Borreliosis symptoms treatment. How is the therapy carried out? Atrophic changes in the skin

The meninges are rarely affected in the first stage of the disease, usually in patients with a compromised 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 infiltrative, during which diffuse or nodular subcutaneous infiltrates of a burgundy-bluish color are formed, mainly on the extensor surfaces of 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 conditionally 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 internal organs and systems of the patient, the infectious disease specialist resorts to the appointment of 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

Instrumental studies prescribed for borreliosis

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 an alcohol or aqueous solution of iodine, the wound itself is treated, and then the skin around it within a radius of 2–3 cm. In this case, the bandage must move 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.

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 bronchodilatory 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 involves 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 a 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 enter the fetus's body also die, as in the body of a 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. However, 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.

Borreliosis is a transmissible type of infectious disease, localized in natural foci, often prone to chronicity and recurrent course. The causative agents of borreliosis are Borrelia spirochetes. The disease mainly affects the skin, nervous and cardiac systems, the musculoskeletal system, especially the joints.

Borreliosis has a variety of symptoms, which successfully disguises itself as other diseases and complicates timely diagnostic actions.

The ixodid tick is recognized as the main carrier, because it is in its body that the B.burgdorferi reservoir is located. The peculiarity of this genus of ticks is that the infection lasts their entire life cycle and can be transmitted transovarially to future offspring.

The geographical distribution is quite extensive, borreliosis is actually found everywhere on all continents, with the exception of glaciers. Natural foci of infections prevail in forest landscapes; infection can vary from 5 to 90%.

The causative agent of borreliosis is able to penetrate into the cells of the body and “remain in a dormant state” there, without showing up in any way, for a significantly long time - about 10 years, this is what causes chronic borreliosis and relapses of this pathology. A patient with borreliosis is not dangerous and not contagious for others.

According to pathophysiological mechanisms, the development process is similar to the development of syphilis, therefore, first of all, it is necessary to differentiate these two diseases.

The forms of borreliosis are distinguished:

- Asymptomatic. It is determined during laboratory tests, but there are no symptomatic manifestations.

- Stormy manifesto. It includes both a complete symptom complex and a laboratory enriched picture.

The stages of borreliosis, according to the symptoms, have subspecies:

- Acute (up to 3 months) and subacute stages (3 - 6 months), divided into subspecies: erythema with a skin manifestation at the site of a tick bite, non-erythema - with the presence of a fever syndrome, intoxication symptoms, but without erythema.

- Chronic borreliosis (continuously progressive form) - with a progressive increase and continuous complication of disorders. Characterized by pathological processes of the skin, destruction of the joints, changes in the nervous structures, the development of heart disease.

What is tick-borne borreliosis?

Tick-borne borreliosis is a disease that affects all organ systems of the body, with a complex pathogenesis and a whole range of immunological reactions.

The disease is relatively recently singled out as a separate nosology, it was first described in 1975 as an outbreak of arthritis.

Many animals are the hosts of the causative agent of borreliosis - these are sheep, birds, cattle, deer, rodents, dogs. But for humans, the most dangerous tick vectors that have already come into contact with the hosts or become infected in another way are Ixodes damini, Ixodes ricinus and Ixodes persulcatus.

Most often, ticks are attached to clothing when visiting nature on vacation or walking in the forest, when a person, moving, touches the branches of trees, shrubs, sits on the grass. Remaining on outer clothing or related items (bedspreads, chairs), ticks can crawl onto a person even some time after leaving the endemic zone of infection. In addition, ticks that cause borreliosis can get into a living room with flowers, firewood, hay, or be brought from the street by animals.

The main mechanism of infection in 89% of cases is the result of sucking a female tick. From the moment of contact with the body from clothes and a bite, a small time interval passes, about 1 - 2 hours. Favorite places are the cervical zone, chest, armpits, inguinal zone, for children - this is the scalp, that is, places with thin, easily bitten skin with a rich blood supply.

