Lyme disease is an infectious disease. Tick-borne borreliosis and symptoms of Lyme disease. Stage of chronic infection

Tick-borne borreliosis, Lyme borreliosis, Lyme disease - these are all names for one infectious disease.

The first outbreak of pathology occurred in 1975 in the American town of Lyme. Its main symptoms were also described there.

The incubation period of borreliosis is from 2 days to 1 month. There are 3 stages in the development of pathology, differing in the severity of the patient's condition. In tick-borne borreliosis, the symptoms and treatment at different stages are different, different types of drugs are used, and schemes for their use. The disease can be defeated if adequate antibiotic treatment is started in a timely manner.

Although tick-borne encephalitis and borreliosis have similar symptoms, they remain different effects on the body and affect the brain in different ways.

Symptoms of the onset of the disease

It is very difficult to establish a diagnosis immediately after an insect bite. I have these symptoms for a variety of diseases. The initial symptoms of borreliosis resemble catarrh of the upper respiratory tract. The manifestations of the disease are as follows:

elevated temperature;
headache;
aches in joints and muscles;
sore throat;
runny nose;
weak cough;
general weakness;
sometimes inflammation of the mucous membrane of the eyes develops.

If the main symptom of a tick infection is absent, as happens in 25% of all cases, the patient takes the pathology for a cold. The main symptom of Lyme borreliosis is erythema in the form of a ring. This is the only characteristic manifestation of the disease in stage I. The skin turns red, thickens, and nearby tissues swell. Itching, burning appear. The papule increases in a few days, a ring with a clear red rim is formed. It is usually round or oval in shape. Its dimensions in diameter can reach 60 cm. Inside the rim, the skin is lighter. Sometimes erythema can be in the form of several concentric rings.

In addition, other signs of borreliosis may be observed, namely:

rash similar to hives;
hypertonicity of the neck muscles;
an increase in lymph nodes corresponding to the location of the erythema.

Erythema may disappear on its own in a few days or a month. In its place are peeling and pigmentation. The body copes with the symptoms of the disease at stage I on its own, without medication.

II stage of the disease

It happens that after a tick bite, Lyme disease bypasses stage I and begins with the second. This period may be short, but it can last for months. There are disturbances in the work of the central nervous system (CNS), cardiovascular diseases develop, the skin is damaged, the joints become inflamed.

With damage to the central nervous system, serous meningitis can occur, which is characterized by headaches, photophobia, hypertonicity of the occipital muscles.

Damage to the cranial nerves has the following symptoms:

the face becomes distorted, the eyes do not close, the patient does not own his mouth;
hearing and vision deteriorate;
the movements of the eyeball are disturbed, strabismus develops;
it becomes difficult to chew and swallow (with inflammation of the hypoglossal nerve).

The consequences of damage to the spinal nerves are expressed as pain in the form of "lumbago" in the legs (lamp pains), lower back (girdle pains). After a while, the patient begins to feel muscle weakness. A person bitten by an infected tick may perform involuntary movements, have a shaky and unsteady gait, and speak poorly.

With damage to the heart, pain behind the sternum, shortness of breath, increased heart rate are possible. Skin lesions are represented by a rash similar to urticaria, secondary erythema or lymphocytomas - nodules that usually appear in the groin, nipple, and earlobe.

The infection is transmitted through the bloodstream throughout the body and any organ can get sick: kidneys, liver, eyes, bronchi, testicles, but this is rare.

The last stage of tick-borne borreliosis

Stage III can be characterized as chronic. It can begin six months after the completion of the previous stage of the pathology. After a tick bite, Lyme disease can become chronic in as little as 2 years if the infection has not been treated before.

A person with borreliosis aggravates damage to the nervous system, joints and skin, and develops chronic ailments. So, arthritis leads to the fact that the joints are gradually deformed, osteoporosis, chronic myositis develops. A person has constant aching pains with lumbago, it is difficult for him to perform certain movements.

Emerging encephalomyelitis over time aggravates the patient's condition, is the cause of memory impairment, epileptic seizures, dementia, impaired coordination of movements. Such people have changes in gait (cock or duck gait).

