and resembles crumpled tissue paper. In some patients (1/3) there is a simultaneous lesion of bones and joints, in 45% - sensitive, less often motor disorders. The latent period before the development of atrophic acrodermatitis ranges from 1 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 atrophic acrodermatitis with a disease duration of 2.5 years and 10 years. Borreliosis infection adversely affects pregnancy. Although pregnancies in women with Lyme disease can proceed normally and end 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, aortic coarctation, endocardial fibroelastosis), cerebral hemorrhages, etc. are described. At autopsy, borrelia are found in the brain, heart, liver, and lungs. There have been cases of stillbirth and intrauterine death of the fetus. It is believed that borreliosis can be the cause of toxicosis of 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 found in the urine. In a biochemical study, in some cases, an increase in the activity of aspartate aminotransferase is detected. Not every patient has 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 character. The most common syndrome is arthritis, which recurred over several years and acquired a chronic course through the destruction of the bones of the iris.

There are changes such as osteoporosis, thinning and loss of cartilage, less often - degenerative changes.

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

Diagnosis of borreliosis (Lyme disease)

Lyme disease is diagnosed on the basis of 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 migrating 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 the affected tissues and biological fluids of a sick person (marginal zone of migrating annular erythema, skin biopsy specimens with benign skin lymphocytoma and chronic acrodermatitis atrophic). Since the number of spirochetes in tissues and body fluids is insignificant, the direct isolation of the causative agent of Lyme disease varies widely. For example, the isolation of Borrelia from the marginal zone of migrating annular erythema ranges from 6-45%. The results of isolation of Borrelia from cerebrospinal fluid and blood are even lower and depend on the stage of the disease. Spirochetes can be seen under the microscope after silver impregnation by the Wartin-Starry method. Very important for confirming the diagnosis is a serological study, which is based on the detection of antibodies to Borrelia in the blood serum, cerebrospinal and synovial fluids, using the reaction of indirect immunofluorescence (RNIF), enzyme-linked immunosorbent assay (ELISA) and immunoblotting. In these reactions, both whole microbial cells and ultrasonic B.burgdorferi disintegrators are used as antigens. RNIF usually uses whole microbial cells. A titer of 1:64 and above is considered diagnostically significant. Less commonly, indirect agglutination and immunofluorometry are used for diagnosis. Laboratory diagnostic methods are essential in establishing the diagnosis of erased, subclinical forms and in the later stages. It should be noted that in the early stages of Lyme disease, serological testing is uninformative in about 50% of cases, so it is important to test paired sera with an interval of 20-30 days. The late stages of the disease are characterized by a significant increase in antibody titers, especially in atrophic acrodermatitis (100% of cases). In chronic arthritis, the isolation of borreliae from the blood at low serum antibody titers has been described. False-positive serological reactions are observed in patients with syphilis, relapsing fever, other spirochetosis, as well as 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, eryzepeloid, cellulitis, etc. From the listed diseases, borreliosis must be differentiated in stage I. In stage II, a differential diagnosis must be made with various forms of tick-borne encephalitis, rheumatic heart disease, and cardiopathy. In stage III, a differential diagnosis should be made with rheumatism, rheumatoid arthritis, reactive arthritis, Reiter's disease. In differential diagnosis, morphological studies of the synovial membrane help.

Treatment of borreliosis (Lyme disease)

Treatment of Lyme disease should be comprehensive, include adequate etiotropic and pathogenetic agents. It is necessary to take into account the stage of the disease.

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 at a dose of 1.0–1.5 g/day for 10–14 days is considered the drug of choice. Untreated erythema migrans may disappear spontaneously, on average, after 1 month (from 1 day to 14 months), however, antibacterial treatment contributes to the disappearance of erythema in a shorter time, and most importantly, it can prevent the transition to stages II and III of the disease.

