Vaccination against Lyme disease borreliosis. Is there a vaccination against tick-borne borreliosis. Tick-borne encephalitis and borreliosis: symptoms, diagnosis, treatment, prevention

Tick-borne borreliosis (Lyme disease, tick-borne erythema) is a disease that develops as a result of the bite of an ixodid tick infected with Borrelia. The causative agent of borreliosis affects the skin, joints and nervous system. There is no vaccination against Lyme disease, and long-term immunity is not developed even after illness.

Way of infection with borreliosis

Lyme disease got its name from the city of Lyme in Connecticut (USA). There, for the first time, the pathogen was isolated - the bacterium Borrelia burgdorferi, which gave the disease a second name. The reservoir of infection are infected birds and mammals. The transmission of Borrelia is provided by ticks from the genus Ixodes - they also carry tick-borne encephalitis and can transmit both diseases in one bite at the same time. Borreliosis is less dangerous than tick-borne encephalitis - the victim has much more chances for a successful recovery, but it must be taken into account that ticks infected with borreliosis are much more common than ticks carrying the encephalitis virus.

It is known that Borrelia can be transmitted during pregnancy from mother to fetus. However, the manifestations of Lyme disease in infants infected before birth have not been recorded.

Prevention of borreliosis

The best way to protect against ticks is special clothing with cuffs at the wrists and ankles and regular (once every 2-3 hours) inspection of each other. The detected tick must be carefully tied with a thread, pulled out without tearing off the head, and try to send it for analysis. The maximum activity of ticks occurs at the end of spring and the end of summer-beginning of autumn.

If the analysis showed that the tick was infected with Borrelia, then the disease can be stopped even before the first symptoms appear. For this, certain antibiotics are prescribed to the patient within 5 days after the bite. It is not recommended to take medications on your own - only after a positive response from the laboratory.

Symptoms of borreliosis

The incubation period for Lyme disease is 3 to 32 days. One of the first signs is ring-shaped redness at the site of the bite (erythema annulare migrans). It gradually increases in size, the patient may experience pain and itching in this area, general weakness, headache. The temperature rises. If left untreated, from the 4th-5th week of the disease, vomiting develops, increased light and sound sensitivity, symptoms of damage to the nervous system appear: para- and tetraparesis (impaired ability to move arms and legs normally, respectively), paresis of the facial nerves (the patient loses the ability to control muscles faces: speech becomes slurred, there are problems with chewing, cannot close his eyes, etc.). The pathogen also affects the heart muscle and joints. A person experiences pain in the eyes - iritis or iridocyclitis may develop.

In the later stages of the disease, pain and swelling in the joints are accompanied by memory and speech disorders, visual and hearing impairments, pain in the hands and feet. Atrophic acrodermatitis can develop on the skin in the form of blue-red spots on the limbs. The spots merge and become inflamed. The skin at the site of the spots atrophies and becomes like tissue paper.
For the diagnosis of borreliosis, a search for borreliosis is carried out by PCR in the blood, skin, cerebrospinal and joint fluid. In its external manifestations, Lyme disease is similar to allergic dermatitis, tick-borne encephalitis (and it is very important to accurately establish the absence of tick-borne encephalitis virus in the blood), cardiomyopathy and a number of systemic diseases (rheumatoid arthritis, Reiter's disease), etc.

Reusable borreliosis

The peculiarity of borreliosis is also that even a fully transferred disease does not give long-term stable immunity. Borrelia hide in the lymph nodes of an infected person and, being there, do not allow the immune system to fully respond to the introduction of foreign organisms. As a result, in areas endemic for borreliosis, local residents can get Lyme disease more than once.

The name tick-borne infections combines a group of infectious diseases that occur after the bite of ticks containing pathogens. The causative agent is not the tick itself, but the viruses and bacteria that live and multiply in it. These diseases are classified as endemic, that is, they are not common everywhere, but in certain regions.

Are all insects dangerous to humans? Only a part of ticks are infected with infectious agents, therefore, the disease after a bite may not develop. However, it is impossible to determine whether a tick is infected by the appearance of the insect.

In particular, tick-borne infections include borreliosis and tick-borne encephalitis. These diseases often occur together, in the form of mixed infection. If we consider infections separately, then borreliosis occurs several times more often than tick-borne encephalitis.

Insects love relatively cool weather and dark places. Therefore, they are more common in the north of the country.

Ixodid tick-borne borreliosis is one of the most common diseases that develop after a tick bite. The borrelia that causes this disease is not a virus, but a special bacterium that lives in ticks. In its morphological properties, it occupies an intermediate position between viruses and bacteria.

Its presence in the insect is determined in a special laboratory dealing with tick-borne infections. An important condition for determining a microorganism is that the insect must be alive. Otherwise, the bacterium dies along with the tick, and it becomes impossible to determine its presence.

Unlike tick-borne encephalitis, Lyme disease, as borreliosis is also called, occurs with other symptoms. During borreliosis, acute and chronic forms are distinguished.

First, nonspecific symptoms are observed in the form of fever up to 38 ° C, general malaise, moderate headache.

The acute form is characterized by two options:

1 The disease is accompanied by a characteristic reddening of the skin at the site of insect suction - an erythemal form.
2 This redness may not be present - in this case, an erythema-free form is observed.

With a chronic process, symptoms of damage to the skin, bones and joints, and the nervous system develop.

Specific erythema, which occurs in some cases at the site of tick suction, is as follows:

1 The site of hyperemia has a rounded shape and clear boundaries.
2 The size of hyperemia can be different - from a few millimeters to several centimeters.
3Erythema quickly becomes bright, and in the center of it there is an area of enlightenment.
Gradually, the size of hyperemia decreases, and she turns pale.

Residual effects accompanying borreliosis mainly affect the musculoskeletal system and the nervous system. The appearance of these symptoms is observed after an acute period, when the process becomes chronic.

The defeat of the osteoarticular system occurs in the form of pain in the muscles and joints, aggravated by changing weather. They can bother a person for several years, sometimes for life.

The pathology of the nervous system develops 5-7 years after the chronicity of the disease. There are phenomena of encephalopathy, radicular lesions. In some cases, paresis and paralysis of the limbs may develop.

Sometimes there is a chronic skin lesion in the form of areas of compaction and peeling. Periodically, redness may occur, resembling primary erythema.

You need to get vaccinated against tick-borne infections for several reasons:

1 In order not to get sick with encephalitis and borreliosis.
2 If the disease does develop, vaccination gives the course of the disease in a milder form.
3 To avoid serious complications.
4 So that the process does not become chronic.

However, many people underestimate the importance of vaccination and refuse to carry out preventive vaccinations.

Who is at risk of contracting tick-borne infections?

1Persons living in endemic regions.
2People who frequent the forest: hunters, fishermen, tourists.
3People whose profession is related to visiting the forest: geologists, foresters, builders of roads, oil and gas pipelines, power lines.
4 The urban population may be attacked by ticks in the forest park zone, in summer cottages.

When visiting the forest zone, you must wear special protective clothing. It should cover the body as much as possible, have cuffs on the sleeves and legs. Pants must be tucked into boots, and hair must be completely removed in a headdress.

It is important to know that ticks are most active in the short period from late April to early June. At this time, it is better to refrain from visiting the forest belt. If this is still necessary, you need to use special repellents that repel insects.

After returning from the forest, you need to examine yourself well for the presence of a tick. These insects contain an anesthetic in their saliva, so a person does not even notice that he has been bitten. A tick can stay on the human body for several days and all this time secrete borreliae into the blood.

At the moment, a specific protective vaccine against ixodid borreliosis has not been created. There is only specific prevention of tick-borne encephalitis. A person can protect himself from borreliosis only by non-specific measures. They include:

1Measures to protect against insect attacks - protective clothing and repellents.
2Treatment of the bite site with antiseptics.
3Tick research in a special laboratory.
4Immunoenzymatic blood test for the detection of specific antibodies.
5 Taking Doxycycline for several days.

Who should be vaccinated:

1Any person can receive a vaccination against tick-borne encephalitis and borreliosis at will.
2 Vaccination is mandatory for children and people from risk groups.

The vaccine is called Encevir and Encepur. Vaccination begins in a child from the age of one. It consists of two stages, between which at least a month must pass. After a year, the first revaccination is carried out. Subsequent revaccination is carried out with a three-year interval.

Since tick-borne encephalitis and borreliosis often occur together, the same preventive measures can be used to protect against borreliosis as for encephalitis.

If you find a stuck tick, you need to carefully remove the insect so as not to damage it. The bite site is treated with an antiseptic. Ticks are examined in the laboratory to detect the causative agent of infections.