Atrophic dermatitis develops in the last stage of Lyme disease. Lesions are usually found on the arms and legs (occasionally occur on other parts of the body). First, spots appear from bright red to purple. Then, instead of them, places of seals with flaky skin are formed. Later, atrophic processes will form there, as a result of which the skin becomes thinner, it becomes like crumpled tissue paper. Inflammatory processes lead to the formation of non-healing ulcers.

Diagnosis and treatment

Diagnosis of the disease is not easy. Firstly, pathology cannot be diagnosed in the first days after an insect bite. Secondly, even a blood test and a biopsy of the edge of erythema or lymphocytoma give a reliability of no more than 50%. Therefore, additional diagnostics is prescribed, based on the study of blood serum, cerebrospinal fluid (cerebrospinal fluid) and synovial fluid (located in the joint cavity). It is carried out in order to detect Borrelia DNA and antibodies to them. The most accurate diagnosis is the search for traces of DNA.

If a tick has bitten, an examination of the patient's skin provides additional data, but is not sufficient to establish the disease.

Treatment of borreliosis is complex and lengthy, depending on the stage of the disease. It is carried out in 2 directions: etiotropic therapy, aimed at suppressing the infection, and pathogenetic, in which it is necessary to treat the affected organs, joints, and nervous system. The first at different stages is carried out with various antibiotics. The duration of the use of drugs in some cases can be 28 days. If the course of treatment is not carried out to the end, some Borrelia are able to survive and begin to multiply.

Therapeutic pathogenetic complex consists of antipyretic, anti-inflammatory, antihistamine and cardiac drugs. The body is detoxified, vitamin therapy is used.

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

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

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

How is a person infected with borreliosis?

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

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

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

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

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

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

Symptoms, stages and forms of Lyme disease

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

When do symptoms of tick-borne borreliosis appear?

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

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

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

Acute stage

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

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

There are erythema and non-erythema forms.

erythema form

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

Erythematous form

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

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

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

Subacute stage

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

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

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

There are complaints of pain in the joints.

chronic stage

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

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

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

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

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

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

Signs and symptoms of borreliosis

Lyme disease is characterized by the following symptoms:

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

Diagnosis of borreliosis

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

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

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

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

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

Treatment of tick-borne Lyme borreliosis

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

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

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

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

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

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

Dangerous consequences of running berreliosis

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

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

For the first time, signs of the disease were diagnosed in the United States, in 1975. Conducted clinical studies revealed the presence of juvenile rheumatoid arthritis in patients. In 1977, the causative agent, the ixodid tick, was identified, and medical reference books were replenished with articles describing the new disease.

The observations that followed this event and a comprehensive study of the disease in the best clinics and scientific centers of the world led to the creation of the most effective methods for diagnosing and treating borreliosis. And today, despite the found means of combating the disease, scientists and physicians continue to search, hoping to create a potent vaccine that can prevent infection with tick-borne borreliosis forever.

Signs of borreliosis

On the territory of Russia, the distribution of two types of ixodid ticks was noted: taiga and dog. The first species is found in the forests of the Far East and Siberia, the second one lives in the European part of the country. By itself, a meeting with an insect can go unnoticed, because only a part of the ticks are infected. If you are unlucky and the virus is transferred into human blood, it is important to know exactly the main visual sign of borreliosis:

At the site of the bite, ring-shaped redness, erythema, the edges of which are slightly raised, the center is colored less intensely than the circle formed by inflammation.

A natural continuation of the lesion is itching or pain in the area where the erythema is located. It is difficult to identify the disease in a timely manner, since the symptoms of borreliosis really manifest themselves only one, or maybe two weeks after receiving the bite. According to the severity and severity of symptoms, the disease is divided into three stages.

1st stage(local infection) is observed in 40-50% of those infected. Taking into account the incubation period, it manifests itself in the first month after the bite and has the following symptoms:

ring-shaped migratory erythema
temperature rise to 39-40 degrees
fever
headache
joint and muscle pain
general weakness
rarely nausea and vomiting

Seeing a doctor immediately, even if you have doubts that it was the Ixodes tick that bit you, will help you quickly begin treatment. Only at the first stage there is a real, one hundred percent guarantee of complete relief of the actions of borrelia.

