This disease (syn. Lyme disease) is a natural focal chronic infectious disease. Tick-borne Borrelia is caused by one of the species Treponema – Borrelia Burgdorfer. How the disease manifests itself, how to identify it and treat the disease, find out below in the article.

Symptoms of different stages of tick-borne borreliosis

There are 3 stages of the disease. The signs of each of them have their own specifics.

Stage I symptoms tick-borne borreliosis

Stage I lasts up to 40 days and is characterized by the development at the site of introduction of the pathogen of primary affect in the form of chronic migratory erythema of Afzelius-Lipschütz. The main symptom of the disease at this stage is a single (sometimes several) rounded red spot at the site of the bite, which over the course of several weeks, gradually growing centrifugally, reaches 15–20 cm or more in diameter.

As the erythema grows with tick-borne borreliosis, its central part undergoes regression; in its zone a mark (in the form of a reddish dot) from a tick bite can be clearly visible. The edge of the erythema is represented by a narrow erythematous strip (width from a few millimeters to 1–2 cm). Most often, the focus of borreliosis is localized on the torso, limbs, but can also be on the face.

The marginal border of the erythema as it grows can break, turning into a garland-like strip that sometimes passes through the chest, neck, and face of the patient. Subjective symptoms are usually absent. Erythema is a marker sign of the disease, but in 30–60% of cases it may be absent. In addition to adult ticks, a person can be attacked by much smaller young individuals, which attach painlessly, and the fact of the bite may not be noted.

Symptoms of tick-borne borreliosis at stage II

Stage II of the disease, caused by lympho- and hematogenous dissemination of the pathogen and developing from the 3rd to the 21st week of the disease (usually in the 4th–5th week), is characterized by the following symptoms of tick-borne borreliosis:

damage to the nervous system with the development of serous meningitis,

neuritis cranial nerves,

radiculoneuritis,

cardiovascular system with the development of myocarditis,

pericarditis,

conduction disorders (especially atrioventricular block).

Often, with tick-borne borreliosis, a flu-like syndrome occurs (headache, fever, weakness, myalgia). Skin lesions in this stage of the disease borreliosis can be in the form of secondary ring-shaped elements with a diameter of 1–5 cm, an erythematous rash on the palms of the type of capillaritis, urticarial rashes, as well as benign lymphocytoma of the skin of Spiegler in the form of a single infiltrate - a nodule or disseminated plaques, most often on the earlobes, nipples and areolas of the mammary glands, swollen, bright crimson in color, slightly painful on palpation.

Signs of tick-borne borreliosis at stage III

In stage III of tick-borne borreliosis, late, developing more often a year after infection and lasting from several months to 10 years or more, persistence of the pathogen is often noted in any organ, damage to the musculoskeletal system is observed - monoarthritis (mostly of the knee joints) or polyarthritis , chronic encephalitis, encephalomyelitis. Develop on the skin

• acrodermatitis atrophic chronic,
• spotty atrophy,
• scleroderma-like changes.

Histologically, borreliosis reveals microangiopathy, lymphocytic infiltration of the skin with an admixture of plasma cells.

There are also possible cases of congenital tick-borne borreliosis with heart defects.

Diagnosis is based on clinical and serological data. The causative agent of borreliosis can be isolated from the affected skin, cerebrospinal fluid, blood, synovial fluid, for which the material is inoculated and cultured. The most informative RIF in diagnosing the disease is the detection of antibodies to the pathogen in the blood and cerebrospinal fluid, which gives a positive result in 60% of cases in stage I of the disease and in 100% in stages II and III. Differential diagnosis is carried out with various types of erythema, scleroderma.

Symptoms and diagnosis of neuroborreliosis

The disease is a manifestation of Lyme disease. The causative agent of this form of the disease is Borrelia, which belongs to the genus Spirochetes. Infection occurs transmissibly through the bites of ixodid ticks.

Clinical manifestations of neurogenic borreliosis occur against the background of general clinical symptoms of neuroborreliosis, characteristic of borreliosis infection.

Characteristic symptoms of neuroborreliosis are ring-shaped erythema at the site of the bite, damage to the joints and nervous system. The appearance of headache, photophobia, hyperacusis, hypersthesia of the skin, vomiting, obvious signs meningeal syndrome, focal symptoms indicate the development of meningitis or meningoencephalitis. Most often pathogenic effects 3–4, less often 9–12, pairs are exposed to borrelia.

Another typical symptom complex of neuroborreliosis is Bannwart's lymphocytic meningopolyradiculoneuritis. A characteristic manifestation is pain syndrome, associated with the site of tick suction and resulting from involvement of the spinal nerve roots in any part of the spine, more often in the cervicothoracic. Characteristic signs of irritation and loss of functions of sensory and motor roots. Liquorological changes in Bannwart syndrome are characterized by moderate lymphocytic pleocytosis and moderate protein content.

The etiological diagnosis of neurogenic borreliosis is based on serological tests with paired sera. The most promising methods are molecular genetic diagnostics.

Features of the treatment of tick-borne borreliosis

The general principles of therapy are as follows: Penicillin - 2,000,000 units or more per day for 2-3 weeks (depending on the stage), Tetracycline - 1,000,000-2,000,000 units per day, Amoxicillin - 1,000,000- 2,000,000 units per day (children 20–40 mg/kg per day).

For the treatment of tick-borne borreliosis, Erythromycin is also used at a dose of 1,000,000 units per day (for children 30 mg/kg per day). For damage to the nervous system and arthritis, Penicillin G and Ceftriaxone are used.

Etiotropic therapy of tick-borne borreliosis

Treatment includes a complex therapeutic measures, in which the leading role is given to etiotropic therapy for the treatment of borreliosis. Medicines are prescribed orally or parenterally depending on the clinical picture and period of illness. Among oral medications, preference is given to tetracycline antibiotics .

The drugs are prescribed in the first period of the disease in the presence of erythema at the site of tick bite, fever and symptoms of general intoxication, provided there are no signs of damage to the nervous system, heart, or joints. Tetracycline 0.5 g 4 times a day or Doxycycline (Vibramycin) 0.1 g 2 times a day are prescribed for the treatment of tick-borne borreliosis, the course of treatment is 10 days.

Children under 8 years of age are prescribed Amoxicillin (Amoxil, Flemoxin) orally 30–40 mg/kg per day in 3 doses or parenterally 50–100 mg/kg per day in 4 injections. Cannot be reduced single dose drug and reduce the frequency of taking medications, since to obtain therapeutic effect it is necessary to constantly maintain a sufficient bacteriostatic concentration of the antibiotic in the patient’s body.