Sometimes the manifestations of the disease do not occur immediately, but several weeks after infection. To find out if there is an infection, you need to donate blood to detect specific antibodies - class M immunoglobulins. Their presence indicates an acute tick-borne infection in the body. If antibodies are detected, this is an indication for a course of anti-borreliosis treatment in an infectious diseases hospital.

After an insect bite, an intramuscular injection of anti-encephalitis human immunoglobulin is carried out. To prevent the development of borreliosis, Doxycycline is prescribed for several days.

Although there is no specific prevention of borreliosis, vaccination against endemic infectious diseases is still necessary.

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Prevention of borreliosis: is there a vaccination?

Borreliosis, or Lyme disease, is transmitted by ixodid ticks and is a serious infectious disease. The disease affects the nervous system, skin, heart, musculoskeletal system. Of great importance is the prevention of borreliosis, since any disease, and even more so having serious consequences, is better to prevent than to treat.

Unlike encephalitis, the main preventive measure for which in dangerous areas is vaccination, there is no vaccination against Lyme disease. The carrier of these two diseases is one - ixodid ticks, therefore, a mixed infection is sometimes observed.

Cases of borreliosis occur on all continents (with the exception of Antarctica). In Russia, many regions are considered endemic, that is, cases of the disease are constantly recorded in these areas. The existence of a vaccination against borreliosis could significantly reduce the incidence in dangerous regions. But there is no vaccine, so the only preventive measure is non-specific, that is, protection against ticks on the skin, their quick and correct removal.

How to protect yourself from a tick

All measures for the prevention of tick-borne borreliosis or Lyme disease can be divided into three groups:

1.Use of protective clothing.

You can use ordinary clothes, while following a number of rules:

Be sure to use a headdress under which the hair is removed.
Shoes should be high, closed, trouser legs should be tucked into it.
Sleeves, trousers should be long.
Shirt, jacket must be tucked into trousers.
Clothing should be without buttons, with a zipper or without a zipper at all. Cuffs should be tight-fitting or elasticated.
Clothing color should be light. On light fabrics, mites are more visible. Slippery materials are preferred so that the tick cannot gain a foothold on them.
Special protective clothing, such as Biostop, Stop-mite, Wolverine suits, which provide mechanical and chemical protection. The cut of the suit does not allow ticks to get under it, and the cuffs and special folds are equipped with special traps with chemicals. Falling into such a trap, ticks die.

2.Use of chemicals

For example, the drug Medilis Ziper is an insecticide that is used to combat not only ticks, but also mosquitoes, ticks, cockroaches, and other insects. The active substance of the drug is cypermethrin, which, when it enters the tick's body, acts on its nervous system, destroys it, leading to death.

The use of chemicals when hiking in the forest, with a long stay in areas with a high risk of infection is one of the most effective methods of preventing Lyme disease (borreliosis).

All drugs are divided into three groups:

Repellents - repel ticks.
Acaricides - kill ticks.
Repellent-acaricidal - act in two directions.

3.Quick and correct removal of the tick

The probability of infection with borreliosis directly depends on how long the infected tick sucked blood. You need to remove the tick with tweezers or a loop of thread. You can not crush the tick, lubricate with oil. These actions increase the chance of infection.

There is no vaccination against borreliosis, so non-specific prevention is of paramount importance - preventing ticks from getting on the skin.

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Features of vaccination against borreliosis

How to remove a stuck tick?
A little about Lyme disease
Treatment of the disease and its consequences

Before the season of tick activity, many vaccinate, which only work against encephalitis. There is no vaccine against borreliosis. In order not to get sick with this unpleasant ailment, it is better to take measures in advance that can prevent insect bites.

Prevention of tick-borne borreliosis

There is currently no vaccine available for this disease. Therefore, a person should take care of protective measures himself before visiting places where ticks can live.

The greatest tick activity occurs in May and June. But in the period from April to October, when the soil temperature is within 5 °, bites of these insects are also possible. Mostly ticks crawl on the ground or live in the grass. They do not bite their potential victims immediately. First they cling to clothes, then for several hours they look for a place to bite.

Ticks live not only in forests, but also in garden plots, on city lawns, in parks and in other places with grass cover. Pets after a walk can bring them to their apartment. Therefore, you need to carefully examine dogs and cats after returning home.

To prepare for visiting insect habitats, you need to do the following:

shoes should be as closed as possible;
trousers are tucked into shoes;
the jacket should be with tight-fitting sleeves;
it is necessary to use various repellents that repel ticks;
it is better to vaccinate against encephalitis in advance, even if there is no way to protect yourself from borreliosis.

Shops offer anti-encephalitis suits. This is good clothing for visiting the forest, it protects against insects. You can treat the suit with anti-tick agents from above.

The tick does not immediately dig into the body, but looks for a place for a long time. Therefore, it is necessary to constantly examine yourself and your companions. If the clothes are light, then all insects are better visible on it.

Returning home, you need to carefully examine yourself again. Taking a shower, you can get rid of unattached ticks - the water will wash them away. You can’t crush them with your hands - you can get infected.

If the area is endemic for borreliosis, then prophylaxis with antibiotics is carried out. But this does not guarantee that a person will not get sick. A person bitten by a tick should monitor his well-being, even if he was previously given medication. If the symptoms of tick-borne borreliosis are not observed, then it is better to play it safe and get tested after 6 weeks. If the result is negative, the test is repeated after another month, and then after six months, since antibodies can appear with a delay.

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If the tick has stuck, then it is important to get rid of it correctly in the shortest possible time. In no case do not smear it with oil - the risk of contracting borreliosis increases.

To remove, you can use tweezers, which you need to capture the body of the insect closer to the proboscis. Rotating around the axis, slowly sip. After a couple of turns, the tick is well removed.

After removing the harmful creature, the wound must be smeared with iodine or any antiseptic. Wash hands thoroughly with soap and disinfect tools.

If the proboscis remains, then there is nothing to worry about. A slight suppuration forms at this place, gradually everything will come out with pus.

There are a few rules to remember to get rid of a tick:

caustic solutions (ammonia, gasoline, etc.) should not be applied to the bitten place;
do not cauterize the tick with improvised means (for example, with a cigarette);
when extracting, do not pull sharply to prevent rupture;
do not pick something in the wound;
in no case do not crush the tick.

The extracted insect must be taken to the laboratory for analysis. This will help to understand if the bitten person has a disease. In the sanitary and epidemiological station, the tick is examined for 3 days.

You can check the tick yourself, with a special rapid test at hand.

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Tick-borne borreliosis also has such a name. The disease was first diagnosed in 1975 in the USA, in the city of Lyme. At the same time, several people were diagnosed with rheumatoid arthritis. After 2 years, the pathogen was established - it turned out to be an ixodid tick infected with the Borrelia microbe.

The study of the disease began, which led to the possibility of treating the disease. But it has not yet been possible to prevent infection: an effective vaccine against the disease has not been found.

The incubation period lasts about two weeks, sometimes up to a month. Where the tick has stuck, the skin turns red - this is the first sign of the disease. Gradually, the red spot increases. Its size is up to 10 cm. There are cases of a much larger spot - up to 60 cm. The shape of the spot is round, the outer layer is more red and convex. Gradually, the central part of the spot turns pale and may even acquire a bluish tint. A crust appears at the site of the bite, turning into a scar. If treatment is not performed, the stain disappears after 2-3 weeks.

The following symptoms appear on average after a month: lesions of the heart, nervous system, joints.

Lyme disease is divided into 3 stages of development:

The first stage lasts about a month. The bite site turns red. Possible necrosis. Gradually there are secondary spots, rashes on the face in the form of rings, conjunctivitis.
In the second stage, the pathogen penetrates into other organs. The nervous system is affected. At the same time, the liver, kidneys, eyes, and also the skin can be affected.
After 3 months, the third stage begins. The disease becomes chronic. The patient becomes very tired, sleep is disturbed, depression appears. Many organs begin to work poorly.

The disease is not transmitted to a healthy person from an infected person. But during pregnancy, a woman can infect the fetus with borreliosis.

In general, the incidence of tick-borne borreliosis is very high. Immunity against the disease is developed for a short time, so re-infection is possible after 5 years from the date of treatment.

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Lyme disease affects the joints, so the patient needs rest. Antibacterial therapy is prescribed for treatment. The patient takes drugs for at least two weeks, usually tetracyclines. Treatment is most effective in the early stages. If a pregnant woman has been infected, it is necessary to inform the doctor conducting her pregnancy as soon as possible.