The very moment of attachment of the tick to the body in the majority goes unnoticed, since the composition of the saliva of females includes painkillers, vasodilators and anticoagulants. Discomfort or itching occurs only after 10-12 hours or much later. The process of bloodsucking can last up to a week, however, the transmission of pathogens with saliva occurs in the first few hours. Borrelia multiply in the blood and migrate, penetrating into various parts of the skin and internal organs, with the flow of lymph, blood and perineural path, penetrating to the membranes of the brain.

Most of Borrelia die, releasing endotoxin upon death, which triggers the entire cascade of immunopathological reactions and hyperimmune response. In the body, the production of IgM increases, followed later by IgG. The level of immune complexes in the blood that circulate increases, it is they who settle on the internal organs, form inflammatory lymphoplasmic infiltrates (in the skin, subcutaneous tissue, lymph nodes, brain, peripheral ganglia). Neutrophilic infiltration provokes a long-term inflammatory process, followed by the destruction of organ and tissue structures.

Cellular immunity reacts with increasing progression, mononuclear cells follow to target tissues, the level of T-helpers, T-suppressors and the index of stimulation of lymphocytes increases.

With a slow response, when the activity of borreliosis in the blood is poorly expressed, autoimmune reactions develop and persistence occurs intracellularly, leading to chronicity.

In both children and adults, borreliosis causes equally dangerous symptoms that can further disable. Immunity is unstable, which means that re-infection is possible after 5-7 years.

borreliosis: photo on the human body

Causes of borreliosis

The causal factors in the development of such a disease as borreliosis in humans are pathogenically dangerous four types of unicellular protozoa. These species are represented by spirochetes Borrelia burgdorferi sensu stricto, bacteria Borrelia garinii, Borrelia afzelii and B.miyamatoi.

Depending on which subspecies penetrates into the human bloodstream during a tick bite with saliva, the following will depend: the symptom complex, the nature of specific organ lesions, the therapeutic measures taken and, in the future, possible complications of further life activity, since each of the subspecies is tropenous to different internal organs, based on which and begins to trigger the response mechanism for the development of immune response reactions of the affected macroorganism.

B. afzelii provokes 90% of the development of skin lesions, in particular chronic atrophic dermatitis and erythema migrans.

B. garinii causes up to 40% of cases of abnormal development of processes in the structures of the nervous system, manifesting itself with very rich symptoms.

B. burgdorferi is tropic to the musculoskeletal system as a whole, the articular tissue is especially favorite, the so-called lime arthritis is most often noted when determining this pathogen.

B. miyamatoi, it is associated with the formation of recurrent forms of febrile syndrome, but without erythematous manifestations.

Symptoms and signs of borreliosis

Borreliosis begins clinically after being bitten by an infected tick, although about 30% of patients cannot remember or deny a history of being bitten. Classify two periods and three stages of borreliosis: early - stage I and II, late - stage III.

→ I stage of borreliosis can be counted from the moment the pathogen enters the body, when the Borrelia begin the process of active reproduction in the lymph nodes. It can take several months, but often it is in the range of 3 to 30 days. The first symptoms disappear completely even without treatment, the only constant is the annular migratory.

The first stage of borreliosis includes the following signs:

- The onset is acute, the temperature is 37.5-39.5 ° C, in 50% of patients - a febrile character. Chills, cough, dropsy of testicles;

- Increased regional lymph nodes - generalized;

- Skin manifestations on the face of the type of urticaria, urticaria, pinpoint or small ring-shaped rashes, conjunctivitis, sometimes false erysipelas;

- In 10% of patients, pronounced symptoms of meningitis appear: headaches, nausea, vomiting, irritability, photophobia, hyperesthesia;

- hepatitis without jaundice of the skin, .

- In 80% of patients, ring-shaped migrating erythema is formed - the main marker of the entire disease. Red macula with ring-shaped circles around, prone to extensive distribution. The edges are delimited by a bright red border, more hyperemic than the central part, and protruding above the unaffected skin. The center has a light shade, which becomes cyanotic over time. A vesicle may form in the center or necrosis may appear. Dimensions 3 to 70 cm, but the severity of the disease has nothing to do with this. Erythema leaves behind pigmentation, peeling, the bite site itself is covered with a crust with further transformation into a scar. Patients complain of discomfort, burning, itching, pain, feeling of tightness. The location is mainly on the legs, but it may appear on the abdomen, sacrum, neck, armpits and groin, but then its size is much smaller.