Neurological treatment for borreliosis

If damage to the nervous system, heart, or joints is detected in patients (in patients with acute and subacute course), it is not advisable to prescribe tetracycline drugs, since some patients experienced relapses after the course of treatment, late complications, the disease became chronic. When identifying neurological, cardiac and articular lesions, Penicillin or Ceftriaxone is usually used. In contrast to the recommended penicillin therapy regimens, we have specified the single dose of the drug, the frequency of its administration and the duration of the course of treatment. Benzylpenicillin (penicillin G) is prescribed at 500 thousand. ED intramuscularly 8 times a day (with an interval of strictly 3 hours). The duration of the course is 14 days.

For patients with clinical symptoms for the treatment of tick-borne borreliosis in the form of meningitis (menigoencephalitis), a single dose of Penicillin is increased to 2–3 million units depending on body weight and reduced to 500 thousand. ED after normalization of cerebrospinal fluid. Repeated administration of Penicillin maintains a constant bactericidal concentration in the blood and affected tissues. A similar scheme of penicillin therapy has been tested and successfully used in the treatment of syphilis, the pathogenesis of which is in many ways similar to the pathogenesis of Lyme disease. Yes, it is noted similar mechanism early defeat central nervous system in these infections, common features of immunological processes and the similarity of the causative agents of both infections.

Currently, the most effective drug for the treatment of tick-borne borreliosis is Ceftriaxone (Longacef, Rocephin) in daily dose 1–2g. Course duration is 14–21 days.

Treatment of chronic tick-borne borreliosis

In case of a chronic course of the disease, the course of treatment with penicillin according to the same regimen lasts 28 days. It seems promising to use long-acting penicillin antibiotics – extencillin (retarpen) in single doses of 2.4 million units once a week for 3 weeks.

In the chronic course of the disease with isolated skin lesions, positive results can be obtained from treatment with tetracycline antibiotics.

In cases of mixed infection (Lyme disease and tick-borne encephalitis) along with antibiotics, anti-tick gamma globulin is used.

Preventive therapy for tick-borne borreliosis

Preventive (preventative after a bite) treatment of borreliosis victims of a tick bite infected with Borrelia (the intestinal contents and hemolymph of the tick are examined using dark-field microscopy) are treated with Tetracycline 0.5 g 4 times a day for 5 days or Bicillin-3 - 1 million 200 thousand - 2 million 400 thousand. ED intramuscularly once. Also for these purposes, at the Department of Infectious Diseases of the Military Medical Academy with good result use Retarpen (Extencillin) at a dose of 2.4 million units intramuscularly once, Doxycycline 0.1 g 2 times a day for 10 days, Amoxiclav 0.375 g 4 times a day for 5 days. Treatment of borreliosis is carried out no later than the 5th day from the moment of the bite. The risk of developing the disease is reduced by up to 80%.

Pathogenetic treatment of the disease

Along with antibiotic therapy, pathogenetic treatment of tick-borne borreliosis is used. It depends on the severity of the disease. So:

in case of high fever, severe intoxication, detoxification solutions are prescribed parenterally,

for meningitis - dehydration agents,

with cranial neuritis and peripheral nerves, arthralgia and arthritis - physiotherapeutic treatment.

Patients with signs of heart damage are prescribed Panangin or Asparkam 0.5 g 3 times a day, Riboxin 0.2 g 4 times a day.

In cases of immunodeficiency, Timalin is prescribed for the treatment of tick-borne borreliosis at 10–30 mg per day for 10–15 days.

In patients with symptoms of autoimmune manifestations, for example, often recurrent arthritis, Delagil is prescribed 0.25 g once a day in combination with non-steroidal anti-inflammatory drugs (Indomethacin, Metindol, Brufen, etc.). The course of treatment for borreliosis is 1–2 months.

Prognosis for recovery from tick-borne borreliosis

The prognosis is favorable. With late or inadequate etiotropic therapy, the disease progresses, often becoming recurrent and chronic. Decreased ability to work and, in some cases, disability are caused by persistent residual symptoms of tick-borne borreliosis. Those who have recovered from the disease are subject to dynamic medical observation for a year (examination by an infectious disease specialist, therapist, neurologist, indirect immunofluorescence reaction every 3 months), after which a conclusion is made about the absence or chronicity of the infection.

How is tick-borne borreliosis transmitted?

The carriers of the causative agent of tick-borne borreliosis are ixodid ticks, which are widespread in wooded areas of the temperate climate zone. The area of ​​the disease is close to the area of ​​tick-borne encephalitis. Ticks retain the pathogen for life and can transmit it to offspring. Sources of infection for borreliosis are mouse-like rodents (voles, small hamsters) - feeders of the preimago - the early phase of tick development, large ungulates (elk, deer, farm animals) - feeders of the imago.

The main route of transmission of tick-borne borreliosis to humans is transmissible - specific inoculation with the saliva of an infected tick. The seasonality of borreliosis is pronounced with an increase in the number of cases in the spring-summer and summer-autumn periods. The incubation period of tick-borne borreliosis ranges from 3 days to 3 months (on average 3 weeks).

Lyme disease(or Lyme disease, tick-borne borreliosis, Lymeborreliosis) - predominantly infectious vector-borne disease with high polymorphism clinical manifestations and caused by at least three species of bacteria of the genus Borrelia, a type of spirochete. Borrelia burgdorferi dominates as the causative agent of Lyme disease in the United States, while Borrelia afzelii and Borrelia garinii dominate in Europe.
Lyme disease is the most common disease transmitted by ticks in the Northern Hemisphere. The bacteria are transmitted to humans through the bite of infected Ixodes ticks belonging to several species of the genus Ixodes. Early manifestations of the disease may include fever, headaches, fatigue and a characteristic skin rash called erythema migrans. In some cases, in the presence genetic predisposition, V pathological process joint tissues, the heart, as well as the nervous system and eyes are involved. In most cases, symptoms can be relieved with antibiotics, especially if diagnosis and treatment are carried out in the early stages of the disease. Inadequate therapy can lead to the development of “late stage” or chronic Lyme disease, when the disease becomes difficult to treat, causing disability, or leading to death. Differences in opinion regarding the diagnosis, testing and treatment of Lyme disease have led to two different standards of care.

History of the study of Lyme disease, borreliosis

The first report of systemic tick-borne borreliosis appeared in 1975 in the USA, where on November 1 in the state of Connecticut, in the small town of Lyme, cases of this disease were registered. The Department of Health contacted two women whose children suffered from “juvenile rheumatoid arthritis" It has been noted that several adults also suffer from this disease. A study conducted by the Centers for Disease Control's Division of Rheumatology and researcher Allen Steere found that 25% of patients had juvenile arthritis. It was noted that the disease occurs after a tick bite, and arthritis was often combined with migratory erythema annulare. This peculiar skin lesion was known in Europe as erythema of Aphrelius.