If the doctor has not yet received the results of the tests, but suspects the presence of the disease, then the treatment is already prescribed. Severe patients are hospitalized. Affected joints may undergo surgery.

Complications occur in the absence of treatment. It can be:

heart disease - arrhythmia, increased fatigue;
diseases of the nervous system - childhood dementia, mental disorders, multiple sclerosis, paralysis of the nervous periphery;
diseases of the musculoskeletal system - arthritis, muscle atrophy, joint inflammation.

All this leads to a change in the habitual way of life. Complications in children are especially dangerous - the child's body is destroyed.

Tick-borne encephalitis and borreliosis: symptoms, diagnosis, treatment, prevention

Over the past 30 years, the number of tick-borne infections has increased significantly. Various types of ticks have populated the world, and many of them are carriers of pathogens. It is important to know their symptoms, diagnostic methods and treatments for tick-borne encephalitis and borreliosis (Lyme disease), two of the most common diseases in Europe that can be caused by the bite of these insects. After all, timely treatment plays a key role in preventing serious consequences. The elderly and children are most susceptible to them.

The most common transmitted tick-borne infections - tick-borne encephalitis (TBE) and Lyme disease - have several similar signs in the first stage. Both are accompanied by flu-like symptoms. However, TBE is a viral infection while Lyme disease is caused by bacteria. Both diseases can cause serious long-term complications, so stay in the areas where these insects are likely to live should not be taken lightly.

Tick-borne encephalitis

The incubation period of TBE is generally 7 to 14 days and is asymptomatic. In the first stage, TBE infection causes flu-like symptoms such as high fever, malaise, loss of appetite, muscle pain, headaches, nausea and/or vomiting. They begin to appear one to two weeks after the bite of an infected tick. About 25% of all patients infected with tick-borne encephalitis develop more severe symptoms during the second stage, which begins four weeks later. High fever and constant sleepiness can be a sign of inflammation of the brain or spinal cord. There are also severe headaches, nausea, vomiting, disorientation, convulsions, paralysis, partial or complete loss of consciousness, coma. The disease can be fatal or leave permanent neurological complications.

Borreliosis

Lyme disease can cause a wide range of symptoms, making it sometimes difficult to diagnose. It usually affects the connective tissue, muscles and nervous system. The disease develops 1-3 weeks after the bite. Erythema migrans may also appear - redness with a diameter of one to several centimeters, slightly convex, warm, painful to the touch. This rash often appears at or near the site of the bite, but not necessarily.

If the disease goes unnoticed, then the bacteria can affect the nervous system at a later stage. This causes various neurological symptoms such as local paralysis, speech impediments, and mood swings.

Erythema migrans - a rash in Lyme disease

After a year, Lyme disease becomes chronic and has many symptoms, such as: fever, chills, headaches, arthritis, muscle twitches, dizziness, difficulty speaking, loss of spatial orientation.

Diagnostics

To diagnose encephalitis, the doctor needs information about all the symptoms, as well as recent diseases and risk factors (being close to people with viral infections, in the habitats of mosquitoes or ticks, for example).

Magnetic resonance imaging (MRI), lumbar puncture and electroencephalogram (EEG) are also used. Taking a blood test to check for viruses, bacteria and immune cells is also very informative.

In some cases, a biopsy of the brain tissue is done, which is necessary to confirm the diagnosis if the symptoms worsen and the treatment does not bring positive results. This procedure is important in determining the type of encephalitis and in prescribing the appropriate treatment.

Diagnosing Lyme disease is much more difficult, as it has a number of non-specific symptoms that may accompany other diseases. If there is no rash characteristic of borreliosis, then in order to make a diagnosis, the doctor asks questions about the patient's medical history, including staying in tick habitats where infection is likely.

Laboratory tests for antibodies to bacteria may be used to confirm the diagnosis. These tests are most reliable a few weeks after infection, but, unfortunately, they cannot 100% confirm or deny the presence of borreliosis.

Early diagnosis and initiation of treatment give a better chance of a full recovery.

Treatment

Treatment of tick-borne encephalitis involves intravenous administration of antiviral drugs, such as:

Acyclovir (Zovirax);
Ganciclovir (Cytovene);
Foscarnet (Foscavir).

Side effects of antiviral drugs may include nausea, vomiting, diarrhea, and muscle pain.

For people suffering from encephalitis, additional supportive procedures are also needed. They provide:

continuous monitoring of cardiac function and respiration;
intravenous droppers to ensure proper hydration and the normal content of essential minerals in the body;
anti-inflammatory drugs, such as corticosteroids, to reduce intracranial pressure and swelling;
anticonvulsants to stop or prevent seizures.

After an illness, recovery procedures may be needed. These procedures may include:

physical therapy;
occupational therapy;
speech therapy;
psychotherapy.

Antibiotics are used to treat Lyme disease. At the first stage, their oral use is recommended. Treatment involves the use of doxycycline for adults and children over 8 years of age, or amoxicillin (cefuroxime) for adults, young children, and pregnant and lactating women. The duration of the course is 7-14 days.

If the disease affects the central nervous system, then doctors recommend treatment with intravenous antibiotics lasting from 14 to 28 days.

Along with antibiotics, additional and alternative methods of treatment can be used:

proper nutrition;
the use of probiotics;
phytotherapy.

Prevention

The best prevention against tick-borne encephalitis and borrelioscha is to take the following measures to protect against tick bites:

wear long-sleeved shirts and long trousers when in the woods or areas with tall grass
use repellents - repellents;
wear light-colored clothing that makes it easier to spot ticks, and check your skin carefully after being outdoors.
if a tick is found, remove it with tweezers, making sure that all parts of it (body and head) are removed.

Learn what to do if bitten by a tick.

Vaccination against tick-borne encephalitis and borreliosis

Vaccination against tick-borne encephalitis is possible. It is highly recommended for people who are regularly at risk of exposure to infections in infected areas. A variety of vaccines are available in healthcare facilities. Complete immunization can be achieved after three doses over three weeks. For long-term immunization, three initial doses are given over 9-12 months. But they still need to be updated every three to five years. Children are also immunized.

How much does the tick-borne encephalitis vaccine cost?

Prevention of tick-borne borreliosis

There is currently no vaccine available for this disease. Therefore, a person should take care of protective measures himself before visiting places where ticks can live.

To prepare for visiting insect habitats, you need to do the following:

shoes should be as closed as possible;
trousers are tucked into shoes;
the jacket should be with tight-fitting sleeves;
it is necessary to use various repellents that repel ticks;
it is better to vaccinate against encephalitis in advance, even if there is no way to protect yourself from borreliosis.

Shops offer anti-encephalitis suits. This is good clothing for visiting the forest, it protects against insects. You can treat the suit with anti-tick agents from above.

Returning home, you need to carefully examine yourself again. After taking a shower, you can get rid of unattached ticks - the water will wash them away. You can’t crush them with your hands - you can get infected.

Back to index

How to remove a stuck tick?

If the tick has stuck, then it is important to get rid of it correctly in the shortest possible time. In no case do not smear it with oil - the risk of contracting borreliosis increases.

To remove, you can use tweezers, which you need to capture the body of the insect closer to the proboscis. Rotating around the axis, slowly sip. After a couple of turns, the tick is well removed.

After removing the harmful creature, the wound must be smeared with iodine or any antiseptic. Wash hands thoroughly with soap and disinfect tools.

If the proboscis remains, then there is nothing to worry about. A slight suppuration forms at this place, gradually everything will come out with pus.

There are a few rules to remember to get rid of a tick:

caustic solutions (ammonia, gasoline, etc.) should not be applied to the bitten place;
do not cauterize the tick with improvised means (for example, with a cigarette);
when extracting, do not pull sharply to prevent rupture;
do not pick something in the wound;
in no case do not crush the tick.

You can check the tick yourself, with a special rapid test at hand.

Back to index

A little about Lyme disease

The following symptoms appear on average after a month: lesions of the heart, nervous system, joints.

Lyme disease is divided into 3 stages of development:

The first stage lasts about a month. The bite site turns red. Possible necrosis. Gradually there are secondary spots, rashes on the face in the form of rings, conjunctivitis.
In the second stage, the pathogen penetrates into other organs. The nervous system is affected. At the same time, the liver, kidneys, eyes, and also the skin can be affected.
After 3 months, the third stage begins. The disease becomes chronic. The patient becomes very tired, sleep is disturbed, depression appears. Many organs begin to work poorly.

The disease is not transmitted to a healthy person from an infected person. But during pregnancy, a woman can infect the fetus with borreliosis.