Along with tetracycline, doxycycline (vibramycin) is also effective in 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 a single dose of the drug and reduce the frequency of taking drugs, 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, joints (in patients with acute and subacute course) are detected in patients, it is not advisable to prescribe tetracycline drugs, since in some patients relapses, late complications occurred after the course of treatment, the disease acquired a chronic course. When neurological, cardiac and articular lesions are detected, 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 - with myalgia and fixed arthralgia. High doses of penicillin are used - 20,000 U / kg per day intramuscularly or in combination with intravenous administration. However, ampicillin at a daily dose of 100 mg/kg for 10-30 days has recently been considered more effective. Of the group of cephalosporins, ceftriaxone is considered the most effective antibiotic for Lyme disease, which is recommended for early and late neurological disorders, a high degree of atrioventricular blockade, and arthritis (including chronic ones). 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 erythema migrans 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 multiorganism of the lesion, and with the adequacy of the selected antibiotic, its duration and dose. In this regard, the development of new schemes for the treatment of early borreliosis in children using highly effective antibacterial drugs of the new generation is quite timely.

In the new approach, for a 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 III 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 the treatment of forms with damage to internal organs with a 14-day course of III 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 the transition to a chronic course. The technical result of this therapeutic method is to prevent the development of a chronic course of ixodid tick-borne borreliosis in children and to reduce the duration of inpatient 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 erythematous and non-erythemic forms, cefobid 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; with non-erythema form - intramuscularly once a month for six months at a dose of 50 mg per 1 kg of body weight; in case of damage to internal organs and systems, cefobid 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 the appointment of benzathine benzylpenicillin intramuscularly 1 time in 2 weeks for three months at a dose of 50 mg per 1 kg of body weight and then 1 time per month for another three months at a dose of 50 mg per 1 kg of body weight.

Cefobid (cefoperazone) is a semi-synthetic cephalosporin antibiotic of the third generation with a wide spectrum of activity, intended for parenteral administration only. The bactericidal effect of the drug is due to inhibition of the synthesis of the bacterial wall. High therapeutic levels of cefobid are achieved in all tissues and fluids, which is necessary for the destruction of Borrelia at the site of primary introduction and with 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 cefobid. 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 appointment of benzathine benzylpenicillin (retarpen, extencillin), a long-acting drug that has a bactericidal effect on sensitive proliferating microorganisms by suppressing the synthesis of cell wall mucopeptides, is designed to consolidate the effect of the main course and contribute to the destruction of the pathogen persisting in biological fluids and tissues of the macroorganism. The timing of the appointment of benzathine benzylpenicillin (3-6 months) is due to the fact that the highest frequency of relapses and the development of the 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, the absorption of the active substance occurs for a long time (21-28 days). Increasing the dose does not affect the effectiveness of the antibiotic. In the non-erythematous 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 the regional lymph nodes, disseminate the pathogen and often develop chronic disease. In case of damage to internal organs and systems, cefobid is prescribed for 14 days at maximum doses in order to achieve the penetration of the antibiotic through damaged biological barriers. The subsequent course of benzathine benzylpenicillin is proposed to be carried out 1 time in 2 weeks during the first 3 months, then 1 time in 1 month for another 3 months in order to increase the duration of the antibiotic action on the persistent intracellular microorganism. The duration of the course of 6 months is determined by the fact that this is the most frequent period for the development of chronic disease.

In the chronic course of the disease, the course of treatment with penicillin according to the same scheme continues for 28 days. It seems promising to use long-acting penicillin antibiotics - extencillin (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 the bite of a tick infected with Borrelia (examine the contents of the intestine and the hemolymph of the tick by dark-field microscopy) is carried out with tetracycline 0.5 g 4 times a day for 5 days. Also for this purpose, with good results, retarpen (extencellin) is used 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. So, with high fever, severe intoxication, detoxification solutions are prescribed parenterally, with meningitis - dehydration agents, with neuritis of the cranial and peripheral nerves, arthralgia and arthritis - physiotherapy treatment.

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

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

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

During the period of convalescence, patients are prescribed fortifying agents and adaptogens, vitamins of groups A, B and C.