The incidence of juvenile rheumatoid arthritis ranges from 1 to 15 per 100,000 children (under 16 years of age). The prevalence of juvenile rheumatoid arthritis in different countries is 0.05-0.6%. A. Steer noted that in the state of Connecticut the number of sick children is 100 times higher than this number. The main vector of the pathogen, the ixodes tick (Ixodes damini), was identified in 1977. In 1982, Willy Burgdorfer first isolated spirochete-like microorganisms from ticks, which are new look from the genus Borrelia, which was later named Borrelia burdorferi.

American researchers also isolated Borrelia burdorferi from the blood and cerebrospinal fluid of those affected by borelliosis, and antibodies to B. burdorferi were found in a number of patients in the same biological environments, which made it possible to completely decipher the etiology and epidemiology of this disease. The disease was named Lyme disease (due to the fact that this was the name of the city where the first patients were seen). Lyme disease is being detected in the United States, where it is currently reported in 25 states. Clinical manifestations of the disease, similar to systemic tick-borne borreliosis, have been noted in the Baltic states, northwestern and central regions of Russia, as well as in the Urals, the Urals, Western Siberia and Far East. IN recent years Case reports of Lyme disease are being published in several European countries.

Classification of Lyme disease, borreliosis

Forms of the disease: latent, manifest.

• Downstream:
  • acute
  • subacute
  • chronic;
• By clinical signs:
  • Acute and subacute course
    • erythema form
    • non-erythema form

with primary damage to the nervous system, heart, joints

• • Chronic course
    • continuous
    • recurrent

with primary damage to the nervous system, joints, skin, heart

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

The latent form is diagnosed with laboratory confirmation of the diagnosis, but the absence of any signs of the disease. According to the course: acute course - the duration of the disease is up to 3 months, subacute - from 3 to 6 months, chronic course - more than 6 months. According to clinical signs in the acute and subacute course, the following are distinguished: erythema form - in case of development of skin erythema at the site of the tick bite, and non-erythema form - in the presence of fever, intoxication, but without erythema. Each of these forms can occur with symptoms of damage to the nervous system, heart, and joints.

Epidemiology of Lyme disease, borreliosis

In nature, many vertebrates are the natural hosts of the causative agent of Lyme disease: white-tailed deer, rodents, dogs, sheep, birds, cattle. The main vectors of Borrelia are ixodid ticks: Ixodes damini - in the USA, Ixodes ricinus, Ixodes persulcatus - in Europe and our country. It is very difficult to detect the spirochete in mammalian tissues. This microorganism is not only extremely small, forms spore forms, but is also, as a rule, present in tissues in very small quantities. The most reliable method for detecting B. burgdorferi is to treat the sample with specific Borrelia antibodies labeled with fluorescein. Using this method, Borrelia were found in the eyes, kidneys, spleen, liver, testes and brain of various mammals, as well as some species of passerines (judging by the geography of systemic tick-borne borreliosis, Borrelia are spread by migrating birds with infected ticks attached to them). In areas where Lyme disease is highly endemic, Borrelia is present in digestive system ticks of the genus Ixodes up to 90%, but only a few of them have borrelia in the salivary glands. As it becomes clear from the above, it is ticks that serve as the main reservoir of B. burgdorferi, since their infection continues throughout their lives and they can transmit it transovarially to their offspring. Ticks are extremely widespread in regions with temperate climates, especially in mixed forests. Life cycle Ixodes damini usually lasts 2 years. Adult ticks can be found in bushes, about a meter from the ground, from where they can easily move onto large mammals. Only females overwinter; males die soon after mating.

Since Borrelia enters the human body only with the saliva of the tick, during suction, infection of people occurs infrequently. Lyme disease affects people of all genders and ages equally. Several studies have reported spontaneous miscarriages as well as congenital heart defects in fetuses whose mothers were infected with B. burgdorferi during pregnancy. The detection of borrelia in various fetal organs (brain, liver, kidneys) indicates transplacental transmission of the pathogen. However, in none of these cases were there signs of an inflammatory reaction in the affected tissues, so it is impossible to make a clear conclusion about the causal relationship between the presence of spirochetes and an unfavorable outcome for the fetus. Although the existence of congenital Lyme borreliosis is currently questionable, pregnant women infected with B. burgforferi should be treated with antibiotics. Systemic tick-borne borreliosis is characterized by spring-summer seasonality (May-September), which corresponds to the greatest activity of ticks. The risk of infection increases for those who keep pets. The geographic distribution of systemic tick-borne borreliosis is similar to the area of ​​tick-borne encephalitis, which makes it possible for simultaneous infection by two pathogens and the development of a mixed infection.

Pathogenesis of Lyme disease, borreliosis

The pathogen of systemic tick-borne borreliosis enters the human body with the saliva of the tick. Migrating ring-shaped erythema develops on the skin at the site of tick suction. From the site of introduction with the flow of lymph and blood, the pathogen enters internal organs, joints, lymphatic formations; perineural, and subsequently rostral spread with involvement in the inflammatory process meninges. When Borrelia die, they release endotoxin, which causes a cascade of immunopathological reactions.

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

Immune complexes can also form in affected tissues, which activate the main inflammatory factors - the generation of leukotactic stimuli and phagocytosis. Characteristic feature is the presence of lymphoplasmatic infiltrates found in the skin, subcutaneous tissue, lymph nodes, spleen, brain, peripheral ganglia.

The cellular immune response develops as the disease progresses, with the greatest reactivity of mononuclear cells manifesting itself in target tissues. The level of T-helpers and T-suppressors, the index of stimulation of blood lymphocytes, increases. It has been established that the degree of change in the cellular component of the immune system depends on the severity of the disease.

The leading role in the pathogenesis of arthritis is played by liposaccharides that are part of borrelia, which stimulate the secretion of interleukin-1 by cells of the monocyte-macrophage series, some T-lymphocytes, B-lymphocytes, etc. Interleukin-1, in turn, stimulates the secretion of prostaglandins and collagenase by synovial tissue, that is, it activates inflammation in the joints, which leads to bone resorption, destruction of cartilage, and stimulates the formation of pannus.