2nd stage observed in 10-15% of patients. In the absence of proper treatment, it manifests itself (after a long time) as follows:

cardiopalmus
pain in the heart
liver and kidney damage
acute conjunctivitis
angina
bronchitis
hives

Since Borrelia can settle in any human organ, the clinical picture of the second stage is not a constant and unchanging phenomenon. The general trend is this: where the infection sits, there it hurts more.

3rd stage formed a few months after the end of the first two. The following symptoms of tick-borne borreliosis at this stage are described:

relapsing course
weakness and malaise
irritability or depression
sleep disturbance
damage to various systems and organs

The most difficult stage, leading to life-threatening changes and even death. It is difficult to treat and acquires a chronic course.

How is it diagnosed

The system of diagnosing any disease implies a comprehensive examination of the patient. Even with a banal cold, they measure the temperature, listen to the breath and examine the throat. Infections with more severe consequences than the common cold and cough require serious laboratory tests. That is why, the diagnosis of tick-borne borreliosis consists of:

anamnesis (a conversation with a doctor to identify the fact of localization of a tick bite)
blood test (repeated in 20-30 days)
serological method (detection of antibodies to Borrelia)
solid phase ELISA
PCR (helps to detect Borrelia protein in synovial fluid, serum and tissues)

Having become acquainted with the methods for diagnosing borreliosis, it becomes obvious that the main culprit of the disease is borreliosis, and all ongoing procedures are aimed at searching for them.

These small, convoluted bacteria, belonging to the spirochaete family, live in the nutrient medium of wild and domestic animals, including cattle. The ixodid tick, feeding on the blood of an infected animal, transports borrelia into the human body with its own feces. By scratching a tick bite, we involuntarily help bacteria enter the bloodstream and then settle in our internal organs.

There is another form of borreliosis - without erythema. This means that if you admit the possibility of getting an ixodid tick bite, but do not observe its visual manifestation, anyway, do not be too lazy to visit a doctor and do all the necessary tests.

Early diagnosis of the disease is very important. Only it allows you to avoid the terrible consequences that lead to irreversible physical and, more dangerously, mental changes in the body.

Treatment of borreliosis

Given the serious violations in the functioning of the organs that are fraught with Lyme disease, named after the city of Lyme in Connecticut, you should carefully consider the signs that have appeared and, without delaying for a long time, immediately go to the doctor. Modern scientific and practical medicine, subject to the early start of treatment, guarantees a favorable prognosis upon its completion.

Treatment of borreliosis is the prerogative of infectious disease doctors. The basis of the method of treatment at any stage of the disease is antibiotic therapy. Only doses, frequency and duration of antibiotics change.

Under the action of antibiotics, the mass death of Borrelia occurs, which can lead to intoxication of the body. If such signs appear, the medication is temporarily stopped. In general, with regular and proper use of medications prescribed by a doctor, it is quite easy to cope with borreliosis at the first stage. It is worse if the start of treatment is missed and borreliosis has moved to the next stage.

There have been cases when the first stage of the disease does not manifest itself at all. Erythema is mild and disappears quickly, there are no signs of general malaise and headache. However, inside the process goes on, borrelia multiply and spread throughout the body. You should not hope for a chance and a happy accident, it is better to go to the doctor and make sure that the bite does not pose a danger.

Consequences of borreliosis

All the severe consequences that characterize the disease borreliosis provoke the 2nd and 3rd stages of the disease, provided that the appropriate treatment was not carried out at the 1st stage.

Borrelia have a negative effect on the entire human body, affecting the nervous and cardiovascular systems at the 2nd stage, and attack the musculoskeletal system at the 3rd stage.