Borreliosis in children, in particular its erythemal form, has a mild course, in contrast to the older age group.

→ II stage of borreliosis corresponds to the phase of dissemination of Borrelia with blood flow into the organ systems. The timing of development varies, but often it is 1-3 months from the bite that occurred. By the time of manifestation, the symptoms of the first period disappear. There are recorded cases of the debut of borreliosis immediately from the second stage, but this is a more severe variant of development.

Clinical manifestations are very diverse, since many internal organs are affected:

- Destructive processes of the central nervous system, in particular, cranial and spinal nerve roots, are the first to appear. The roots give shooting pain in the extremities, which has a downward or girdle character of pain when the trunk is affected. It is advisable to allocate symptomatology posindromno. Sensory myalgic syndrome - myalgia, pain along the nerve, plexalgia, radiculoalgia. Myotrophic syndrome is a consequence of segmental radiculoneuritis, isolated neuritis n.facialis, myelitis. Common paralytic syndrome is less common.

At this stage, borreliosis in children is most severe, in 32% of cases the triad of Bannwart's syndrome manifests itself: serous meningitis, neuropathy n. facialis and polyneuropathy. In children, meningeal lesions are more common, in adults, the peripheral nervous system is vulnerable, especially when infected with n. facialis: hearing impairment, facial asymmetry, lacrimation, open mouth, eyelids half open. The auditory and optic nerves are also affected: strabismus, hearing impairment, impaired mobility of the eyeballs, muscle stiffness, pain in the temporal areas, photophobia, sleep disturbance and memory loss.

- Cardiac lesions in the form of severe arrhythmias, more often AV blockade of 1-2 degrees, ventricular conduction disorders, dilated myocardiopathy, pancarditis. General symptoms: shortness of breath, palpitations, squeezing retrosternal pain.

- Skin manifestations in the form of a benign lymphocytoma, with a wave-like course and the appearance of a single nodule or disseminated plaques on the earlobes, nipples, face, genitals.

→ III stage of borreliosis, or late chronic, occurs several years later from the penetration of an infectious agent into the body, it persists all the time in a particular organ system. With ineffective or no treatment at all, persistent chronic borreliosis develops with short remissions and constantly recurrent combined organ damage.

The symptom complex of the late stage includes:

- Atrophic acrodermatitis, it gradually develops with the appearance of blue-red infiltrates on the extensors: knees, elbows, hands. Then there are fibrous nodules, swelling, regional lymphadenopathy. This process lasts more than 8 years, the transition to a focal sclerotic form is inevitable: atrophied skin looks like crumpled thick paper, 47% of patients have sensory and motor disorders.

- Damage to the nervous system: encephalopathy, encephalomyelitis, paraparesis, amnesia, dementia, axonal radiculopathy, polyneuropathy with radicular pain.

- The motor apparatus of the body. Bone pain, muscle pain, in tendons and periarticular bags are noted. With the development of chronic arthritis, the destructive effect affects both large and small joints. Cartilage tissue becomes thinner and deforming and destructive processes develop in the joints. In the skeletal system - subarticular sclerosis, cortical usura, adjacent muscle fibers are involved.

Allocate the following lesions of the joints:

First - alternating arthralgia with pain, especially in the cervical region, tendovaginitis, monoarthritis. There are no objective inflammatory signs, even with complete immobilization of patients. The pain lasts a couple of days and goes away on its own.

Secondly, benign recurrent arthritis, with concomitant abdominal pain, migraine, polyadenitis. The most common symptom is asymmetric mono- or oligoarthritis of large joints: 50% - knee, 30% - shoulder, 20% - elbow and ankle. On the hands and feet, small joints, 10% falls, and much less often - finding Baker's cysts. Pain lasts for 2-3 weeks, mobility is limited and periarticular tissue swells. Equally often unilateral and symmetrical lesion.

Thirdly, chronic progressive arthritis in 10% is a benign variant of the disease, lasting up to 5 years. In the articular syndrome, the formation of pannus, cartilage erosion, the synovial membrane and periarticular tissues are affected.