Prognosis of borreliosis (Lyme disease)

A favorable outcome of the disease largely depends on the timeliness and adequacy of etiotropic therapy carried out in the acute period of the disease. Sometimes, even without treatment, systemic tick-borne borreliosis stops at an early stage, leaving behind a "serological tail". Prognostically unfavorable in terms of recovery is the preservation of high titers of IgG antibodies to the pathogen. In these cases, regardless of the clinical manifestations of the disease, it is recommended to repeat the 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 organism. In the case of neurological and articular lesions, the prognosis for complete recovery is unfavorable. After the illness, dispensary observation of patients in the conditions of the CIZ is recommended 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 with an indication of the etiology of the disease. Issues of further ability to work are resolved with the participation of an infectious disease specialist at the VKK polyclinic.

Prevention of borreliosis (Lyme disease)

Specific prophylaxis for BL has not yet been developed. Measures of nonspecific prevention 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, high-necked shirts, long trousers, 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 movement. 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 through intact skin is possible. After washing the wound, wash your hands with soap and water. Since ticks are very small, it is important to look for them carefully, preferably with a flashlight. Ticks often attach themselves to pets, so during the tick season, they should be checked after they return from a walk.

Not all ticks are sources of disease, bearing a provocative bite pattern. Ixodid tick-borne borreliosis is present only in those ticks that have managed to become infected with borreliosis from an infected animal, which he 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 hit by a tick, people may notice redness (erythema) on their skin, increasing to an impressive size. The inner part of the erythema brightens, taking on a rounded shape, the bite site will heal. 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

The bite of a tick, in itself, is not felt on the body. When the infection enters the bloodstream, it is carried by the bloodstream throughout the body. With the organs of the heart, muscles, joints, central nervous system, borreliosis can be for a long time, which provokes a chronic form of the disease.

The immune system of the body is trying to fight harmful microorganisms, but the forces are not enough. The disease can take several forms.

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

The 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 this is 7 days. The course of the disease begins acutely, accompanied by fever up to 39 degrees. Patients complain of headaches, painful sensations of the muscles, throat during swallowing, joints. Symptoms of berilliosis can affect the enlargement of the liver and spleen.

Within a week of the onset of infection, a papule forms, which quickly turns into erythema annulare. Often, the bite site can be the neck, thighs, wrist, torso. An increase in the size of erythema, can reach a diameter of more than 20 cm, while having the correct shape, in some cases, erythema, occupies a large part of the body, sometimes with the manifestation of stripes.

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

The disease of the first stage has a long duration. The affected skin, over time, atrophies, becomes thin, nondescript, dry as paper. At this stage of the disease, manifestation of iritis, iridocyclitis with pathology of the organs of vision is possible. Perhaps the development of phlebectasia. Most often, the disease of this form lasts about a month.
Symptoms, accompanied by the first stage of the disease, look like this: pain near the bite, redness, itching, swelling. Most often, the symptoms of the manifestation of the first form of the disease go away on their own without drug therapy.

Second stage

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

Most often, three areas of violations are noted. Nervous system - meningitis (serous), sciatica, damage to the intracranial nerve. The symptom of serous meningitis resembles the meningeal form of tick-borne encephalitis. There is lymphocytic pleocytosis in the cerospinal fluid with an increase in the amount of protein.

Often there is a symptomatology similar to encephalitis, encephalomyelitis, the development of oculomotor paresis, para and tetraparesis of the facial and intracranial nerves is possible. Perhaps a typical manifestation of paralysis of the cranial nerves of the 4th pair (Bell's palsy), the pathology of neuralgia.

A tick bite after manifestations of erythema is manifested by pain. The occurrence of polyrradiculoneuritis or meningoradiculoevritis leads to a violation of the sensitivity of the thoracic region and the motor functions of the spinal nerve roots.

Possible changes in the work of the heart appear at 5 weeks. They are characterized by pathology of anterior ventricular (atrioventricular) conduction, in rare cases, heart block, cardiac arrhythmias, sometimes with signs of myocarditis, pericarditis, accompanied by an increase in the heart organ. Perhaps the development of heart failure of the left ventricle. The duration of the pathological condition of the heart can last from 7 to 45 days.

The third stage of the disease

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

• violation of the nervous system (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 a complex lesion is possible.
Arthritis of the chronic type can affect both small and large joints, due to the recurrence of the disease, the joints are deformed. Cartilage becomes thinner and gradually destroyed, osteoporosis begins to develop in the bone structure, the process affects 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, knees. The skin thickens, swells. Relapses of the process and the duration of the existing disease leads to atrophy (thinning) of the skin.