If we move away from generally accepted concepts to specifically expressed complications of borreliosis, it looks like this:

cardiovascular system - severe arrhythmia, fatigue
nervous system - multiple sclerosis, the development of dementia in children, a general violation of the mental functions of the body, paralysis of peripheral nerves (distortion of facial expressions)
musculoskeletal system - rheumatoid arthritis, muscle atrophy, periodic inflammation of the joints

As you can see, any form of complication of borreliosis inevitably leads to a change in lifestyle, limits the mental and physical capabilities of a person. The consequences of the disease are especially dangerous for children. A child, just entering the vast world of emotions, knowledge, hobbies, loses everything. Unprepared for such destructive attacks of bacteria, the body cannot cope with the attack and seriously deteriorates. This is an eternal pain for both parents and children, even if the kids do not realize it mentally. And only the adoption of timely preventive measures can prevent destruction that is detrimental to your child, stop the penetration of harmful bacteria into the body and protect you from the serious consequences of an insidious disease.

Prevention of borreliosis

Almost 40 years have passed since the discovery of borreliosis, but so far an effective vaccine that can prevent infection immediately after a tick bite has not been received. And this is despite the fact that the ixodid tick is a carrier of another serious disease - encephalitis. As you know, there is a vaccine against encephalitis and it is effective. So what to do, how to protect yourself from borreliosis and can it be made available to everyone by means and methods?

Precautionary measures

The main prevention consists in the adoption of protective measures of a household profile. If you are planning a trip to nature or you live in places of the epidemiological distribution of the ixodid tick, you should do this:

wear shirts and other clothes with long sleeves, trousers made of thick material, hats (hats, scarves), gloves, high boots for a walk in places where insects accumulate
treat all clothing with special means of protection against insect bites
if the tick is already found on the body, carefully and very carefully, trying not to tear off the head of the insect, remove it with tweezers or fingers
carry out removal with slow twisting movements
it is forbidden to press and drag the insect vertically
after removal, the wound is washed, small particles, if any, are cleaned, hands are disinfected

The ixodid tick did not appear out of nowhere and people have long been familiar with its bites. There are several popular ways to remove a tick: lubricate the tick and the bite with vegetable oil, smoke the insect with cigarette smoke, drip wax. Attention: do not resort to folk methods without special need. There is a risk that the tick, lacking breath, will regurgitate the contents of the stomach into the human blood and infection will occur.

The first cases of systemic borreliosis were noted in 1975 in the American city of Lyme (Connecticut). Several people complained of arthritis, which was combined with annular erythema. The main carrier of the infection was identified after 2 years, it turned out to be the ixoid tick.

In 1981, the causative agents of the disease were isolated - previously unknown spirochete-like bacteria from the genus Borrelia. They were also found in the blood and cerebrospinal fluid of the victims, which helped to study in detail the origin and epidemiology of Lyme disease.

10 facts about borreliosis:

The name was given in honor of the city in which the first cases of infection occurred. Later it turned out that in addition to the countries of North America, Lyme disease is common in many countries of Asia and Europe.
In Russia, borreliosis is quite common; here it was detected already in 1985.
Natural carriers of the pathogen are American white-tailed deer, dogs, white-footed hamsters, sheep, cattle and birds, but it has proven difficult to identify it in animal tissues.
Judging by the geographical distribution of the infection, infected ticks are carried by birds during seasonal migration.
Spirochete pathogens are found mainly in the digestive organs, sometimes in the salivary glands of the tick, and are transmitted to offspring.
Ixoid ticks prefer to live in mixed forests of temperate climatic zones. Their life expectancy is about two years. In the adult state, ticks are massively found at a height of no more than one meter from the surface of the earth. Here it is quite easy for them to move onto the fur of mammals that pass by.
The pathogen enters the human body by transmission along with the saliva of the carrier at the moment of suction. Rare cases of infection have been recorded after taking unboiled goat milk or when rubbing arthropod secretions on the surface of damaged skin.
Lyme disease can affect different people, regardless of age or gender. Most often, children under 15-16 years of age and adults aged 20-44 years are infected.
There is evidence of a possible transplacental transmission of the pathogen from mother to fetus.
Borrelia are not transmitted between people and from animal to person.

Borreliosis is characterized by a clear seasonality, outbreaks of infections are recorded in the spring and summer from May to September and correspond to the time of activity of ixoid ticks.

The territory of distribution of Lyme disease and tick-borne disease has common borders, therefore, with simultaneous infection with two types of pathogens, Lyme disease occurs with mixed symptoms.

After suffering an infectious disease, persistent immunity is not developed, after 5-7 years, re-infection is possible.