In general, the incidence of tick-borne borreliosis is very high. Immunity against the disease is developed for a short time, so re-infection is possible after 5 years from the date of treatment.

The meninges in the first stage of the disease are rarely affected, usually in patients with a broken blood-brain barrier as a result of traumatic brain injury, inflammation, or birth trauma. They are manifested by the classic signs of meningitis - headaches, increased syndrome, photophobia, nausea, vomiting, as well as rigidity ( numbness) of the occipital muscles and a positive Kernig's sign ( one of the symptoms of meningitis).

The defeat of the articular apparatus proceeds according to the type of reactive arthritis. It is noted more often the defeat of several large joints more often than the knee or femoral. At the same time, pain during movement and a slight swelling of the surrounding soft tissues dominate.

Liver damage proceeds according to the type of acute, as a rule, anicteric hepatitis. At the same time, patients complain of nausea, less often vomiting, an increase in the size of the liver and the associated heaviness and sometimes pain in the right hypochondrium.

The second stage of borreliosis ( Lyme disease)

The second stage of borreliosis occurs, as a rule, after 1-3 months from the moment of infection in 10-15% of patients, most of whom did not take specific antibacterial treatment. The development of this stage is associated with the incomplete extermination of the causative agent of the disease at the first stage and, as a result, with its spread to all organs and tissues. According to the latest statistics, the clinical manifestations of the second stage of borreliosis can be extremely diverse. It depends mainly on the organ in which specific lymphoplasmic infiltrates are formed. So, damage to the eyes, skin, genital organs, endocrine glands, spleen, kidneys, lymph nodes, etc. can be noted. However, moderate damage to the nervous system, cardiovascular system and skin is considered the most specific.

Damage to the nervous system in the second stage of borreliosis

The nervous system in the second stage of Lyme disease is affected by the type of meningitis, meningoencephalitis, cranial nerve paresis and radiculoneuritis. In children, damage to the meninges and structures of the central nervous system is more often noted, while in adults, damage to peripheral structures dominates.

Meningitis is manifested by severe headaches, nausea, vomiting, photophobia, stiff neck, and severe general weakness. Fever is usually absent, but subfebrile condition may be noted ( body temperature less than 38 degrees). Brain damage in meningoencephalitis is more common and manifests itself as a decrease in concentration, memory, emotional lability and insomnia.

Damage to the peripheral structures of the nervous system is manifested by various radiculopathies. Thus, the most specific for borreliosis in the second stage is paresis of the facial nerve, which is often bilateral. In addition, a number of patients have radiculoneuritis, mainly of the cervical and thoracic regions. Their manifestations include characteristic acute pain and hyperesthesia ( hypersensitivity) along the zones innervated by the inflamed spinal nerve. Sometimes there are isolated paresis of peripheral nerves.

The defeat of the cardiovascular system in the second stage of borreliosis

The defeat of the cardiovascular system in borreliosis is manifested by conduction and rhythm disturbances due to emerging myocarditis and less often pericarditis. Conduction disturbances are noted in the form of various blockades, among which partial and complete atrioventricular blockades predominate. Rhythm disturbances are manifested by attacks of supraventricular tachyarrhythmias, supraventricular and ventricular extrasystoles, etc. Patients feel weakness, which reflects the degree of hemodynamic disturbance, palpitations, shortness of breath, retrosternal heaviness, and less often pain. On the background of treatment, these symptoms, as a rule, completely regress. The only exceptions are complete blockades, which, in the absence of a response to drug treatment, require the installation of pacemakers.

Skin lesions in the second stage of borreliosis

The most specific skin manifestations for the second stage of borreliosis include benign lymphocytoma, which in this disease is a limited bright red infiltrate, painful on palpation, localized mainly in the earlobes, areolas and nipples. Other, less specific skin manifestations of borreliosis include secondary annular erythema, widespread urticaria, etc.

The third stage of borreliosis ( Lyme disease)

Clinical signs of the third stage of borreliosis begin to be observed within a period of 6 months to two years from the moment of infection. According to statistics, tertiary borreliosis develops in no more than 10% of patients. The most specific complications of this stage include damage to the articular apparatus, deep damage to the structures of the nervous system, as well as irreversible atrophic changes in the skin.

Damage to the articular apparatus

The defeat of the articular apparatus can proceed according to three scenarios.

The mildest of these is the appearance of migrating arthralgias ( joint pain) that end as quickly as they started. The duration of such pain, as a rule, does not exceed a few days, and objective signs of inflammation of the joints, as well as any residual effects, are completely absent even with pain of high intensity. Often migrating arthralgias are accompanied by severe muscle pain and tendovaginitis ( inflammation of the synovial sheaths of the tendons).

The average severity scenario for the lesion of the articular apparatus in tertiary borreliosis is a benign recurrent ( constantly escalating) arthritis. With its development, there is a fairly clear causal and temporal relationship with the development of primary erythema. The first episode of arthritis occurs several months after the onset of erythema migrans. As a rule, one knee joint is affected, less often joints of other localizations. Objective signs of inflammation, such as swelling, redness, local hyperthermia, and joint dysfunction, are usually most intense during the first episodes of arthritis. The duration of such episodes is from 1 to 3 to 4 weeks. After the end of the attack, a period of remission begins ( ), lasting several months, after which the attack is repeated. Each repeated attack is characterized by a lower intensity of clinical manifestations, and the interictal period, on the contrary, increases. It is believed that the appearance of such arthritis is possible only for five years from the moment of infection, after which the mechanism of its development exhausts itself.

The third scenario of joint damage in tertiary borreliosis proceeds according to the type of chronic progressive arthritis. Unlike the first two variants of damage to the articular apparatus, in this case, there is a massive lesion not only of the synovial membranes, but also of the cartilage tissue, as well as the auxiliary apparatus of the joint ( surrounding ligaments, tendons, synovial sheaths, etc.). As arthritis progresses, joint remodeling occurs, accompanied by a decrease in its range of motion and a decrease in cartilage thickness. This, in turn, worsens the nutrition of the cartilage and leads to even more pronounced pathological changes.

Damage to the structures of the nervous system

Damage to the nervous structures in the third stage of borreliosis is deeper and irreversible, compared with neurological manifestations in the second stage. The most common are movement disorders ( spastic paraparesis), mental activity ( deterioration of short-term and long-term memory, mental retardation, disinhibited behavior, etc.) and sensitivity ( polyneuropathy).

Atrophic changes in the skin

Atrophy of the skin in the third stage of Lyme disease develops over a long period of time. The longest phase is the infiltrative one, during which the formation of diffuse or nodular subcutaneous infiltrates of a burgundy-bluish color occurs, mainly on the extensor surfaces of the large joints of the extremities. As the inflammatory process progresses, the epithelium over the affected areas of the skin gradually becomes thinner and atrophies. At this stage, the sclerotic phase of atrophic acrodermatitis develops, in which the skin practically ceases to fulfill its barrier role and outwardly resembles thin and crumpled tissue paper.

Tick-borne encephalitis and borreliosis ( Lyme disease) This is the same?

Tick-borne encephalitis and borreliosis are two independent diseases caused by different infectious agents. Borreliosis is caused by one of the many types of Borrelia, and tick-borne encephalitis is caused by the tick-borne encephalitis virus.

It should be noted that both of these diseases are transmitted to humans by sucking an infected tick. In addition, both diseases can cause neurological symptoms, so it can be extremely difficult to distinguish one from the other, focusing only on clinical manifestations. It is these factors that seem to have led to the fact that among the population these diseases are often mistakenly combined.

However, it should be noted that these infectious diseases are not mutually exclusive. In the same patient, after sucking a single tick, a mixed infection may develop, combining borreliosis and tick-borne encephalitis virus.

Diagnosis of borreliosis ( Lyme disease)

Diagnosis of borreliosis, like the diagnosis of any other infectious disease, comes down to several fundamental methods, which are conventionally divided into clinical and paraclinical. Clinical methods include history taking and physical examination of the patient ( inspection, palpation, percussion, auscultation, etc.). Paraclinical methods include numerous additional instrumental and laboratory studies.

Which doctor to contact if you suspect borreliosis ( Lyme disease)?

If borreliosis is suspected, the patient may need to consult such specialists as a surgeon and an infectious disease specialist. In cases accompanied by complications from the body systems, it may be necessary to consult a neurologist, cardiologist, cardiac surgeon, dermatologist, allergist, rheumatologist, hepatologist, nephrologist, etc.