With the defeat of the nervous system 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, 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 symptomatic tick-borne berilliosis lasts about a month. The manifestation of symptoms depends on the course and pathological process of the disease, and 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 the attack of ticks with all seriousness, recognize the disease in a timely manner, contact specialists, and pass clinical tests. If the diagnosis is confirmed, it is required to undergo the recommended treatment, it is better to do this at a specialized infectious diseases department.

In a medical institution, therapy will be complex, focused on the destruction of Borrelia. The lack of the correct course of therapy will lead to the transition of the disease to a chronic form, sometimes with disability.

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

• arrhythmia;
• decreased strength of muscle tissue in the legs and arms;
• heart failure;
• impaired sensitivity;
• damage to the facial nerve with visible deformation;
• deterioration of vision and hearing;
• impaired function of the joints and their 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 a 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 reduces the likely provocation of cardiac, neurological arthralgic consequences.

Early infection with migratory erythremia is treated with doxycycline (0.1 twice a day orally), amoxicillin (0.5 three times a day). The course of therapy is at least 3 weeks. During the development of carditis, 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 beginning of the disease, treatment with Tetracycline 1.0-1.5 g per day for two weeks is possible. Erythema is able to disappear on its own without the use of medications, but bacterial therapy contributes to the disappearance in a shorter time. In bacterial therapy, it is important that it helps to prevent the transition of the disease 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, annular erythema, benign skin lymphoma. The course of therapy is designed for 2-4 weeks, 200 mg each.

The appointment of Penicillin takes place for patients with systemic borreliosis, in cases of damage to the nervous system in the second stage. In the first stage, with myalgia, fixed arthralgia, a high dose of the drug of 20,000,000 units is recommended. per day intramuscularly, or in combination with IV. Recently, doctors prefer treatment with Ampicillin at a dose of 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. In Lyme disease, Ceftriaxone is prescribed both in the early and late stages, as well as in atrioventricular blockade, arthritis, and neurological disorders. The drug is recommended to be administered intravenously 2 g once a day for 14 days. If patients have intolerance to various types of antibiotics, doctors may prescribe Erythromycin, a group of macrolides.

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

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

Forecasts after undergoing courses of medical therapy are mostly positive, but in some cases disability is possible due to damage to the central nervous system and joints.
Patients who have been ill with borriliasis must be on medical records for a quarterly examination 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 areas of endemic foci, special anti-tick suits are required, however, other ordinary clothing can be used. Shirt must be tucked into pants, trousers tucked into closed high shoes. Cuffs and collar must fit snugly to the body, a headdress is a mandatory ammunition.

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

The suit has 100% protection against bloodsuckers. Made by a domestic manufacturer, which is guaranteed to have a well-deserved recognition along with foreign samples. Using the Bio Stop suit, there is no need for the use of repellents and frequent inspection of 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 body systems 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 barrels and belong to the type of spirachets. In a disease such as borreliosis, the symptoms and consequences are interconnected, because if you do not start a course of therapy when the first signs appear, the pathology will worsen. To do this, it is necessary to pass the examination in time. In this case, the detection of Lyme disease will be timely and after the treatment, you can be left without any complications.

A tick bite is the cause of development, but initially the bacteria that cause the disease are in their natural reservoir, namely in animals. Blood-sucking insects pick up barrels from them and become carriers of an infection that 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, Ural) 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.

Most active blood-sucking insects begin to bite at the end of spring. In turn, people are too susceptible to bacteria, so the chance of getting infected is very high.

Development of pathology

A person bitten by an ixodid tick needs to know how the infection develops. After a bite with insect saliva, bacteria enter the skin. Further, the infection penetrates into the nearest lymph nodes and actively multiplies, and after 2-3 days it spreads through the bloodstream throughout the body. In this way, a borreliosis infection after a tick bite enters the cardiovascular and nervous systems, as well as muscle tissues and joints.