Of significant importance are the processes associated with the accumulation of specific immune complexes containing spirochete antigens in the synovial membrane of joints, dermis, kidneys, and myocardium. The accumulation of immune complexes attracts neutrophils, which produce various inflammatory mediators, biologically active substances and enzymes that cause inflammatory and dystrophic changes in tissues. The pathogen persists in the body for more than 10 years, apparently in the lymphatic system, but the reasons leading to this are unknown.
A slow immune response associated with relatively late and mild borrelemia, the development of autoimmune reactions and the possibility of intracellular persistence of the pathogen are some of the main reasons for the chronicity of the infection.

Congenital Lyme borreliosis

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

Clinical picture of Lyme disease, borreliosis

Incubation period of borreliosis (Lyme disease)

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

By stage, Lyme disease is divided into 2 stages:

• Early period
  • Stage I
  • Stage II
• Late period
  • Stage III

Stage Iborreliosis (Lyme disease)

characterized by acute or subacute onset. The first manifestations of the disease are nonspecific: chills, fever, headache, muscle aches, severe weakness and fatigue. Stiffness of the neck muscles is characteristic. Some patients experience nausea and vomiting, and in some cases there may be catarrhal symptoms: sore throat, dry cough, runny nose. At the site of tick suction, a spreading ring-shaped redness appears - migratory ring-shaped erythema, which occurs in 60-80% of patients. Sometimes erythema is the first symptom of the disease and precedes the general infectious syndrome. In such cases, patients first turn to an allergist or dermatologist, who diagnose “ allergic reaction for a tick bite." First, a macula or papule appears at the site of the bite within 1-7 days, and then over the course of several days or weeks the area of ​​redness expands (migrates) in all directions. Its edges are intensely red and slightly raised above the unaffected skin in the form of a ring, and in the center the erythema is slightly paler. Sometimes migrating annular erythema is accompanied by regional lymphadenopathy. The erythema is usually oval or round, with a diameter of 10-20 cm, sometimes up to 60 cm. Within such a large area there may be individual ring-shaped elements. In some patients, the entire affected area is uniformly red; in others, vesicles and areas of necrosis appear against the background of erythema. Most patients indicate discomfort in the area of ​​erythema, a minority experience severe burning, itching and pain. Migratory ring-shaped erythema is most often localized on the legs, less often on the lower part of the body (abdomen, lower back), in the axillary and groin areas, and on the neck. In some patients, along with primary skin lesions at the site of tick bite, multiple ring-shaped rashes appear within a few days, reminiscent of migratory erythema, but they are usually smaller in size than primary focus. The mark left by a tick can remain visible for several weeks in the form of a black crust or bright red spot. Others are also noted skin symptoms: utricarial rash on the face, urticaria, small transient red dotted and ring-shaped rashes, and conjunctivitis. In approximately 5-8% of patients, already in acute period signs of damage appear soft shells brain, manifested by general cerebral symptoms (headache, nausea, repeated vomiting, hyperesthesia, photophobia, the appearance of meningeal symptoms). At lumbar puncture in such patients, increased cerebrospinal fluid pressure (250-300 mm H2O), as well as moderate lymphocytic pleocytosis, is recorded, increased content protein, glucose. In some cases, the composition of the cerebrospinal fluid does not change, which is regarded as a manifestation of meningism. Patients often experience myalgia and arthralgia. In the acute period of the disease, some patients exhibit signs of anicteric hepatitis, which manifest themselves in the form of anorexia, nausea, vomiting, pain in the liver, and an increase in its size. The activity of transaminases and lactate dehydrogenase in the blood serum increases. Migratory annular erythema is constant symptom Stage I of the disease, other symptoms of the acute period are changeable and transient. In approximately 20% of cases skin manifestations are the only manifestation of stage I Lyme disease. In some patients, erythema goes unnoticed or is absent. In such cases, in stage I only fever and general infectious symptoms are observed. In 6-8% of cases, a subclinical course of infection is possible, with no clinical manifestations of the disease.

The absence of symptoms of the disease does not exclude the development of subsequent stages II and III of the disease. As a rule, stage I lasts from 3 to 30 days. The outcome of stage I may be recovery, the likelihood of which increases significantly with adequate antibacterial treatment. Otherwise, even with normalization of body temperature and disappearance of erythema, the disease gradually turns into the so-called late period, including stages II and III.

Stage II borreliosis (Lyme disease)

characterized by dissemination of the pathogen through the blood and lymph flow throughout the body. True, stage II does not occur in all patients. The timing of its onset varies, but most often, 10-15% of patients develop neurological and cardiac symptoms 1-3 months after the onset of the disease. Neurological symptoms may manifest as meningitis, meningoencephalitis with lymphocytic pleocytosis of the cerebrospinal fluid, cranial nerve palsy and peripheral radiculopathy. This combination of symptoms is quite specific to Lyme disease. Characterized by throbbing headache, stiff neck, photophobia, fever is usually absent; Patients, as a rule, are bothered by significant fatigue and weakness. Sometimes there is moderate encephalopathy, consisting of disorders of sleep and memory, concentration, and severe emotional lability. Of the cranial nerves, the facial one is most often affected, and isolated paralysis of any cranial nerve may be the only manifestation of Lyme disease. This disease (as with sarcoidosis and Guillain-Barré syndrome) causes bilateral paralysis facial nerve. Damage to the facial nerve can occur without impairment of sensitivity, hearing, or lacrimation.