In most cases, the suspicion of borreliosis arises when patients find a stuck tick on themselves, on the skin around which annular erythema grows. In this case, you should not remove the tick yourself, but you should go to the nearest hospital, where the surgeon will correctly and completely remove it. After removing the tick, the wound is treated with local antiseptic preparations, and the patient is sent for a scheduled consultation with an infectious disease specialist. The infectious disease specialist, in turn, makes or refutes the diagnosis and, if necessary, prescribes treatment. In the absence of an infectious disease specialist, treatment can be prescribed by a general practitioner in the hospital admissions department, a pediatrician ( if the patient is a child) or family doctor.

In more rare cases, when borreliosis is accompanied by symptoms of damage to the meninges, brain, peripheral nerves, cardiovascular system or other systems and organs, additional specialists may need to be consulted - neurologists, cardiologists or hepatologists. The decision on the need for these consultations is made by the infectious disease specialist and, in more rare cases, the doctor of the admission department of the hospital ( doctor on duty). If the patient's condition causes concern, then he convenes a council of specialists who, in his opinion, are necessary, which decides the further tactics of managing the patient. However, in fairness, it should be noted that such cases are extremely rare. For the most part, the condition of patients makes it possible to routinely contact an infectious disease specialist and receive treatment without increasing the risk of subsequent complications.

What happens at the doctor's office when a patient with borreliosis is treated ( Lyme disease)?

Since the main specialist in the management of patients with borreliosis is an infectious disease specialist, it is precisely the features of his admission that will be discussed in this section.

Having got an appointment with an infectious disease specialist, the patient, first of all, is asked to voice all his complaints, including those that he does not attribute to borreliosis. The doctor usually finds out the timing of the appearance of specific complaints, their duration, intensity, dynamics, changes under the influence of drugs or other factors.

Then the doctor proceeds to examine the patient. First of all, with the help of a magnifying glass or special optics, the place of tick suction is carefully examined. If the tick is still in the wound, then the infectious disease specialist sends the patient to the surgeon for its accurate and complete removal, after which the patient returns to the infectious disease specialist. As a rule, these manipulations take no more than one hour. If the tick is absent in the wound, then the infectious disease specialist is convinced that after its removal, there are no fragments of his body left in the wound, which could subsequently fester. The skin immediately around the site of tick suction is subject to a thorough examination. Often in this area migrating annular erythema is found - a specific sign of the first stage of borreliosis. Equally important is the examination of the rest of the skin, for which the patient may need to completely undress, or at least to underwear. The doctor in this case is interested in rarer skin symptoms of borreliosis, indicating later stages of the development of the disease. These include secondary annular erythema, benign lymphocytomas, atrophic acrodermatitis, disseminated urticaria, etc. It is extremely important to examine the pharynx ( throat) for angina or acute pharyngitis.

The next step in the clinical examination of a patient with suspected borreliosis is palpation ( feeling). First of all, the infectious disease specialist examines all available lymph nodes. If there are certain changes in them, such as pain, an increase in size, cohesion with surrounding tissues, etc., he notes them for himself in order to subsequently take them into account in the process of differential diagnosis. In addition to the lymphatic vessels, muscles and joints are palpated, and subsequently the abdominal organs. With borreliosis, muscle pains can be expected, especially in the region of the occipital muscles, which are aggravated by fever. Palpation of the joints may reveal their soreness, which increases with movement, as well as some limitation in the range of their movements, combined with characteristic clicks. On palpation of the abdominal organs, there may be an increase in the size of the liver and less often the spleen, combined with pain in the corresponding hypochondria. Even less frequently, there may be signs of inflammation of the kidneys and urinary tract, stomach, pancreas, gallbladder, intestines, etc.

percussion ( tapping) in case of borreliosis, it is mainly used to detect the pathology of the kidneys and urinary apparatus. It can also be used to exclude concomitant lung diseases ( pneumothorax, hydrothorax, etc.) and bones ( osteomyelitis, osteoporosis, osteitis, fractures, etc.). auscultation ( listening) in borreliosis, just like percussion, it is used rather to exclude concomitant diseases, mainly of the respiratory system ( pneumonia, bronchitis, tuberculosis, etc.).

After a thorough collection of clinical information regarding the state of the patient's internal organs and systems, the infectious disease specialist resorts to prescribing additional paraclinical studies to confirm or exclude the diagnosis.

What tests can a doctor prescribe if you suspect borreliosis ( Lyme disease)?

All studies that an infectious disease specialist prescribes for suspected borreliosis are divided into laboratory and instrumental. In this section, only those studies are listed, the purpose of which is to confirm or exclude certain pathological conditions caused by borreliosis. It does not provide studies necessary for differential diagnosis with clinically similar diseases.

Laboratory tests prescribed for borreliosis

Laboratory research *(analysis)*	Methodology	Interpretation of results
*General blood analysis*	For this analysis, up to 5 ml of venous blood or up to 2 ml of blood from a finger is used ( in children).	an increase in the concentration of leukocytes - an active inflammatory process; an increase in the concentration of stab neutrophils - an active inflammatory process of bacterial etiology; an increase in the concentration of lymphocytes and monocytes - a concomitant viral infection or the development of autoimmune mechanisms of inflammation; decrease in the concentration of red blood cells and / or hemoglobin - the development of concomitant anemia ( rarely); an increase in the concentration of platelets - the reaction of the bone marrow to the inflammatory process; increase in ESR ( erythrocyte sedimentation rate) is a sign of an inflammatory process, etc.
*General urine analysis*	For analysis, it is required to collect, mainly, the average portion of morning urine after a thorough toilet of the external genitalia in an amount of 20 to 100 ml.	the appearance in the urine of high concentrations of protein - an inflammatory process in the kidneys or urinary system, accompanied by a violation of the filtration function of the kidneys; the appearance of leukocytes in the urine - an active inflammatory process in the kidneys or urinary tract; the appearance of fresh red blood cells in the urine - bleeding in the urinary tract ( predominantly lower divisions); the appearance of leached erythrocytes in the urine - a gross violation of the filtration function of the kidneys as a result of inflammation of the glomerular apparatus, as well as bleeding in the upper urinary system; decreased acidity of urine alkalization) - an indirect sign of the inflammatory process; the presence of cylinders in the urine is a sign of inflammation of the tubular apparatus of the kidneys; the appearance in the urine of bacteria, mucus, micelles - the development, respectively, of a bacterial or fungal inflammatory process; the presence of salts in the urine is an indirect sign of a metabolic disorder in the body, a harbinger of urolithiasis, etc.
*Blood chemistry*	For this analysis, it is necessary to take up to 20 ml of venous blood.	an increase in the concentration of C-reactive protein and thymol test - an inflammatory process; an increase in the concentration of transaminases ( AlAT, AsAT) – destruction of hepatocytes ( liver cells); an increase in the concentration of total bilirubin and its fractions - the destruction of liver cells, a violation of the processes of binding free bilirubin or the evacuation of bile; an increase in the concentration of serum creatinine and urea - a violation of the excretory function of the kidneys; decrease in the concentration of total protein and albumin - a violation of the synthetic function of the liver; an increase in the concentration of blood amylase and free pancreatic enzymes in the blood - acute pancreatitis or pancreatic necrosis; a decrease in the concentration of prothrombin and fibrinogen - a decrease in blood clotting as a result of liver damage; an increase in total cholesterol, triglycerides, low density lipoproteins - a violation of lipid metabolism; an increase in the concentration of glucose and / or glycated hemoglobin - a violation of carbohydrate metabolism, diabetes mellitus, etc.
*Bacteriological examination of biological samples*	For this study, a minimum amount of the biological environment is required, which potentially contains the pathogen. Blood, skin of the marginal zone of migrating erythema, a fragment of a benign lymphocytoma, a fragment of a skin area of atrophic acrodermatitis, less often cerebrospinal fluid, sputum, joint fluid and urine are suitable as such samples. For prenatal diagnosis, amniotic fluid or cord blood obtained by cordocentesis is used.	growth on nutrient media of colonies identified as one of the Borrelia species is a direct confirmation of borreliosis ( Lyme disease).
*Serological blood test* *(paired sera method, enzyme immunoassay, indirect immunofluorescence reaction, etc.)*	For this study, 5-10 ml of venous blood is taken. The method is applicable no earlier than two weeks after infection ( the time required for the formation of the first peak of antibodies).	detection of antibodies to Borrelia in the blood by various methods ( increase in antibody titer in paired sera, ELISA, RNIF, etc.) indicates an acute or chronic phase of borreliosis infection.
*PCR* *(polymerase chain reaction)*	For this study, the minimum amount of any biological medium potentially containing Borrelia is used. Dense media ( leather) preferably homogenized before testing. The principle of the method is to detect in the sample at least one DNA fragment corresponding to Borrelia DNA. PCR is one of the most modern and high-precision express methods for diagnosing borreliosis.	the test is positive if DNA markers of at least one bacterium from the Borrelia group are found in the sample.
*Histological examination of the biopsy*	This study requires a small piece of tissue ( at least three fragments are better), presumably containing Borrelia. The most suitable substrate is modified skin ( erythema migrans, benign lymphocytoma, acrodermatitis atrophic), as well as pathologically altered fragments of organs. Histological examination has almost absolute diagnostic accuracy.	the study is considered positive if its conclusion describes tissue changes characteristic of Borrelia ( specific lymphoplasmic infiltrates).