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

Finding an infected tick in a person does not make it a carrier of the disease. The same applies to pregnant women, as well as women during lactation (breastfeeding). Infection in adults, like 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 to the first signs of borreliosis, namely from 5-10 days to 1 month;
• 1 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;
• 2 period. This stage is characterized by the time when the bacteria began to actively spread through the bloodstream;
• 3 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 latter is already considered an advanced form of the disease.

First period of development

Symptoms of tick-borne borreliosis stage 1 are mostly common with local manifestation. The most common early signs of infection are:

• 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 symptom that can confirm the presence of the disease is erythema.

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

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

With borreliosis, other skin manifestations also occur, for example, urticaria. Sometimes an 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.

Sometimes with Lyme disease, stage 1 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 are already actually disappearing and instead of them, signs characteristic of such pathological processes appear:

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

For the first pathology, the following symptoms are characteristic:

• 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 of attention;
• An increase in the 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 often the visual, oculomotor and auditory. This process manifests itself with the following symptoms:

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

Often the defeat of the cranial nerves is bilateral. In more rare cases, one side is first damaged by the 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 a shooting type;
• Weakness (paresis) in muscle tissues;
• Sensitivity jumps;
• Decreased tendon reflexes.

In addition to the manifestation of signs of certain syndromes, with borreliosis, neurological symptoms are sometimes observed that occur due to damage to the nervous system:

• incoherent speech;
• Disorder of coordination of movements;
• Unsteady gait;
• involuntary movements;
• Trembling in the limbs (tremor);
• problems with swallowing;
• epileptic seizures.

Due to infection, arthritis gradually develops and it mainly affects such joints:

• Ankle;
• Hip;
• Knee;
• Elbow.

Both 1 joint and several at once can be affected. This manifests itself in the form of pain and the inability to carry out full-fledged movements.

With damage to the heart, signs of such forms of diseases most often appear:

• Myocarditis;
• Antriventricular blockade;
• Pericarditis.

Such pathologies are mainly manifested as follows:

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

On the skin, an infection of the 2nd stage of development is manifested by the following symptoms:

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

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

With borreliosis, the rest of the 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

From the moment of the first manifestations of Lyme disease to the development of stage 3, sometimes 1-2 years pass. 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 (HAD).

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

Arthritis in this stage becomes chronic and affects both small and large joints. The pathology manifests itself with periodic relapses, due to which a gradual deformation of the cartilaginous 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 type of course and manifests itself in the form of red and blue spots. They are localized on the extensor sides of the lower and upper limbs, as well as on the back of the hands and feet. In these places, the skin hardens and edema 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 such signs:

• Weakening of muscles (paresis);
• Impaired sensitivity, manifested in the form of pain of a different nature and symptoms of paresthesia (numbness, tingling and goosebumps);
• Failures in coordination of movements;
• Problems with mental abilities, namely with memory, intelligence and quick wits;
• Violation of the pelvic organs.

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

Chronic course of Borreliosis

As it develops, borreliosis becomes chronic, which 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;
• Joint damage;
• Lymphocytomas.

Diagnostics

Diagnosis of borreliosis is performed using a serological study, as well as by visible symptoms. Barrels are detected using electron microscopy. If their concentration is low enough, then polymerase chain reaction (PCR) is used to determine.

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

Separately, it should be noted that the development of tick-borne encephalitis and borreliosis is not related. They are 2 independent diseases and from the common they have only a method 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 in the diagnosis.

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 can remain disabled.

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

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

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

• The treatment methods and medicines used for detoxification will help relieve the symptoms of fever;
• With meningitis, dehydration (dehydration) occurs;
• Non-steroidal anti-inflammatory drugs and physiotherapy will help relieve pain and inflammation;
• To normalize the work of the heart, special drugs are used. They are selected based on clinical manifestations;
• Desensitizing therapy, which serves to reduce sensitivity to the allergen, will help remove allergies.
• Vitamin complexes and immunostimulants will help strengthen the immune system and improve the general condition.

Consequences

There are consequences of tick-borne borreliosis in cases where patients do not undergo therapy and bring the disease to stage 3 or even to a chronic course. The disease gradually progresses and internal deformations in places where bacteria accumulate are aggravated. 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 disorders of the heart;
• Multiple arthritis;
• Neoplasms of a benign type that appear on the skin near the bite site.