CAUSES

Until recently, the causative agent of borreliosis was considered to be one species of spirochetes - Borrelia burgdoiferi, but a more detailed microbiological study provided information on the etiological heterogeneity of Lyme disease. Now distinguish ten types of pathogen, for convenience combined into the Borrelia burgdorferi sensu lata complex. Of the ten representatives of the group, only three are dangerous to humans: B. garinii, B. burgdorferi sensu stricto, B. afzelii. These bacteria belong to gram-negative microaerophiles; under conditions of laboratory cultivation, they are quite demanding on the nutrient medium.

The bacteria of the complex are unevenly distributed over the continents, their ability to cause certain symptoms differs depending on the type of pathogenic bacterium. There are studies confirming the relationship between damage to the central nervous system and B. garinii. B. burgdorferi sensu stricto is associated with arthritis, and B. afzelii causes atrophic dermatitis. For this reason, the characters observed in different ranges of spirochetes will differ due to the genetic heterogeneity of the complex.

The causative agent of tick-borne borreliosis, together with tick secretions, enters under the skin when bitten. Together with the blood and lymph, the infectious agent spreads through the body: first in the internal organs, lymph nodes and joints, and then affects the meninges. The death of Borrelia provokes the release of endotoxins, which serves as a signal for the development of immunopathological reactions.

CLASSIFICATION

Forms of Lyme disease:

latent - confirmation of the diagnosis according to the results of a laboratory analysis without showing symptoms of infection;
manifest - confirmation of the diagnosis by clinical signs and test data.

Types of the disease by the nature of the process and symptoms:

Chronic - damage to the heart, nervous system, joints, the duration of the disease is more than six months.
Subacute - the duration of the disease is 3-6 months, the symptoms are similar to the acute form.
Acute - there is damage to the skin, joints, heart and central nervous system, the duration of the disease is not more than three months, there are non-erythemic and erythemal varieties.

Stages of Lyme disease:

Stage I - local infection in non-erythemic and erythemal form;
II stage - dissemination (meningeal, neurotic, cardiac, febrile and mixed course);
III stage - persistence (acrodermatitis, arthritis).

SYMPTOMS

The latent period lasts about 1-2 weeks. Then comes a period of local infection, during which skin lesions and intoxication syndrome develop. A papule forms at the site of the bite, it turns red, itches, swelling and soreness appear in this area.

The papule grows peripherally and increases in diameter, this phenomenon is called tick-borne erythema migrans. It is characterized by the formation of a ring about 20 cm in diameter with a clear red border and less pronounced pigmentation in the center. Most often, within one or two months, migrating erythema suddenly disappears, leaving pigmentation and traces of peeling in its place. Against the background of erythema, general infectious signs appear.

General infectious symptoms of stage I Lyme disease:

chills;
weakness;
fever;
joint pain;
headache;
enlargement of regional lymph nodes;
hives;
pharyngitis, runny nose.

Early stages of Lyme disease may end in self-healing, otherwise the transition to the next stage begins.

The disseminated stage develops for a long time, over the next 3-5 months after the spread of infection throughout the body.

If Lyme disease manifests itself in a non-erythemic form (without skin redness), then borreliosis makes itself felt with systemic lesions of the body.

Neurological syndrome of Lyme disease:

Bell's palsy;
cerebral ataxia;
serous meningitis;
throbbing headache;
radiculoneuritis;
Bannwart's syndrome;
myelitis;
neuralgia;
memory loss;
fast fatigue;
sleep disturbance;
photophobia;
myalgia;
hearing loss;
decrease in skin sensitivity;
paresis and paralysis.

Lyme Cardiac Syndrome:

atrioventricular blockade;
myocarditis;
Heart arythmy;
pericarditis;
dilated cardiomyopathy.

Signs of joint damage:

migrating pains in muscles and joints;
bursitis;
tendinitis;
arthritis of large joints.

Symptoms of skin lesions:

lymphocytoma;
migratory erythema.

Symptoms of damage to the organs of vision:

iritis;
choroiditis;
panophthalmitis;

Symptoms of damage to the excretory and reproductive system:

erythrocytes in the analysis of urine;
orchitis;
proteinuria.