Instrumental studies prescribed for borreliosis

Instrumental research	Methodology	Interpretation of results
*X-ray of the joints*	During this study, the patient is in a position that the radiologist or his assistant asks him. As a rule, not only the disturbing composition is investigated, but also the second, which does not bring inconvenience. Images are taken in at least two mutually perpendicular projections.	signs of synovitis inflammation of the synovium) can be observed in all stages of borreliosis, but more often in the second and third; signs of damage to the articular cartilage are observed mainly in the third stage of borreliosis, less often in the second.
*Chest x-ray*	In this study, the patient is in a standing position, pressing his chest against the plane of the x-ray table. The picture is taken at the height of inspiration. If suspicious foci are detected, an additional image is taken in the lateral projection, and, if necessary, an aiming image.	pathological changes in the lung fields can cause the development of borreliosis ( rarely); in most cases, chest x-ray reveals concomitant pathology of the respiratory system; In some cases, radiographs can show signs of heart damage ( constrictive or effusion pericarditis, myocarditis).
*Magnetic resonance imaging of the brain and internal organs*	During this study, the patient is in the supine position, on the table of the apparatus. The table itself is fed into a tunnel whose walls are a powerful electromagnet. During the study, the patient must remain motionless for at least 30 minutes, and in some cases more. The principle of the magnetic resonance imaging method is to register a stream of photons of certain wavelengths, which are emitted by hydrogen atoms in the patient's body in a powerful alternating magnetic field.	determination of pathological changes in organs, mainly the nervous and cardiovascular systems, as well as the articular apparatus against the background of borreliosis, can be considered as its complications; the detection of numerous lymphoplasmic infiltrates in the internal organs may indicate in favor of the second and third stages of borreliosis.
*Electrocardiography*	During electrocardiography, the patient is in a supine position or sitting on a chair. According to a certain scheme, electrodes are attached to his limbs and chest, connected to an electrocardiograph. When the device is turned on, the electrical activity of the heart muscle is recorded. The output of information occurs in the form of numerous curves printed on a paper tape or displayed on a monitor screen.	detection of conduction disturbances ( blockades) and excitability ( extrasystoles) is one of the indirect signs of heart damage in borreliosis; a decrease in R-wave voltage in conjunction with tachycardia may indicate myocarditis or constrictive pericarditis.
*echocardiography*	During this study, the patient is in the supine position. The researcher applies a special gel to the heart area, which reduces interference from air between the sensor and the skin. He then applies an ultrasound transducer to various reference points on the chest and visualizes the various cavities of the heart, noting their size, wall thickness, and movement along the way. In conclusion, the doctor describes the pathological changes that he identified during the study.	an inflammatory increase in the size of the heart against the background of a diffusely reduced myocardial contractility may be a consequence of borreliosis myocarditis; an increase in heart size due to pericardial fluid, combined with a reduced ejection fraction and reduced heart cavities may be a consequence of borreliosis pericarditis.
*Electrophysiological examination of the heart*	During this study, the patient is in the supine position, completely undressed, as in ordinary surgery. Through an incision in the radial or femoral artery or vein ( depending on which cavity of the heart you need to get into) a special probe is inserted into the cavity of the heart. Its feature is the ability to read the electrical activity of the heart directly from its cavity with the highest accuracy. With the help of low-power aimed discharges, this probe causes the appearance of paroxysmal tachycardias, which it itself subsequently stops. The purpose of the method is to identify additional pathways of intracardiac conduction that provoke the development of attacks of paroxysmal tachycardia and their destruction by ablation ( burning out).	in rare cases, borreliosis is accompanied by such pronounced disturbances in excitability that it provokes the development of severe attacks of paroxysmal tachycardia with a drop in blood pressure; it is in such cases that rhythm restoration by cardioversion followed by ablation of the accessory pathway during an electrophysiological study may be indicated.
*ultrasound* *(ultrasound procedure)* *internal organs*	In this study, the position of the patient is arbitrary. However, more often he is lying on his back. A special gel is applied to the abdominal cavity, which reduces the interference caused by air between the emitter and the skin. Then the researcher alternately applies the tube of the ultrasound emitter to different parts of the abdominal cavity, alternately visualizing certain organs, determining their size and composition. Upon completion of the study, a record of all measurements and observations made is made. At the end of the recording, the doctor makes a conclusion regarding the pathological changes observed by him in the patient with possible causes of the latter.	with borreliosis, one can expect an increase in the liver, spleen, inflammatory changes in the pancreas, as well as numerous lymphoplasmic infiltrates in the internal organs; in some cases, enlarged lymph nodes are noted.
*Dermatoscopy*	During this study, the patient is in an arbitrary position. With the help of special magnifying optics, the doctor examines all suspicious skin formations, noting those changes that are not visible to the naked eye.	focusing on specific signs, it is often possible to diagnose such skin changes as benign lymphocytoma, atrophic acrodermatitis, primary and secondary migratory erythema, and urticaria.

Treatment of borreliosis

Treatment of borreliosis is predominantly medical, except in rare cases when the disease has progressed to this point and has led to the appearance, for example, of a persistent atrioventricular block requiring the implantation of a pacemaker. It should be noted that drug treatment at the first stage of borreliosis is highly effective and prevents the progression of the disease into subsequent, more complicated stages. Physiotherapy and exercise therapy is effective, mainly in the recovery period with damage to the articular apparatus and the nervous system. However, it also has a number of contraindications, which must be taken into account in order to avoid worsening the patient's condition.

Treatment of the skin around the primary focus in case of borreliosis ( Lyme disease)

The primary focus in borreliosis is that small area of skin to which the tick has stuck. It is also a small puncture wound that forms after the removal of the tick. The primary focus in borreliosis should not be confused with erythema annulare, even though these skin elements in most cases appear on the same area of the skin almost in parallel. The mechanism of their formation is different, as well as the timing of their appearance and further evolution.

One of the terrible complications after the suction of any tick, whether it is infected with borreliosis or not, is the attachment to the primary focus of the secondary bacterial flora. As a rule, the causative agents of such an infection are saprophytic or opportunistic microorganisms from the surface of the skin, among which Staphylococcus aureus dominates. When it enters the wound, suppuration develops, which, as it progresses, can turn into an abscess, phlegmon, and even sepsis, which is fraught with high chances of death. In order to minimize the chances of suppuration of the primary focus, it is extremely important to correctly remove the tick, and then carefully treat the focus itself and the skin around it.

A surgeon trained in such manipulations should remove the tick. This is especially important when not adult mites are found, but their larvae, which sometimes penetrate so deeply into the thickness of the skin that it is extremely difficult to remove them without special tools, without damaging them.

After extracting the tick and visual control of both the integrity of the insect itself and the wound left by it, it is treated with antiseptic agents. First of all, it is necessary to abundantly apply an aqueous solution of hydrogen peroxide to it, and it is desirable to penetrate as deep as possible into the wound with a sterile bandage moistened with this solution. The foam formed upon contact with blood mechanically pushes out particles of dust, dirt and even the remnants of the body of the tick ( If there are any). Then all the foam is removed with a dry sterile bandage. After that, with the help of another bandage moistened with alcohol or an aqueous solution of iodine, the wound itself is treated, and then the skin around it within a radius of 2–3 cm. The movements of the bandage should be made in a spiral from the center, which is the wound, to the periphery. This order of processing is necessary in order to avoid entering bacteria from the surrounding skin into the primary focus. For the best effect, iodine treatment can be carried out sequentially 2-3 times. At the end of the treatment, the wound is not bandaged or sealed with adhesive tape, as this contributes to wetting and prevents the formation of a protective crust.