Ixodid tick-borne borreliosis is an infectious disease that is 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 inspect your body after arriving home.

Once, speaking 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 it slipped through.

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

Botox blockades were also offered to me - I brushed it off for a whole year. And in May 2014, an article by the chief infectious disease specialist of the region 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 rest on our Curonian Spit, at home I found a tick on my left side. Pulled it out and threw it away...

Again I passed the tests and after 10 days I received the diagnosis: tick-borne borreliosis, Lyme disease. I was placed in the regional infectious diseases hospital, where I underwent a course of treatment. At the time of discharge
The attending physician sympathetically spread her hands: "Your illness is incurable, adapt to life as best you can."

In the district polyclinic, 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 disappeared.

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

Taking advantage of a short respite, I started looking for a cure. I was interested in an article about herbal medicine by an eminent phytotherapist, 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 collections - antistaphylococcal and antifungal. The course of treatment is at least 3 months. Immediately listed the collection of herbs. There are many, but I outlined everything in detail.

So in anti-staphylococcal collection included: yarrow herb - 8 parts by weight; burdock leaves - 5 parts by weight; herb St. John's wort, sweet clover, common oregano, nettle leaves and large plantain - 3 parts by weight; coltsfoot herb, highlander bird, cinnamon rose hips, grass and roots of erect cinquefoil, medicinal dandelion, marigold flowers, tansy - 2 parts by weight; chamomile flowers, horsetail herb - 1 part by weight.

Grinding and mixing all the ingredients, 1 tbsp. I poured a spoonful of collection with 0.5 liters of boiling water, insisted for 1 hour. After straining, I drank 0.5 cups 2 times a day 30 minutes before meals.

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

1 st. I poured 0.5 liters of boiling water into a spoonful of the collection, insisted for 1 hour. - Having filtered, 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 action. It is indicated for fungal and viral diseases, giardiasis, chlamydia, helicobacteriosis, as well as for gastritis, duodenitis, peptic ulcers.

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

The chief infectious disease specialist of the military hospital did not believe in my healing either, offering to conduct an in-depth analysis. I did not have Lyme disease.

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

Gluskin Garry Aronovich for the newspaper HLS

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

borreliosis tick

According to statistics, this disease is the most common among all that spread through these insects in the Northern Hemisphere. Its main feature is 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 the usual bites of these insects.

Features of the transmission of the borreliosis tick

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

When an ixodid tick bites a mammal, it sucks in blood that contains microbial particles. After that, they begin the process of their development, but already in the body of an insect.

how is the disease transmitted?

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

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

The symptoms and consequences of a 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 to various organs and systems. A number of characteristic reactions occur in them, which cause the development of the corresponding symptoms.

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

1. With blood, the microbe spreads throughout the body to the brain, internal organs, muscles. An annular erythema forms at the site of the bite.
2. After the borrelia dies, it provokes a whole cascade of humoral reactions that cause the further progression of the disease.
3. In response to the appearance in the body of specific antigens of the pathogen, the immune system begins to actively produce antibodies - IgM and IgG. They are sent to places of greatest accumulation of alien organisms.
4. In specific organs and systems where antigen-antibody interaction occurs, local inflammatory reactions progress with the release of a large number 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 into bones, joints, tissues of internal organs, gradually destroying them.

After a baralium tick bites, symptoms begin to develop already 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 patient disability or even death. Lyme borreliosis is a very insidious and multifaceted disease with a complex clinical picture.

Symptoms of the presence of a borreliosis tick and its bites of the 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, the activity of the disease falls on the period of time from late spring to early autumn. During this period, nymphs mature - forms of ticks, which are mainly the cause of human infection.

tick bite on hand

In the process of development of the clinical picture, 2 periods are conditionally 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.

Tick ​​borreliosis symptoms in the initial stages demonstrates non-specific:

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

Often, catarrhal symptoms (nasal congestion, cough, and others) may appear.

However, the main symptom of the disease at this stage remains a special annular erythema, which develops at the site of the tick bite. It has the appearance of 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 times when it takes the form of a kind of roller. Other annular elements may be present within the circle.

