Lyme disease( anecdotal or systemic tick-borne borreliosis)

Lyme disease( Iskidovy tick-borne borreliosis, System tick-borne borreliosis) is a chronic, natural focal bacterial infection, with a predominantly transmissible transmission mechanism, characterized by damage to the skin, nervous and cardiovascular systems.

Causes of Ixodes tick borreliosis

The causative agents are the gram-negative spirochaetes of the complex Borrelia burgdarferi sensu lato.

Borrelia

Prevalence coincides with the geographical area of tick-borne encephalitis, so the development of mixed infection is possible. The susceptibility is high, all age groups are at risk. The reservoir of infection is animals that come into contact with nature, and the source is ixodid mites, which later infect humans. Seasonality - spring-summer( from March to September).The transmission path is transmissive, that is, through the tick bite.

Ixodes tick

Symptoms of Ixodes tick borreliosis

The incubation period lasts from 5 to 30 days, at this time there is no symptomatology, and only at the site of the tick bite is a slight reddening( migraving calcipotent erythema), which can be overlooked, because the bite itselfthe tick can not be felt because the sucking mite secretes an anesthetic-like substance blocking the skin sensitivity.

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Ring-like migratory erythema

As the pathogen multiplies, it passes into the lymphogenous and hematogenous pathways, infects the internal organs, joints, CNS, with a partial death of the pathogen with the release of endotoxin. Isolation of endotoxin gives rise to the next period with clinical manifestations.

The period of clinical manifestations is nonspecific, because apart from erythema, there are no specific symptoms. The onset is acute, and febrile-intoxication syndrome appears: fatigue, chills, fever, fever, headache, dizziness, weakness, aching muscles, pain in bones and joints, catarrhal phenomena are frequent( sore throat, dryness, coughing).Because of these nonspecific symptoms, the probability of diagnostic errors is high. Over time, the erythema site at the site of the bite begins to expand in all directions, so it is often called "migrating".

If you start treatment at this stage, then the chance of recovery increases, otherwise, the disease can go to the stage of dissemination.

The stage of dissemination develops in a few weeks or months, after the end of the stage of an early localized infection. Hematogenous skid often occurs in the nervous system, cardiovascular, skin and joints, but infection of other organs and systems is not excluded.

• The defeat of the nervous system is manifested in the development of neuritis of the cranial nerves, meningitis and the symptoms associated with it, radiculoneuritis, lymphocytic meningoradiculoneuritis( Bannwarth syndrome) manifested as predominantly nocturnal radicular pain and lymphocytic pleocytosis in CSF.

• Cardiac damage is often manifested in the violation of the conductor system and inflammatory formations of the heart tissue( myocarditis, pericarditis).

• Joint damage is manifested by the first attacks of arthritis: swelling of the joint( s) and restriction of movement due to accumulation of fluid in the cavity, pain may not be. After the process of inflammation subsides, relapses occur in the same joints that were affected. Specific features of Lyme arthritis have not yet been determined.

• Skin manifestations are characterized by multiple erythematous eruptions. Much less common are lesions of the eyes( conjunctivitis, iritis, retinitis, panophthalmitis), respiratory organs( pharyngitis, tracheobronghitis), urogenital system.

When infected with Lyme disease, the immune response is rather weak and there is one feature - Borrelia stimulate the production of various inflammatory mediators( IL-1, IL-6, TNF) involved in the development of lime arthritis and autoimmune reactions. At the time of the development of the disease, circulating immune complexes are formed, which subsequently settle in the synovial membrane of the joint, dermis, kidneys, myocardium.

Often the disease takes a chronic course that is characterized by polyarthritis, lymphocytoma of the skin in the form of nodular elements on the skin, atrophic acrodermatitis manifested by skin atrophy. Chronicle of the nervous system manifests itself in the form of encephalomyelitis, polyneuropathy, spastic paraparesis, ataxia, chronic axonal radiculopathy, dementia or a more mild memory disorder.

Diagnostics

ELISA, PCR, SMP( spinal puncture)

Treatment of Ixodes tick borreliosis

Compliance with diet and regimen, which are determined by the severity of the condition. Drug therapy, which consists in the appointment of the following antibiotics: doxycycline or ceftriaxone( depending on the severity of the flow) - as the main drugs, they are already combined with the drugs of choice( amoxycycline, cefixime, azithromycin, amoxiclav, penicillin, cefatoxime).The main thing is not to use bactericidal and bacteriostatic drugs at the same time, otherwise you can cause the strongest toxicosis, because the action of endotoxin occurs when the pathogen is dead, and the drugs will act antagonistically without work at full strength. In the case of mixed infection, along with the drugs, immunoglobulin of tick-borne encephalitis is used in calculated doses. Disintoxication therapy is carried out according to general rules.

Complications of

Complications are related to the timing of the infection described above.

Prevention of

No specific prophylaxis has been developed. Nonspecific is to prevent infection: acaricidal treatment of forest park areas, wearing protective clothing, individual use of repellents. For emergency prevention, antibiotics of various groups are used: doxycycline, bicillin-3, amoxicillin, clavulanic acid.

Therapist doctor Shabanova I.Е.