If the treatment was carried out correctly, then the inflammation in the area of the primary focus will be minimal, and after 1 - 2 days there will be no trace of it, except for a small crust, which will disappear on its own no further than after 5 - 7 days. However, in the first days after the tick is sucked, even after proper antiseptic treatment of the primary focus, inflammation may occur, which is nothing more than an annular erythema that is forming, which can be mistaken for a forming abscess. However, after a few hours, the differences become more pronounced. The annular erythema expands, a pale area appears in the center, and, most importantly, it is only a superficial element. The abscess increases due to growth in depth, more dense and hot to the touch. Often with it, an increase in body temperature of more than 38 degrees is also noted. If an abscess is suspected, a surgeon should be contacted immediately to avoid more serious complications.

Drug treatment of borreliosis ( Lyme disease)

The use of drugs is the main method of treatment for Lyme borreliosis. The choice of drug is based on the stage and clinical manifestations of the disease. Conventionally, antibiotics for the treatment of this disease are divided into drugs of the first, second and third line.

Antibiotics for the treatment of borreliosis are divided into:

first line drugs tetracyclines);
second line drugs penicillins and cephalosporins);
third line drugs macrolides, azalides, carbapenems, etc.).

First line drugs tetracycline, doxycycline) are prescribed only in case of annular erythema and general intoxication syndrome without concomitant complaints from the nervous or cardiovascular system. They can also be used as a prophylaxis for borreliosis in non-erythematous forms.

Second-line drugs are used in all stages of the disease when there are additional symptoms from the central nervous system, cardiovascular system, skin and articular apparatus. Thus, patients with skin lesions ( in addition to erythema annulare) amoxicillin with clavulanic acid or benzathine benzylpenicillin is recommended. Damage to the joints, heart and nervous system requires the appointment of III or IV generation cephalosporins ( cefotaxime, ceftriaxone, cefepime, etc.). Also, cephalosporins can be prescribed in the first stage of the disease, with an absolute absence of response to treatment with tetracyclines and penicillins.

Third-line drugs are prescribed only in case of resistance ( inefficiency) first and second line drugs. In order to verify this, it is necessary to carry out a bacteriological examination ( sowing on nutrient media) tissue sample containing Borrelia ( blood, biopsy, sputum, etc.). After the growth of the necessary colonies of Borrelia, their response to various antibacterial drugs is assessed. This study is called an antibiogram and has two main goals - to identify drugs that are ineffective in the treatment of borreliosis ( confirmation of resistance), as well as the identification of drugs to which sensitivity is sufficient to achieve a sustained antimicrobial effect. Thus, third-line drugs are selected based on the antibiogram from all naturally occurring antibiotics that could completely destroy Borrelia in the patient's body.

It should also be noted that a significant role in the treatment of borreliosis is played by drugs that relieve symptoms at various stages of the disease and with various complications.

The drugs used for the symptomatic treatment of borreliosis are:

non-steroidal anti-inflammatory drugs ( nimesulide, ibuprofen, celecoxib, paracetamol, etc.);
nootropics ( piracetam);
microcirculation correctors ( pentoxifylline, vinpocetine, etc.);
vitamins ( groups B, C, A, etc.);
enzymes ( lidase);
antiarrhythmic drugs ( amiodarone, verapamil, etc.);
anticholinergics ( atropine);
hepatoprotectors ( ursodeoxycholic acid, silymarin) and etc.

Surgical treatment of borreliosis

It should be noted that surgical treatment of borreliosis is purely symptomatic or even palliative in some cases ( aimed at reducing suffering in a known progressive disease) and is rarely used.

With the development of medically irreversible atrioventricular blockade, a pacemaker is surgically installed, which normalizes the heart rate.

With the development of meningitis with a pronounced syndrome of increased intracranial pressure, in some cases, a catheter is installed connecting the subdural space with the jugular vein. The purpose of this catheter is a constant outflow of excess CSF. However, due to the large number of side effects, especially with prolonged use, they rarely resort to installing such a catheter.

In the case of the development of spastic contractures of the joints, surgical treatment is used to dissect them and increase the range of motion of the joint changed by inflammation.

Physiotherapeutic methods of treatment of borreliosis ( Lyme disease)

Physiotherapeutic methods for the treatment of borreliosis are exclusively auxiliary and they are used only in the recovery period. The appointment of such treatment in the acute period of the disease is fraught with aggravation of the patient's condition and a greater likelihood of complications.

When the articular apparatus is affected, electrophoresis with lytic enzymes is often used ( lidase), contributing to the resorption of connective tissue overlays in the joints, preventing normal movements. Balneotherapy can produce a similar effect ( mud baths) and exercise therapy.

;

active oncological diseases;

oncological diseases in remission ( disappearance of clinical signs of the disease);

suspicion of cancer in the process of diagnosis) and etc.

It should also be noted that even if there are no contraindications to physiotherapy, but after several sessions the patient feels a deterioration in his general condition, the procedures should be stopped.

Alternative methods of treatment of borreliosis ( Lyme disease)

Alternative methods of treating borreliosis exist, but their effectiveness should not be overestimated. The main area of their application is the relief of certain symptoms, while the cause of borreliosis - directly the bacteria themselves cannot be destroyed by traditional medicine methods.

Most often, with borreliosis, linden decoctions and raspberry teas are used, which have a moderate antipyretic and detoxifying effect due to increased sweating. All plants rich in vitamin C have a general strengthening effect. Thus, fresh salads made from parsley, sorrel, soaked dandelion leaves, and sauerkraut are extremely useful. Decoctions or alcohol tinctures from these substances reduce the concentration of vitamin C to almost zero values, which is why plants should not be heat treated before cooking, but only thoroughly washed in warm water.

With borreliosis, manifested as acute pharyngitis or amygdalitis, warm milk with honey 4-5 times a day will have a softening and moisturizing effect on the cough. And if you add butter at the tip of a teaspoon and a pinch of baking soda to this cocktail, the mucolytic effect will increase significantly ( sputum thinning), contributing to the transition of a dry cough into a wet one.

Steam inhalations over peeled freshly boiled potatoes are considered highly effective. You can enhance the effect by draining the water in which the potatoes were boiled and adding a few grams of menthol extract to it. Upon penetration into the lungs, such a mixture has a pronounced mucolytic, expectorant and bronchodilator effect.

Decoctions of St. John's wort and thyme have a certain immunostimulating effect. With liver damage, an improvement in the condition is noted after the use of decoctions of herbs that have a choleretic effect due to a decrease in the viscosity of bile. Among these herbs, yarrow definitely occupies a leading position.

An important condition for the use of traditional medicine is that their use should be secondary and in no case interfere with or replace traditional drug therapy. In the manufacture of decoctions, high concentrations should not be created, since the effect of the plants used may differ from what is expected. Low and medium concentrations of decoctions contribute to a milder effect, less likelihood of side effects and the ability to use such collections for a longer time.

Prevention of borreliosis ( Lyme disease)

Prevention of borreliosis is divided into primary and secondary. Primary prevention implies the prevention of infection, and secondary - the treatment of the disease in the early stages in order to avoid its progression and the development of complications from the nervous, cardiovascular system and articular apparatus.

Primary prevention methods include:

avoiding visiting endemic foci of borreliosis;
wearing closed clothing that prevents ticks from crawling under its covers;
applying protective repellents to clothing in the form of sprays, stickers;
applying repellent creams to the skin;
independent and mutual thorough examination of the body for the presence of ticks attached to the skin after visiting endemic foci.

Secondary prevention methods include:

correct extraction of the tick, without leaving parts of its body in the skin ( preferably by a surgeon);
empiric treatment ( carried out without establishing the exact cause a) tetracycline or doxycycline for erythema annulare;
empiric treatment with tetracycline or doxycycline, even in the absence of erythema annulare, if the tick bite occurred in an endemic focus of borreliosis.

Is borreliosis dangerous in pregnant women?

It can definitely be said that borreliosis is more dangerous for pregnant women than for other categories of patients. Moreover, the course of the disease in the pregnant woman herself practically does not differ from the common clinical picture, however, the effect on the growing fetus is likely to be negative, and the degree of this effect directly depends on the duration of the disease persistence in the body of the expectant mother.

One of the main features of Borrelia is its small size relative to other types of bacteria. In combination with a spiral shape, this microorganism has a paradoxical ability to penetrate all histohematological barriers in the short term after infection. In particular, borrelia without great difficulty penetrate into the closed circulatory system of the fetus, and subsequently into all its internal organs or foci of their laying.

If the pregnant woman consulted a doctor in time and started treatment with appropriate antibacterial drugs, then with a high degree of probability it can be argued that all borrelia that managed to get into the body of the fetus also die, as in the body of the pregnant woman. With this development of events, the negative impact on the future fetus is minimal.