Without antibiotic therapy, meningitis can last from several weeks to several months. A characteristic feature of systemic tick-borne borreliosis is the combination of meningitis (meningoencephalitis) with neuritis of the cranial nerves and radiculoneuritis. In Europe, among neurological lesions, the most common lymphocytic meningoradiculoneuritis of Bannawart, in which intense radicular pain appears (more often there are cervicothoracic radiculitis), changes in the cerebrospinal fluid, indicating serous meningitis, although in some cases meningeal symptoms weakly expressed or absent. Neuritis of the oculomotor, optic and auditory nerves is possible. In children, meningeal syndrome usually predominates; in adults, the peripheral nervous system is more often affected. Patients with Lyme disease may have more severe and prolonged manifestations of the nervous system: encephalitis, myelitis, chorea, cerebral ataxia. In stage II of the disease, the cardiovascular system also continues, which, however, is observed less frequently than damage to the nervous system and does not have characteristic features. Typically, 1-3 months after erythema migrans annulare, 4-10% of patients experience cardiac abnormalities. The most common symptom is conduction disturbances such as atrioventricular block, including complete transverse block, which, although rare, is a typical manifestation of systemic tick-borne borreliosis. It is difficult to document transient block due to its transient nature, but an ECG is desirable in all patients with erythema annulare migrans because complete transverse block is usually preceded by less severe arrhythmias. With Lyme disease, pericarditis and myocarditis may develop. Patients experience palpitations, shortness of breath, chest pain, and dizziness. Sometimes cardiac damage is detected on an ECG only by prolongation of the PQ interval. Conduction disturbances usually go away on their own within 2-3 weeks, but complete atrioventricular block requires the intervention of cardiologists and cardiac surgeons. In the early years of studying the clinical picture of Lyme disease, it was believed that stage II was characterized mainly by neurological and cardiac manifestations. However, in recent years, evidence has accumulated indicating that this stage has very clear clinical polymorphism, due to the ability of Borrelia to penetrate any organs and tissues and cause mono- and multi-organ lesions. Thus, skin lesions can occur with secondary ring-shaped elements, an erythematous rash on the palms of the capillary type, diffuse erythema and utricarial rash, and benign skin lymphocytoma. Along with erythema annulare migrans, benign cutaneous lymphocytoma is considered one of the few manifestations of Lyme disease. Clinically, benign skin lymphocytoma is characterized by the appearance of a single infiltrate or nodule or disseminated plaques. The most commonly affected areas are the earlobes, nipples and areolas of the mammary glands, which look swollen, bright crimson and slightly painful on palpation. The face, genitals and groin areas. The duration of the course (wavy) is from several months to several years. The disease can be combined with any other manifestations of systemic tick-borne borreliosis. The clinical picture of benign cutaneous lymphocytoma has been well studied thanks to the research of Grosshan, who proved the spirochetal etiology of this condition even before the discovery of Lyme disease. At the dissemination stage of Lyme disease, various nonspecific clinical manifestations also occur: conjunctivitis, iritis, choriretinitis, panophthalmos, tonsillitis, bronchitis, hepatitis, splenitis, orchitis, microhematuria or proteinuria, as well as severe weakness and fatigue.

I II stage borreliosis (Lyme disease)

is formed in 10% of patients 6 months - 2 years after the acute period. The most studied in this period are joint lesions (chronic Lyme arthritis), skin lesions (atrophic acrodermatitis), as well as chronic neurological syndromes similar in terms of development tertiary period neurosyphilis. Currently, a number of etiologically undeciphered diseases are presumably associated with borreliosis infection, for example, progressive encephalopathy, recurrent meningitis, multiple mononeuritis, some psychoses, convulsive conditions, transverse myelitis, cerebral vasculitis.

In stage III, there are 3 types of joint damage:

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

Migrating arthralgia is observed quite often - in 20-50% of cases, accompanied by myalgia, especially intense in the neck, as well as tenosynovitis, and occasionally, quickly passing monoarthritis. Objective signs of inflammation are usually absent even with high intensity arthralgia, which sometimes immobilizes patients. As a rule, joint pain is intermittent, lasting for several days, combined with weakness, fatigue, and headache. Pain in the joints of very significant severity can be repeated several times, but goes away on its own. In the second type of joint damage, arthritis develops, often chronologically associated with a tick bite or the development of migratory cutaneous erythema. Patients are bothered by abdominal pain, headaches, and polyadenitis is detected. Others are also registered nonspecific symptoms intoxication. This variant of joint damage develops from several weeks to several months after the onset of migratory cutaneous erythema. The most common is asymmetric monooligoarthritis involving the knee joints; less typical is the development of Baker's cysts (protrusion of the bursa knee joint with exudative inflammatory process), damage to small joints. Joint pain can bother patients from 7-14 days to several weeks, and can be repeated several times, with the intervals between relapses ranging from several weeks to several months. Subsequently, the frequency of relapses decreases, attacks become increasingly rare and then stop completely. It is believed that this benign variant of arthritis, which occurs as an infectious-allergic type, does not last longer than 5 years. A significant number of patients may have only 1-2 episodes of arthritis. The third type of joint damage - chronic arthritis - usually does not develop in all patients (10%), and after a period of intermittent oligoarthritis or migratory polyarthritis. The articular syndrome becomes chronic, accompanied by the formation of pannus (inflammation of the cornea of ​​the eyes) and cartilage erosions; sometimes morphologically indistinguishable from rheumatoid arthritis. In chronic Lyme arthritis, not only the synovial membrane is affected, but also other joint structures, such as periarticular tissues (bursitis, ligamentitis, enthesopathies). In later stages, changes typical of chronic inflammation are revealed in the joints: osteoporosis, thinning and loss of cartilage, cortical and marginal lesions (disappearance of a limited part of the organ), less commonly degenerative changes: osteophytosis (layering of loose young mass on the bone), subarticular sclerosis.

The clinical course of Lyme arthritis may be similar to that of rheumatoid arthritis, ankylosing spondylitis and other seronegative spondyloarthritis. The late period of Lyme disease is characterized by much less pronounced clinical polymorphism, and the leading ones, in addition to joint damage, are considered to be peculiar lesions of the nervous system (chronic encephalomyelitis, spastic paraparesis, some memory disorders, dementia, chronic axonal polyradiculopathy). Late-period skin lesions include atrophic acrodermatitis and focal scleroderma. Acrodermatitis atrophicum occurs at any age. The onset of the disease is gradual and is characterized by the appearance of cyanotic-red spots on the extensor surfaces of the extremities (knees, elbows, dorsum of the hands, soles). Inflammatory infiltrates often appear, but nodules of fibrous consistency, swelling of the skin, and regional lymphadenopathy may be observed. The extremities are usually affected, but other areas of the trunk may also be involved. The inflammatory (infiltrative) phase develops over a long period of time, persisting for many years, and turns into a sclerotic one. The skin at this stage atrophies and resembles crumpled tissue paper. In some patients (1/3) there is simultaneous damage to bones and joints, in 45% - sensitive, less often movement disorders. Latent period before the development of atrophic acrodermatitis ranges from 1 year to 8 years or more. After the first stage of Lyme disease, a number of researchers isolated the pathogen from the skin of patients with atrophic acrodermatitis with a disease duration of 2.5 years and 10 years. Borreliosis infection negatively affects pregnancy. Despite the fact that pregnancy in women with Lyme disease can proceed normally and result in the birth of a healthy child, there is the possibility of intrauterine infection and the occurrence of congenital borreliosis, similar to congenital syphilis. Cases of death in newborns a few hours after birth due to serious congenital pathology heart (aortic valve stenosis, coarctation of the aorta, endocardial fibroelastosis), cerebral hemorrhages, etc. At autopsy, borrelia are found in the brain, heart, liver, and lungs. Cases of stillbirth and intrauterine fetal death have been observed. It is believed that borreliosis may be the cause of toxicosis in pregnant women. In the blood with systemic tick-borne borreliosis, an increase in the number of leukocytes and ESR is detected. Gross hematuria may be detected in the urine. Biochemical studies in some cases reveal an increase in aspartate aminotransferase activity. Not every patient experiences all stages of the disease.