Upper respiratory tract symptoms:

bronchitis;
pharyngitis;
tracheobronchitis;

Symptoms of damage to the digestive tract:

hepatolienal syndrome.

After six months (or within a period of no more than two years), the acute phase of Lyme disease becomes chronic. At this stage, skin lesions with acrodermatitis, benign lymphoplasia, or chronic arthritis of the joints are usually detected.

Characteristic signs of the chronic stage of Lyme disease:

With atrophic acrodermatitis, inflamed skin areas appear on the limbs, in place of which, after inflammatory infiltration atrophic processes are observed.
With benign lymphocytoma on the surface of the auricles, skin of the face, in the inguinal folds and armpits reddish-blue rounded nodes appear, which in rare cases can transform into malignant tumors.
In addition to skin lesions, the chronic stage is also characterized by pathological changes in bone tissue. At this stage, the symptoms are very similar to those of rheumatoid arthritis, Reiter's disease, or ankylosing spondylitis.
Among the neurological manifestations of the last stage of borreliosis, there are encephalopathy, ataxia, dementia, constant fatigue, polyneuropathy, chronic encephalomyelitis. Usually they appear in the interval from one to ten years from the moment of infection. The chronic form of Lyme disease is characterized by an undulating course with alternating periods of exacerbations and remission of symptoms.

Transplacental infection of the fetus can lead to its intrauterine death. Newborns have prematurity, heart defects and delayed psychomotor development.

DIAGNOSTICS

The initial stage of diagnosis includes the collection of an epidemiological history with the study of early symptoms of the disease.

Data for collecting an anamnesis at an early stage of the disease:

visits to epidemic areas of distribution of ixoid ticks, forests and park areas;
the fact of a tick bite;
spring-summer season;
erythema at the site of the bite;
rashes on the body;
increase in body temperature;
inflammation in the tissues of the joints;
neck muscle tension.

Laboratory diagnostic methods:

Complete blood count - an acute course is characterized by an increase in the ESR and leukocytosis.
Study of the cerebrospinal fluid. With tension in the muscles of the neck, nausea and vomiting, a spinal puncture is performed for bacteriological examination of the cerebrospinal fluid.
PCR helps to detect bacterial DNA and antibodies to Borrelia from various body fluids. This method is predominantly used for research purposes.
Serological methods (RNIF, ELISA) are designed to detect antibodies to borelliae.

As a rule, the presence of erythema migrans is sufficient for the diagnosis. At the initial stage of Lyme disease, serological methods cannot detect traces of the pathogen.

Difficulties in diagnosis arise when identifying forms of the disease that occur without skin rashes, as well as chronic borreliosis.

Differential diagnosis is carried out with a wide range of diseases that have similar symptoms. To exclude certain pathologies serological analysis is carried out. However, false positive results will also be detected in concomitant infectious diseases such as syphilis, mononucleosis, typhoid and rheumatic diseases.

TREATMENT

Treatment of borreliosis carried out comprehensively, its basis is etiotropic therapy aimed at suppressing the pathogen. Timely antibacterial treatment is the prevention of severe complications of Lyme disease and the transition of pathology to the chronic stage.

The main stages of therapy:

The patient is admitted to the hospital infectious diseases department of the hospital. The exception is patients with erythema migrans without signs of intoxication, their treatment can be carried out at home. When late forms of the disease are detected, the patient is referred for treatment to specialized cardiological, rheumatological and neurological hospitals, depending on the clinical manifestations.
Medical therapy depends on the stage of the disease. Taking antibiotics is often accompanied by a reaction associated with the release of endotoxins and the development of spirochetosis against the background of the death of Borrelia. In this case, antibiotic treatment is temporarily stopped, and then resumed with a decrease in their dosage.
In case of detection of a mixed infection (borreliosis and tick-borne encephalitis) while taking antibiotics immunoglobulin is used from tick. Vascular preparations and antioxidants contribute to the accelerated elimination of toxins.

The result of treatment is evaluated by the dynamics of clinical manifestations. For optimal rehabilitation a course of physical therapy is recommended, massage and oxygenation. In the chronic course of the disease, treatment in sanatoriums during remission is indicated. Persons who have had Lyme disease are subject to dispensary observation for two years.