- There are also many concomitant disorders of the whole organism, so borreliosis in children causes a slowdown in the growth of the child and his puberty, there is mental disability, a violation of coordinating functions. In adults, borreliosis provokes disorders of the pelvic organs and epileptic seizures, strong emotional changes in behavior.

borreliosis: photo in an adult

Diagnosis and analysis for borreliosis

The diagnostic complex consists of the following stages:

- Finding out the moment of contact with the insect carrier of borreliosis, finding out the patient's stay in endemic dangerous areas, visiting the forest, matching the season and the onset of the disease, eating raw dairy products. Drawing up a characteristic clinical picture with the presence of migrating annular erythema and concomitant organ disorders (neurological, articular, cardiac).

- Laboratory indicators of researches are important. By resorting to microscopic methods, it is possible to determine the morphology of the etiopathogenetic agent, but not its pathogenic properties. Borrelia are isolated from biological fluids and tissues: from the marginal part of erythema, biopsy specimens from the skin of lymphocytoma and atrophic acrodermatitis.

- The number of borrelia in the blood is insignificant and it is almost impossible to isolate them. A laboratory assistant in a blood test for borreliosis can distinguish common signs of inflammation, with an increase in indicators: leukocytes, ESR (80% in children, 50% in adults), C-reactive protein, transaminase activity. Macrohematuria in the urine.

- Serological examination of blood serum, lumbar punctate and synovial fluid is very important. The results of the methods directly depend on the staging of the disease. The PCR method establishes the presence of even single borreliosis DNA in the sample. The NRIF method is inferior to ELISA and immune blotting, since they have higher specificity and the possibility of standardization. But, there is a flaw in all methods, due to the body's immune response to borreliosis, antibodies are found rather late. Therefore, it is necessary to repeat the analysis after 2-4 weeks.

- False positive reactions occur with such diseases:, typhus, other spirochetosis, rheumatic lesions,. Western-blot is used for differentiation.

- When performing a puncture of the spinal cord, an increase in CSF pressure of 280 mm of water column is found, lymphocytic pleocytosis is 250 cells / μl, protein is up to 1 g / l, glucose is slightly increased. If the composition does not change, this is regarded as meningism.

“The method of treating an existing sample with special fluorescein-labeled antibodies has been recognized as the most reliable.

— The EEG reveals small scattered changes in the cortical rhythm, especially a decrease in the alpha rhythm, zonal smoothness, an increase in slow theta and delta waves, persistent disturbances in the bioelectrical activity of the brain.

- On CT and MRI, atrophy of the cerebral cortex, expansion of the ventricular system, is determined.

- Arthrocentesis shows polymorphonuclear 100,000 cells / μl, protein growth up to 0.8 g / l, CEC in 50%, fibrin deposits, lymphocytic infiltration, vascular proliferation is present. The main diagnostic factor is the detection of borreliosis antibodies and the absence of rheumatic factor.

- On ultrasound diagnostics of the affected joint, there is a thickening of the synovium, an increase in fluid, changes in the surrounding tissues - their thickening and swelling, tendonitis.

- X-ray of the acute stage will show changes in the soft tissues, in the chronic stage - loss of cartilage, subcartilaginous Baker's cysts and osteoporosis with uzura.

- When removing the ECG, hypoxic changes are observed (Q-T prolongation, T wave inversion), AV blockade, conduction disturbances in the legs of the His bundle,.

borreliosis: photo of a bite in a child

Treatment of borreliosis

If borreliosis is suspected, the patient is immediately hospitalized in the infectious box of the hospital. Treatment includes a whole range of therapeutic measures with a leading focus on etiotropic antimicrobial therapy. With early timely suppression of the development of borreliosis with antibiotics, there is every chance to avoid complications.