Chronic symptoms of borreliosis (Lyme disease)

If the disease is treated ineffectively, or not treated at all, a chronic form of the disease may develop. This stage is characterized by alternating remissions and relapses, but in some cases the disease has a continuously relapsing nature. The most common syndrome is arthritis, which recurred over several years and acquired a chronic course through the destruction of bones and cartilage.

Changes such as osteoporosis, thinning and loss of cartilage, and less commonly degenerative changes are observed.

Among skin lesions there is a benign lymphocytoma, which has the appearance of a dense, edematous, crimson nodule (infiltrate) and causes painful sensations upon palpation. A typical syndrome is acrodermatitis atrophica, which causes atrophy of the skin.

Diagnosis of borreliosis (Lyme disease)

Lyme disease is diagnosed based on an epidemiological history (visiting a forest, sucking a tick), taking into account the time of year (summer, early autumn), as well as the clinical picture: the appearance of migratory annular erythema. Subsequently to skin lesions neurological, articular and cardiac symptoms are added. It should be borne in mind that some patients do not notice or forget that they removed the tick from the skin. In these cases, the presence of clinical stages diseases, as well as laboratory data. Borrelia can be isolated in pure culture from affected tissues and biological fluids of a sick person (marginal zone of migrating annular erythema, skin biopsies for benign skin lymphocytoma and chronic atrophic acrodermatitis). Since the number of spirochetes in tissues and body fluids is insignificant, the direct release of the causative agent of Lyme disease varies widely. For example, the isolation of Borrelia from the marginal zone of migratory annular erythema ranges from 6-45%. The results of isolating Borrelia from cerebrospinal fluid and blood are even lower and depend on the stage of the disease. Spirochetes can be seen under a microscope after silver impregnation using the Warthin-Starry method. Very important to confirm the diagnosis is a serological study, which is based on the detection of antibodies to Borrelia in blood serum, cerebrospinal and synovial fluids, using the indirect immunofluorescence reaction (IRIF), enzyme immunoassay(ELISA) and immunoblotting. In these reactions, both whole microbial cells and ultrasonic disruptors of B.burgdorferi are used as antigen. RNIF usually uses whole microbial cells. A titer of 1:64 or higher is considered diagnostically significant. Less commonly used for diagnosis are the indirect agglutination reaction and immunofluorometry. Laboratory diagnostic methods are essential in establishing the diagnosis of erased, subclinical forms and in later stages. It should be noted that in the early stages of Lyme disease, serological testing is uninformative in approximately 50% of cases, so it is important to study paired sera with an interval of 20-30 days. Late stages of the disease are characterized by a significant increase in antibody titers, especially in acrodermatitis atrophicus (100% of cases). In chronic arthritis, the isolation of Borrelia from the blood at low antibody titers in the serum has been described. False-positive serological reactions are observed in patients with syphilis, relapsing fever, other spirochetoses, as well as for rheumatic diseases and infectious mononucleosis.

Differential diagnosis of Lyme disease

The differential diagnosis of Lyme disease depends on the stage of its development. It is necessary to differentiate systemic tick-borne borreliosis from tick-borne encephalitis, erysipelas, erysepeloid, cellulite, etc. Borreliosis must be differentiated from the listed diseases in stage I. In stage II differential diagnosis must be carried out with various forms of tick-borne encephalitis, rheumatic carditis and cardiopathy. In stage III, differential diagnosis must be made with rheumatism, rheumatoid arthritis, reactive arthritis, and Reiter's disease. IN differential diagnosis Morphological studies of the synovial membrane help.

Treatment of borreliosis (Lyme disease)

Treatment of Lyme disease should be comprehensive and include adequate etiotropic and pathogenetic agents. The stage of the disease must be taken into account.

If treatment with antibacterial drugs is started already at stage I, provided there are no signs of damage to the nervous system, heart, joints, then the likelihood of developing neurological, cardiac and arthralgic complications is significantly reduced. In the early stages, tetracycline is considered the drug of choice at a dose of 1.0-1.5 g/day for 10-14 days. Untreated migratory erythema annulare may disappear spontaneously after an average of 1 month (range 1 day to 14 months), however antibacterial treatment promotes the disappearance of erythema in a shorter period of time, and most importantly, can prevent the transition to stages II and III of the disease.

Along with tetracycline, doxycycline (vibramycin) is also effective for Lyme disease, which must be prescribed to patients with skin manifestations of the disease (erythema migrans annulare, benign skin lymphoma) - 0.1 g 2 times a day, the course of treatment is 10 days. Children under 8 years of age are prescribed amoxicillin (Amoxil, Flemoxin) orally 30-40 mg/(kg day) in 3 doses or parenterally 50-100 mg/(kg day) in 4 injections. It is impossible to reduce the single dose of the drug and reduce the frequency of dosing, since in order to obtain a therapeutic effect it is necessary to constantly maintain a sufficient bacteriostatic concentration of the antibiotic in the patient’s body. If signs of damage to the nervous system, heart, and joints are detected in patients (in patients with acute and subacute course), it is not advisable to prescribe tetracycline drugs, since in some patients, after the course of treatment, relapses, late complications occurred, and the disease became chronic. When identifying neurological, cardiac and articular lesions, penicillin or cefotaxime, ceftriaxone are usually used.

Penicillin is prescribed to patients with systemic tick-borne borreliosis with lesions of the nervous system in stage II, and in stage I for myalgia and fixed arthralgia. High doses of penicillin are used - 20,000 units/kg per day intramuscularly or in combination with intravenous administration. However, more effective in lately ampicillin is considered in a daily dose of 100 mg/kg for 10-30 days. From the group of cephalosporins, the most effective antibiotic for Lyme disease is ceftriaxone, which is recommended for early and late neurological disorders, high degree of atrioventricular block, arthritis (including chronic). The drug is administered intravenously at 100 mg/kg/day for 2 weeks. Of the macrolides, erythromycin is used, which is prescribed to patients with intolerance to other antibiotics and in the early stages of the disease at a dose of 30 ml/kg per day for 10-30 days. In recent years, reports have been received on the effectiveness of sumamed, used in patients with migratory erythema annulare for 5-10 days.