COMPLICATIONS

Among the likely negative consequences of borreliosis, one should highlight irreversible changes in the nervous system, heart and inflammatory diseases of the joints, which, if not properly treated, lead to disability, and in severe cases, cause death.

PREVENTION

Specific prophylaxis in the form there is no vaccine against borreliosis, so the only effective method of protection are non-specific methods. They consist in the use of measures to prevent tick bites.

Prevention of infection with borreliosis:

limit walks in the forest in epidemic areas of ticks during the period of their greatest activity;
before walking in the forest, wear clothes that hide exposed areas of the body;
individually apply repellents;
after leaving the forest, inspect the body, hair and clothes for the presence of ticks;
removal of the tick, treatment of the bite site with iodine or any antiseptic;
examination of the tick for the possibility of infection with borreliosis in the laboratory;
examine the blood for the presence of specific antibodies a month after the bite;
with an increase in body temperature or the appearance of local redness in the bite area, immediately consult a doctor;
carrying out anti-mite treatments of forests, forest belts and places of mass recreation of people.

PROGNOSIS FOR RECOVERY

With early detection of Lyme disease and preventive antibiotic therapy favorable prognosis. These measures help prevent the transition to a chronic course and prevent the development of severe complications. Sometimes tick-borne borreliosis ends with self-healing in the early stages, but high titers of antibodies to the pathogen remain in the blood. In this case, a second course of antibiotics and symptomatic treatment is recommended.

Late diagnosis with the detection of lesions of the nervous system and internal organs often leads to low efficiency of therapeutic measures. In most such cases the prognosis for a complete cure is unfavorable.

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Rheumatologist, candidate of medical sciences.

Research interests: cardiovascular pathology in systemic connective tissue diseases, modern methods in the diagnosis and treatment of rheumatoid, psoriatic, gouty and other arthritis, reactive arthritis.

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Lyme disease (synonyms: Lyme borreliosis, Lyme borreliosis, tick-borne ixodid borreliosis, Lyme disease) is an infectious pathology that occurs in acute or chronic form with damage to the skin, musculoskeletal system, nervous, cardiovascular system, etc. It refers to natural focal infections, carriers are ixodid ticks. Lyme borreliosis is widely found in the habitat of ixodid ticks, namely in the northern hemisphere. In our country, about 8 thousand new cases of the disease are registered annually, all age categories are ill, but more than 10% of the cases are children. Ixodid ticks can be carriers of several infections at the same time, so if a single tick bites, a person is at risk of contracting several infections.

According to the severity, this pathology can have a mild, moderate and severe course, as well as early and late periods. The disease without treatment acquires a chronic or relapsing course.

The deciphering of the causes and mechanisms of the development of Lyme disease was carried out almost 35 years ago - in 1982. At the moment, more than 10 species of Borrelia are known, of which 3 of them are dangerous for humans.

Clinical picture of Lyme disease

Redness of the skin (erythema migrans) is the very first and most typical symptom of Lyme borreliosis. It appears at the site of a tick bite: initially there is a slight redness and induration of the skin, which subsequently spreads and can increase to 20 cm in diameter (range from a few centimeters to 15-20 cm). At the onset of the disease, there may also be symptoms resembling a cold: fever, sore throat, swollen submandibular lymph nodes. Patients are not always aware of the fact of being bitten by ticks, therefore, in some cases, specific treatment is not carried out, and the process becomes chronic. Over time, similar foci appear, but in other places (stage of dissemination).

Education is quite typical. benign lymphocytoma. This tumor-like formation can occur on the earlobe, in the area of the nipple, scrotum, less often in other places.

Characteristic is the defeat of the nervous and cardiovascular systems. Damage to the nervous system can manifest itself in the form of:

meningitis,
encephalitis,
meningoencephalitis,
neuropathy,
radiculopathy, etc.

Heart damage:

violation of the rhythm and conduction of the heart (blockade),
myocarditis,
pericarditis.