With a mild course of borreliosis, it is enough to prescribe medications orally, the tetracycline series (Doxycycline) is preferable. With an average and severe course, the addition of neurological and cardiac disorders, cephalosporins of the II-III generation (Ceftriaxone, Cefobid and Cefoperazone) and semi-synthetic penicillins (), but already with intramuscular or intravenous administration, are more appropriate. It is rational to add synergistic preparations (Eufillin, sodium caffeine benzoate) to increase the permeability of the blood-brain barrier in order to create maximum concentrations in the central nervous system.

Currently, Ceftriaxone is most effective, both in the early and late stages, and in the presence of already developed complications or chronicity of the process.

In case of an allergic reaction, intolerance to the above drugs, Levomycetin or Clarithromycin are used. With recurrence of the disease, the duration of therapy is doubled. After the end of the main course, supporting and finally completing, for 1 month, antibiotic therapy with prolonged action drugs (Retarpen, Extencillin).

Often, the development of the Jarisch-Herxheimer reaction occurs in 25% on the first day with an acute variant of the disease from the start of taking an antibiotic, or on the 3rd day - with a chronic course. The symptom complex includes: fever, chills, headache and muscle pain, an increase in the size of erythema, edema and soreness. Such a reaction is not a reason to cancel the antibiotic, since there is an independent relief of manifestations, or less often resorting to detoxification therapy is possible.

Borreliosis in children has its own nuances of treatment, because the dissemination of the pathogen is much faster, which means that the oral route of taking medications does not make sense due to slow absorption. For the fastest possible elimination of the infection, a parenteral two-stage route of etiotropic therapy is applicable, with the inclusion of Ceftriaxone, Cefaperazone, Retarpen. To improve the effect and increase the concentration in the lesion in children, it makes sense to prescribe enzyme therapy: Wobenzym or Phlogenzym. And, of course, in parallel to carry out the prevention of violations of the intestinal microflora with probiotics.

Pathogenetic therapy for borreliosis is determined by the syndrome of the lesion. Be sure to use drugs that correct the work of internal organ systems:

With damage to the nervous system - neuroprotectors: Gliatilin, Nootropil, Piracetam, Pantogam. Drugs that improve cerebral circulation: Pentoxifylline, Kkavinton.

With febrile syndrome and intoxication, infusion therapy is carried out with glucose-salt solutions.

With cerebral edema: Mannitol, Lasix, Methylprednisolone, Prednisolone, Dexazon.

Extracorporeal techniques are used for severe life-threatening conditions: plasmapheresis, plasmafiltration, simultaneously or after the administration of hormones.

Non-steroidal anti-inflammatory drugs: (Plaquinil, Indomethacin, Chlotazol), antipyretics and painkillers: Paracetamol, Ibuprofen.

Preparations to support the work of the heart: Panangin, Asparkam, Riboxin.

With allergic manifestations, desensitizing drugs in the usual dosages: Phencarol, Loratadin, Tavegil, Diazolin.

Adaptogens, vitamins, antioxidants, massage, exercise therapy, HBO.

Consequences of borreliosis

The consequences very often develop due to untimely diagnosis, since the disease is very successfully masked in the early stages. Complications of borreliosis usually occur in the second and third stages. Borreliosis can drag on for years, with progression and disability, up to death.

The consequences of borreliosis include:

- persistent headaches that are poorly stopped by antispasmodics or painkillers;

- memory loss or partial amnesia;

- mental failure, its development is dangerous especially in childhood, since it is more difficult to treat and develops rapidly, affecting more and more new areas of the brain;

- dementia or acquired dementia; delayed child puberty, in adults, a violation of the adequate functioning of the pelvic organs, accompanied by convulsions;

- Poorly treated paralysis and paraparesis;

- violation of coordination movements; visual disorders, both perception and motor abilities of the eyes;

- deterioration of auditory functions and damage to the mechanism of speech reproduction;

- affective behavioral disorders; , which entails a stable change in the structures of the heart with a reduction in the duration of their functional abilities that ensure human life;

- multiple deforming arthritis, with a chronic protracted course; skin neoplasms, predominantly benign, which regress very slowly.

The acute form of borreliosis, which occurs in the form of erythema on the skin, has a mild course and 90% curability, and does not leave any complications behind. If these first symptoms of the disease go unnoticed and if left untreated, Lyme disease can become chronic, which can persist for many years, be latent, and cause no symptoms.