The risk of developing chronic forms of borreliosis infection is associated both with the severity of the clinical manifestations of the acute period of the disease and the multi-organ involvement of the disease, as well as with the adequacy of the chosen antibiotic, its duration and dose. In this regard, the development of new treatment regimens for early borreliosis in children using new generation antibacterial drugs that are highly effective against the pathogen is quite timely.

In the new approach, in case of localized form, in addition to 14-day oral courses of well-known antibacterial drugs, it is proposed to use benzylpenicillin (penicillin G) intramuscularly for 14 days, and in case of dissemination of the pathogen, it is recommended to prescribe third-generation cephalosporins intramuscularly for up to 14 days. However, the disadvantage of the described method is that after the use of penicillin G, the frequency of chronicity is up to 40-50%, and treatment of forms with damage to internal organs with a 14-day course of third-generation cephalosporins seems insufficient to eliminate the pathogen, which is characterized by intracellular persistence in the reticuloendothelial system of the macroorganism, which leads to relapses of the disease and transition to a chronic course. Technical result of this therapeutic method is to prevent the development of the chronic course of ixodid tick-borne borreliosis in children and reduce the time inpatient treatment. This result is achieved by the fact that when using antibacterial therapy according to the invention, depending on the form and severity of the disease in erythema and non-erythema forms, cephobid is prescribed intramuscularly 2 times a day for 10 days at a daily dose of 100 mg per 1 kg of body weight, followed by administration at erythemal form of benzathine benzylpenicillin intramuscularly once a month for three months at a dose of 50 mg per 1 kg of body weight; for the non-erythema form - intramuscularly once a month for six months at a dose of 50 mg per 1 kg of body weight; if internal organs and systems are affected, cephobid is prescribed intramuscularly for 14 days 2-3 times a day at a daily dose of 200-300 mg per 1 kg of body weight, followed by benzathine benzylpenicillin intramuscularly once every 2 weeks for three months at a dose of 50 mg per 1 kg of body weight and then once a month for another three months at a dose of 50 mg per 1 kg of body weight.

Cefobid (cefoperazone) is a semisynthetic cephalosporin antibiotic of the third generation with a broad spectrum of action, intended only for parenteral administration. The bactericidal effect of the drug is due to inhibition of bacterial wall synthesis. High therapeutic levels of cephobid are achieved in all tissues and fluids, which is necessary to destroy Borrelia at the site of initial penetration and during the development of dissemination in the body. The course duration of 10 days is determined by the rapid regression of clinical symptoms during treatment with cephobid. A daily dose of 100 mg per 1 kg of body weight is determined by the pharmacokinetics of the drug and is sufficient for the substance to penetrate into tissues and fluids with intact biological barriers.

Prescription of benzathine benzylpenicillin (retarpen, extencillin), a long-acting drug that has a bactericidal effect on sensitive reproducing microorganisms by suppressing the synthesis of mucopeptides cell wall, is designed to consolidate the effect of the main course and contribute to the destruction of the pathogen that persists in biological fluids and tissues of the macroorganism. The timing of the prescription of benzathine benzylpenicillin (3-6 months) is due to the fact that the highest frequency of relapses and the development of a chronic course of the disease are observed in the period of 3-6 months. The dose of the drug is maximum in children, and after intramuscular administration, absorption active substance occurs over a long period of time (21-28 days). Increasing the dose does not affect the effectiveness of the antibiotic. In the non-erythema form, the course of therapy with benzathine benzylpenicillin is extended to 6 months, since in this form, after the introduction of borrelia into the skin, they penetrate into regional lymph nodes, disseminate the pathogen and often develop chronicity of the disease. In case of damage to internal organs and systems, cephobid is prescribed for a course of 14 days. maximum doses in order to achieve antibiotic penetration through damaged biological barriers. The subsequent course of benzathine benzylpenicillin is proposed to be carried out once every 2 weeks for the first 3 months, then once every 1 month for another 3 months in order to increase the duration of action of the antibiotic on the persistent intracellular microorganism. The duration of the course is 6 months determined by the fact that this is the most frequent period development of disease chronicity.

In case of a chronic course of the disease, the course of treatment with penicillin according to the same regimen lasts 28 days. It seems promising to use long-acting penicillin antibiotics - extensillin (retarpen) in single doses of 2.4 million units once a week for 3 weeks.

In cases of mixed infection (Lyme disease and tick-borne encephalitis), anti-tick gamma globulin is used along with antibiotics. Preventive treatment victims of the bite of a Borrelia-infected tick (the intestinal contents and hemolymph of the tick are examined using dark-field microscopy) are treated with 0.5 g of tetracycline 4 times a day for 5 days. Also for these purposes, with good results, retarpen (extensillin) is used at a dose of 2.4 million units intramuscularly once, doxycycline 0.1 g 2 times a day for 10 days, amoxiclav 0.375 g 4 times a day for 5 days. Treatment is carried out no later than the 5th day from the moment of the bite. The risk of developing the disease is reduced by up to 80%.

Along with antibiotic therapy, pathogenetic treatment is used. It depends on the clinical manifestations and severity of the course. Thus, for high fever and severe intoxication, detoxification solutions are prescribed parenterally, for meningitis - dehydration agents, for neuritis of the cranial and peripheral nerves, arthralgia and arthritis - physiotherapeutic treatment.

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

To reduce allergic manifestations use desensitizing drugs in normal dosages.

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

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

Forecast of borreliosis (Lyme disease)

A favorable outcome of the disease largely depends on the timeliness and adequacy of etiotropic therapy carried out during the acute period of the disease. Sometimes, even without treatment, systemic tick-borne borreliosis stops at an early stage, leaving behind a “serological tail.” The prognostic factor for recovery is the persistence of high titers of IgG antibodies to the pathogen. In these cases, regardless of the clinical manifestations of the disease, it is recommended to carry out a repeated course of antibiotic therapy in combination with symptomatic treatment. In some cases, the disease gradually passes into the tertiary period, which may be due to a defect in the specific immune response or factors of nonspecific resistance of the body. In the case of neurological and articular lesions, the prognosis for complete recovery is unfavorable. After an illness, it is recommended that patients undergo clinical observation in a clinical medical facility for a year (with a clinical and laboratory examination after 2-3 weeks, 3 months, 6 months, 1 year). If skin, neurological or rheumatic manifestations persist, the patient is referred to the appropriate specialists, indicating the etiology of the disease. Issues of further ability to work are resolved with the participation of an infectious disease specialist at the clinic’s VKK.