Rheumatologists quite often have to carry out differential diagnosis with Lyme borreliosis due to its rather wide distribution in our country and due to the fact that the variety of clinical forms and manifestations of the disease often occurs “under cover” of various rheumatic diseases. So, the clinical picture of this pathology is similar to the manifestations of systemic lupus erythematosus, systemic scleroderma, dermatomyositis, acute rheumatic fever (rheumatism), polymyositis, etc.

Joint damage

Let us dwell on the features of joint damage in Lyme borreliosis. The peculiarity of joint damage lies in the fact that ALL structures of the joint can be involved in the inflammatory process. Clinically, this can manifest itself in the form of joint inflammation - arthritis, or joint pain - arthralgia. In most patients, joint damage occurs several months after a tick bite (on average 3-4 months, in 70% of patients), while in others, the joints are already affected in the later stages of the disease. In this regard, it is advisable to distinguish 2 types of arthritis depending on the time of occurrence: early-stage arthritis and late-stage arthritis.

Clinically, there is an extreme variety of manifestations of joint damage in tick-borne borreliosis: from a single “outbreak” of arthritis to a chronic course with frequent relapses and exacerbations. Most often, large joints are affected: knee, ankle, shoulder, hip, synovitis (effusion in the joint) is often observed. At the same time, no more than 2-3 joints are affected, that is, the process is mono-/oligoarticular.

Diagnosis of Lyme disease

Diagnosis of tick-borne borreliosis is based on a carefully collected history of the disease. Patients do not always associate a tick bite and joint pathology, since, recall, arthritis does not occur immediately. If there was a bite, then you should definitely inform the doctor about it, even if it was a few months ago. In addition, it is worth mentioning the development of erythema migrans, damage to the heart, nervous system, skin and other manifestations.

Among laboratory tests, the definition is important anti-borreliosis antibodies in blood serum, cultivation and isolation of the pathogen (borrelia) from the lesion, microscopy. A number of patients have an increase in circulating immune complexes (CIC), C-reactive protein (CRP), ESR, etc. in the blood test.

Timely diagnosis of Lyme disease is extremely important, since in typical cases this disease is completely treatable with antibiotics, and the earlier treatment is started, the lower the likelihood of developing damage to the musculoskeletal system (this can be considered a prevention of rheumatological manifestations of the disease).

There are currently no specific clinical and laboratory criteria for the disease at 100%. The only specific criterion for this disease is erythema migrans. In the presence of typical erythema migrans and an indication of a tick bite, treatment should be started immediately!

Lyme Disease Treatment

We repeat that in the case of an early visit to the doctor, the disease can be successfully cured, the purpose of which is the complete removal of the causative agent of the infection - Borrelia from the body and the elimination of the symptoms of Lyme borreliosis. Treatment is allowed on an outpatient basis, however, in severe cases or with an atypical course of the process, hospitalization may be required. Treatment regimens for Lyme disease are very diverse, the duration of treatment, depending on the regimen, ranges from 5 days to 2-3 weeks. Treatment of chronic forms of joint damage will require more time (up to 1 month). The following can be used as antibacterial drugs:

doxycycline,
amoxicillin,
azithromycin,
ceftriaxone,
cefotaxime,
benzylpenicillin and some others.

Prognosis and prevention of Lyme disease

The prognosis for the patient is usually good (complete recovery without consequences), the ability to work is fully restored after about 1-2 months.

Prevention of infection is aimed at reducing the risk of tick bite, namely the active use of repellents in nature, wearing clothes and hats in dangerous places that cover open parts of the body as much as possible, and a thorough examination of the skin after being in nature.

Reminder for travelers

ATTENTION!

When planning a trip to the forest, to the park, to the country house, you should dress properly to limit the possibility of ticks crawling under your clothes.
Use repellents as directed.
After being outdoors, you should carefully examine the skin, if a tick is found, if possible, immediately remove it.
If you traveled with children, you should carefully inspect them, make sure there are no ticks.
If a tick is found, it is worth saving it and taking it to the laboratory.
The doctor must be notified of the fact of the bite.
Even in the absence of any manifestations, it is worth donating blood for the presence of antibodies to the pathogen 3-4 weeks after the bite.
If redness appears at the site of the bite, a visit to the doctor is a must!
Remember that in case of early detection, the disease is completely curable!