The main symptom of the disease is erythema annulare.

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.

Erythema annulare is the most common symptom of stage 1 borreliosis. It is observed in 60-80% of patients. She 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 ingress of the pathogen into the corresponding vessels.

Symptoms of borreliosis after a tick bite may also appear in the form of other non-permanent 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 like hepatitis. It is characterized by the progression of dyspeptic manifestations (nausea, vomiting), abnormalities in laboratory tests and an increase in liver size.

There are cases when Lyme disease occurs subclinically. In such cases, it is often confused with common 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 history.

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 does not develop. The disease simply “quietly” passes immediately into the second stage of the pathological process.

Symptoms of the II stage 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 pathology is ignored, then after about 1-3 months, erythema annulare progresses to 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 main blow is taken by the human nervous system. With the flow of blood and lymph, microorganisms penetrate the meninges, where they continue their negative impact on the body. The most common symptoms are meningitis, meningismus, and encephalitis.

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

Accordingly, the following symptoms appear:

• Headache.
• Photophobia.
• Sleep rhythm disorder.
• Irritability.
• Nausea and vomiting that is not relieved by conventional medicines.
• Disorders of motor functions.
• General weakness and decreased muscle strength.

The intracranial pressure also increases. A feature of the defeat of 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 commonly affected. Therefore, it is important to make a differential diagnosis with other diseases that can potentially cause similar symptoms.

The cardiac form of the manifestation of the disease is characterized by damage to the heart. It is relatively rarer than neuralgic. The most common symptom in this case is a violation of the heart rhythm.

At first, lonely ventricular extrasystoles develop, however, they progress quite quickly into episodes of atrioventricular blockade. Sometimes it can manifest a complete transverse blockade. This happens very rarely, but it must be remembered.

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 supply of nutrients to the whole organism.

problems with the heart system

Pericarditis is manifested by characteristic pains in the region of the heart, which patients can sometimes confuse with exertional angina. It is important to carry out an appropriate diagnosis of 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 disturbances in its work. Therefore, you need to be very careful about any disorders in the functioning of the body in the presence of a history of a tick bite.

Symptoms of the III stage of the disease from the borreliosis tick

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 erythema annulare. It is characterized by 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 proceed according to the type of arthralgia, recurrent arthritis or its chronic form. The main symptoms of the disease are joint damage with cartilage degeneration. Pain occurs spontaneously.

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

The chronic variant of the course of the articular syndrome is in many ways reminiscent of rheumatoid arthritis. There is almost the same deformation on the hands, the pain is disturbing mainly in the morning. It is important to conduct appropriate differential diagnosis.

Skin lesions in borreliosis manifest as atrophy or local scleroderma. In the first case, the body cover locally takes on the form of tissue paper. Often there is itching and discomfort in places of the former annular erythema.

Ordinary moisturizing creams and ointments do not help. If the disease progresses according to the type of scleroderma, then skin thickening is fixed in some areas. She doesn't fold. Sometimes it interferes with normal movements.

If chronic neurogenic symptoms develop, they manifest as constant pain in the neck and muscles. The stiffness of the muscles in the cervical region progresses. It is not uncommon for a person to be unable to bend their head or turn it to the side. The symptoms of meningitis and encephalitis increase. In laboratory diagnostics, characteristic changes in the cerebrospinal fluid are revealed.

Features of the treatment of borreliosis after a tick bite

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

When a person has been bitten by a baral mite, treatment should first of all begin with taking antibacterial agents. Erythema annulare may spontaneously disappear up to 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 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.
• doxocycline. It has proven itself in patients with skin manifestations of the disease. On the day you need to use 2 times 0.1 g of this antibiotic for 10 days.
• Treatment of borreliosis after a tick bite in children under 8 years of age begins with the administration of Amoxicillin at a dose of 30 mg / kg of body weight per day. The duration of treatment is similar to that in adults.

In parallel with antibiotic therapy, symptomatic therapy is carried out. Drugs are used to relieve cardiological manifestations of pathology. Be sure to use desensitizing drugs to suppress the immunological manifestations of the disease.

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