Much less favorable prospects should be expected if the pregnant woman did not receive timely treatment at the first stage of borreliosis. For 1.5 - 2 months, necessary for the development of the second stage of the disease, bacteria penetrate into all tissues and internal organs of the fetus, forming numerous lymphoplasmic infiltrates in them. The most vulnerable, as in adults, are the structures of the nervous and cardiovascular systems. Lesions of the skin, musculoskeletal system and liver are less common.

Thus, a child born to a mother who is ill and has not been treated for borreliosis may have mental retardation, heart disease, kidney failure, or liver failure. In the most deplorable cases, these disorders are incompatible with life and the fetus dies some time after birth. Even isolated cases of stillbirths caused by severe intrauterine course of borreliosis have been noted.

In connection with the above, all pregnant women are strongly advised to avoid places where they could be bitten by ticks. If this eventually happened, then one should not expect the appearance of signs of the disease, but should determine as soon as possible whether infection has occurred or not. When using the PCR technique ( polymerase chain reaction) it is possible to conduct a study in the first days from the moment of potential infection. If PCR is not available for any reason, then it is required to pass an analysis for specific immunoglobulins M - fresh antibodies to Borrelia. However, it should be noted that it does not make sense to take this analysis earlier than two weeks from the moment of potential infection, since this is the minimum period necessary for the immune system to form a sufficient antibody titer to fight the pathogenic microorganism.

After diagnosis, antibiotic therapy should be started immediately. Since drugs from the tetracycline group are contraindicated during pregnancy, the doctor will most likely prescribe a course of penicillin, cephalosporin, or macrolide drugs. This course must be completed completely, even if the symptoms of the disease disappear before its completion. This is due to the fact that patients who have undergone an incomplete course of treatment have a higher frequency of chronic infection.

What are the differences between borreliosis in children?

When answering this question, one should distinguish between congenital and acquired borreliosis. Congenital borreliosis can be observed in a newborn whose mother during pregnancy was ill with manifest ( with clear signs) or an asymptomatic form of the disease. Acquired borreliosis occurs when the infection is transmitted by sucking a tick infected with borreliosis.

Congenital borreliosis can be asymptomatic or cause severe malformations of the internal organs, and in some cases the cause of stillbirth. During the course of pregnancy, this bacterium penetrates into all tissues of the body of the newborn, most severely affecting the nervous and cardiovascular systems. The lymphoplasmic infiltrates formed in the tissues prevent the normal development of the internal organs, which is why they are not formed full-fledged by the time of birth, thereby reducing the viability of the newborn. Clinically, congenital borreliosis can be manifested by a lag in mental and physical development, deformation of the musculoskeletal system, concomitant autoimmune diseases, etc.

Acquired borreliosis in children is in many ways similar to that in adults. Some investigators have noted a slightly earlier susceptibility to meningeal involvement with the development of meningitis. Also in children, the phenomena of meningism are more often observed - the clinical picture of meningitis with sterile cerebrospinal fluid.

Is borreliosis transmitted through breast milk, saliva and sexual fluids?

The causative agent of borreliosis is one of the bacteria most prone to spread to all organs and tissues. However, human-to-human transmission of this infection has not been reported.

Despite the fact that a patient infected with borreliosis can contain the pathogen in all biological fluids ( blood, breast milk, saliva, semen, gonads, etc.), infection does not occur when these fluids are transferred to the skin and mucous membranes. This happens due to the fact that the means of non-specific protection of the skin and mucous membranes are an almost insurmountable barrier to Borrelia. Even if there are damages on these shells ( scratches, erosion, ulcers, etc.) the pathogen cannot penetrate deep enough and in sufficient quantity to contribute to the further development of the disease.

The only option in which transmission of infection from one person to another can hypothetically occur is direct blood transfusion, which is now a relic of the past due to the huge risks for the recipient ( patient receiving blood transfusion).

Is there a vaccine against borreliosis?

To date, there is no vaccination or serum against borreliosis. In all likelihood, the need for vaccination against this disease is not so high due to the fact that it reaches disability in rare cases, and the methods of its treatment in the early stages are highly effective.

In addition, the likely risks from the side effects of a potential vaccine with its mass use could equalize or even exceed the rates of severe cases of borreliosis. Thus, the feasibility of developing a vaccine against this disease is currently in question.

Is immunity created after suffering borreliosis?

After suffering borreliosis, a fairly strong immunity is created, which protects the patient from re-infection for 5-7 years. After this period, re-infection is possible. Nevertheless, it is important to note that this immunity is formed only to the causative agent of borreliosis that caused the disease in humans, while there are at least five such pathogens among the most common in different regions of the world.

Thus, if a patient who has been ill with borreliosis caused, for example, by B. garinii, is bitten by a tick infected with B. burgdorferi s.s., then most likely he will suffer the disease again. Clinical manifestations in this case may be the same as in previous times, since immunity is species-specific, but more often the disease manifests itself less clearly due to the fact that antibodies and memory T-lymphocytes existing in the blood still partially bind some common fragments. bacteria. In some cases, infection with borreliosis against the background of already existing immunity even leads to an asymptomatic course, which, as you know, manifests itself only in the second and third phases of the disease, which, unfortunately, is much less treatable at these stages.

How soon after a tick bite should I be tested for borreliosis?

To answer this question, it is necessary to clarify what kind of analysis we are talking about. Most often, they resort to serological analysis, that is, to the determination of specific antibodies in the blood ( class M immunoglobulins). Less often, when this is required by a short time, as, for example, in pregnant women or in newborns, it is necessary to determine the presence of the bacteria themselves in the blood directly. This task is carried out using PCR ( polymerase chain reaction method).

When testing blood for specific antibodies, it is necessary to wait until these antibodies reach a sufficient titer ( concentration), at which the results of the analysis would be most revealing. As a rule, this time is equal to two full weeks from the moment of infection. Conducting this study at an earlier date is fraught with false negative results.

The PCR method is based on the mechanism for detecting DNA fragments possessed by the desired bacterium or virus. The sensitivity of the method is so high that even if there is only one cell in the sample, the result of the study will be positive. Thus, this method is applicable from the first days of the disease. Any tissue hypothetically containing the pathogen can be used as a sample ( skin, blood, lymph node biopsy, mucosal scraping, saliva, etc.). In the first phase of the disease, blood and skin from the edge of the annular erythema are most often chosen as a sample. In other phases of the disease, cerebrospinal fluid, biopsy specimens of tissues of internal organs, etc. can be used as samples.

Symptoms

The most common transmissible tick-borne infections, tick-borne encephalitis (TBE) and Lyme disease, have several of these signs in the first stage. Both are accompanied by flu-like symptoms. However, TBE is a viral infection while Lyme disease is caused by bacteria. Both diseases can cause serious long-term complications, so stay in the areas where these insects are likely to live should not be taken lightly.

Tick-borne encephalitis

Borreliosis

Erythema migrans - a rash in Lyme disease

After a year, Lyme disease becomes chronic and has many symptoms, such as: fever, chills, headaches, arthritis, muscle twitches, dizziness, difficulty speaking, loss of spatial orientation.

Diagnostics

Magnetic resonance imaging (MRI), lumbar puncture and electroencephalogram (EEG) are also used. Taking a blood test to check for viruses, bacteria and immune cells is also very informative.

Early diagnosis and initiation of treatment give a better chance of a full recovery.

Treatment

Treatment of tick-borne encephalitis involves intravenous administration of antiviral drugs, such as:

Acyclovir (Zovirax);
Ganciclovir (Cytovene);
Foscarnet (Foscavir).

Side effects of antiviral drugs may include nausea, vomiting, diarrhea, and muscle pain.

For people suffering from encephalitis, additional supportive procedures are also needed. They provide:

continuous monitoring of cardiac function and respiration;
intravenous droppers to ensure proper hydration and the normal content of essential minerals in the body;
anti-inflammatory drugs, such as corticosteroids, to reduce intracranial pressure and swelling;
anticonvulsants to stop or prevent seizures.

After an illness, recovery procedures may be needed. These procedures may include:

physical therapy;
occupational therapy;
speech therapy;
psychotherapy.

If the disease affects the central nervous system, then doctors recommend treatment with intravenous antibiotics lasting from 14 to 28 days.

Along with antibiotics, additional and alternative methods of treatment can be used:

proper nutrition;
the use of probiotics;
phytotherapy.

Prevention

The best prevention against tick-borne encephalitis and borrelioscha is to take the following measures to protect against tick bites:

wear long-sleeved shirts and long trousers when in the woods or areas with tall grass
use repellents - repellents;
wear light-colored clothing that makes it easier to spot ticks, and check your skin carefully after being outdoors.
if a tick is found, remove it with tweezers, making sure that all parts of it (body and head) are removed.