However, at some point, the disease may suddenly begin to attack again, but not the skin, but the heart or central nervous system. This type of borreliosis can leave behind very serious complications.

Consequences of borreliosis

If the bacterium is not killed, when the disease spreads only to the skin, it can enter through the blood or lymph into almost all organs of our body. That is why the treatment of borreliosis in the early stages of infection is so important. Of course, before the bacterium reaches the brain or heart, it should take a little time - it can be weeks, months, or even years.

Late symptoms of borreliosis are not very characteristic, and, in addition, develop long after infection, which creates additional difficulties for the diagnosis of Lyme disease. Sometimes, before a pathogen is found, i.e. Borrelii the disease can be very developed, and its consequences will become irreversible.

Brain complications of borreliosis

The most serious complications arise if the disease covers the central nervous system. Disease in the nervous system can occur as a mild form of inflammation of the meninges, and sometimes can also involve cranial or peripheral nerves. However, properly treated neuroborreliosis does not leave behind long-term complications.

Erythema migrans...

Consequence inflammation of the facial nerve it may be damaged, which is associated with paresis of the nerves of this side of the face. As a result of the lesion, the appearance of the patient's face changes - the corner of the mouth drops, the skin between the nose and cheek and the skin of the forehead are smoothed. Such a patient is unable to bare his teeth or move his cheeks.

Eyelid regurgitation may also occur, causing the eyeball to dry out and become more susceptible to infections. With neuroborreliosis associated with inflammation of the peripheral nerves, complications can develop in the form of colic in specific parts of the body, severe neuropathy, or fatigue of the arms or legs.

The most dangerous form of neuroborreliosis is chronic brain inflammation. After such a disease, paralysis of all muscles may appear, not only of the limbs or trunk, but also of the sphincters. This can lead to permanent damage to the cranial nerves.

Inflammation of the brain as a result of infection with borreliosis can also lead to changes in the human psyche. They may develop psychosis, dementia, impaired concentration and attention. There are also depressions, the cause of which, most likely, is inflammation of the brain.

A bacterial disease of the brain can also lead to the formation of areas of cerebral ischemia, which can affect its work and the functioning of the body in different ways. It happens that there is a weakening or impairment of hearing and vision.

Cardiac complications of Lyme disease

Chronic bacterial infection Borrelii may result in heart problems. The disease affects the heart muscle, and also causes endocarditis and pericarditis. This can lead to disturbances in the functioning of the heart and, in particular, disturbances in the conduction of nerve impulses that are responsible for the correct contraction of the heart muscle.

Rhythm disturbances can be very dangerous to health and even human life. The patient feels an uneven heartbeat. As a rule, heart problems disappear within 6 weeks, but 5% of people may have irreversible consequences in the form of heart failure.

Complications on the joints after Lyme disease

Sometimes, though rarely, Lyme disease leaves behind permanent inflammation in the joints. Pain can appear simultaneously with skin changes or even two years after infection with a bacterium. Usually the knees are affected.

The disease proceeds spasmodically - asymptomatic periods alternate with periods of exacerbations. As a rule, arthritis resolves after the use of antibiotic therapy and does not leave long-term consequences. However, if the treatment is not implemented at the right time, it can lead to joint deformity.

Unfortunately, Lyme disease, if it does not manifest itself as skin changes, becomes very difficult to diagnose, due to the fact that the internal forms of this disease have completely uncharacteristic symptoms.

Often the key to staying healthy and alive is self-examination at the time of a potential tick attack. However, if this does not happen, symptoms of organ damage may appear many years after the bite and are difficult to associate with borreliosis. In such a situation, the main thing is the intuition and experience of the doctor.

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 doctors 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 ixodid 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 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 negatively affect 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 taking 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 dense 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.

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

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

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

The reasons

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

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

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

Mechanism of infection

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

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

Symptoms of borreliosis

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

The course of borreliosis is divided into several periods:

First stage

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

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

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

Second stage

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

Third stage

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

Diagnostics

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

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

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

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

Treatment of borreliosis

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

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

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

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

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

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

Complications and prognosis

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