Prevention of borreliosis (Lyme disease)

Specific prevention of BL has not currently been developed. Nonspecific prevention measures are similar to those for tick-borne encephalitis. The most effective measures to prevent bites from ticks attached to the body are to use protective clothing(long-sleeved, high-necked shirts, long pants, hats and gloves) and insect repellents. If a tick is found that has settled on any area of ​​the skin, it must be carefully removed slowly, better with your hands wearing gloves using tweezers. If possible, you need to hold the tick by the head and pull it out with a twisting motion. If you pull vertically, there is a high risk that the proboscis and head will remain in the wound. Do not crush the tick, as infection can occur through intact skin. After washing the wound, you need to wash your hands with soap. Since ticks are very small, it is important to look for them carefully, preferably using a flashlight. Ticks often attach themselves to pets, so during tick season you should check them after they return from a walk.

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

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

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

Reasons

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

Borreliosis is widespread, it is often observed 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 suffering from borreliosis is not dangerous in epidemic terms; he cannot infect others.

Mechanism of infection

The process of Borrelia entering the body occurs through a tick bite. 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 over the skin and penetrate into the internal organs - the joint area, nerve tissue or heart tissue.

Borreliosis can last for years, periodically causing exacerbations or relapses. Chronicization of the process occurs over a long period of 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. First and typical sign borreliosis is the formation of red, ring-shaped 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 cm or more by the end of the period. The spots are mostly 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 there is 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, and 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 ring-shaped erythema on the skin with a crust in the center. To confirm the diagnosis, a laboratory blood test and detection of antibodies to Borrelia are performed. It is necessary to take a test for borreliosis 2 weeks after a tick bite.

In parallel with this, a study is being conducted for tick-borne encephalitis, since tick bites can transmit both diseases at once.

X-rays of joints and their examination are necessary, conducting an ECG and ultrasound of the heart, examination by a neurologist and neurological examination, if necessary, puncture to obtain cerebrospinal fluid for analysis.

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

Treatment of borreliosis

If tick-borne borreliosis is suspected, the patient must be hospitalized 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 disability.

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

Borreliosis is most easily cured in the first stage - then the development can be prevented neurological symptoms, joint damage and heart problems.

Doxycycline, tetracycline or amoxicillin is used for up to 20-30 days; if complications develop, antibiotic injections are indicated. Cephalosporins, erythromycin or sumamed can be used.

When arthritis develops, non-steroidal anti-inflammatory drugs, physiotherapeutic drugs and painkillers are used. In order to reduce the risk of allergies during massive intake of antibiotics, antihistamines are used.

During the recovery stage, vitamins and immunotherapy are indicated.

Complications and prognosis

The prognosis for life is favorable, complications arise with untreated borreliosis - arthritis, carditis and multiple sclerosis are formed. This leads to disability and decreased quality of life.

Tick-borne borreliosis (Lyme disease)- an infectious transmissible natural focal disease caused by spirochetes and transmitted, tending to be chronic and recurrent and predominantly affecting the skin, nervous system, musculoskeletal system and heart.

The study of the disease first began in 1975 in the town of Lyme (USA).

Cause of the disease

The causative agents of tick-borne borreliosis are spirochetes of the genus Borrelia. The pathogen is closely related to ixodid ticks and their natural hosts. The commonality of vectors for pathogens of ixodid tick-borne borreliosis and tick-borne encephalitis viruses determines the presence of cases of mixed infection in ticks, and therefore in patients.

Geography

The geographic distribution of Lyme disease is vast, occurring on all continents (except Antarctica). The Leningrad, Tver, Yaroslavl, Kostroma, Kaliningrad, Perm, Tyumen regions, as well as the Ural, West Siberian and Far Eastern regions for ixodic tick-borne borreliosis are considered very endemic (constant manifestation of this disease in a certain area). On the territory of the Leningrad region, the main keepers and carriers of Borrelia are taiga and European forest ticks. Infection with Lyme disease pathogens in tick-carriers in different natural foci can vary over a wide range (from 5-10 to 70-90%).

A patient with tick-borne borreliosis is not contagious to others.

Disease development process

Infection with tick-borne borreliosis occurs when bitten by an infected tick. Borrelia enter the skin with the tick's saliva and multiply within several days, after which they spread to other areas of the skin and internal organs (heart, brain, joints, etc.). Borrelia can persist in the human body for a long time (years), causing a chronic and recurrent course of the disease. The chronic course of the disease can develop after long period time. The process of disease development in borreliosis is similar to the process of development of syphilis.

Signs of Lyme disease

The incubation period of tick-borne borreliosis ranges from 2 to 30 days, on average 2 weeks.

A characteristic sign of the onset of the disease in 70% of cases is the appearance of a tick at the site of the bite. The red spot gradually increases along the periphery, reaching 1-10 cm in diameter, sometimes up to 60 cm or more. The shape of the spot is round or oval, less often irregular. The outer edge of the inflamed skin is more intensely red and rises somewhat above the skin level. Over time, the central part of the spot turns pale or acquires a bluish tint, creating a ring shape. At the site of the tick bite, in the center of the spot, a crust is visible, then a scar. Without treatment, the spot persists for 2-3 weeks, then disappears.

After 1-1.5 months, signs of damage to the nervous system, heart, and joints develop.

Diagnostics

The appearance of a red spot at the site of a tick bite gives reason to think primarily about Lyme disease. To confirm the diagnosis, a blood test is performed.

Treatment should be carried out in an infectious diseases hospital, where, first of all, therapy aimed at destroying Borrelia is carried out. Without such treatment, the disease progresses, becomes chronic, and in some cases leads to disability.

Treatment of tick-borne borreliosis

Treatment should be comprehensive and include adequate etiotropic and pathogenetic agents. The stage of the disease must be taken into account.

If treatment of tick-borne borreliosis with antibacterial drugs is started already at stage I, then the likelihood of developing neurological, cardiac and arthralgic complications is significantly reduced.

For early infection (in the presence of erythema migrans), doxycycline (0.1 g 2 times a day orally) or amoxicillin (0.5-1 g orally 3 times a day) is used, the duration of therapy is 20-30 days. With the development of carditis and meningitis, antibiotics are administered parenterally (ceftriaxone IV 2 g once a day, benzylpenicillin IV 20 million units per day in 4 injections); Duration of therapy is 14-30 days.

In the early stages, tetracycline is considered the drug of choice at a dose of 1.0-1.5 g/day for 10-14 days. Untreated migrating annular erythema can disappear spontaneously, on average after 1 month (from 1 day to 14 months), however, antibacterial treatment helps the erythema disappear in a shorter period of time, and most importantly, can prevent the transition to stages II and III of the disease.

Along with tetracycline, doxycycline is also effective for tick-borne borreliosis, which must be prescribed to patients with skin manifestations of the disease (erythema migrans, benign skin lymphoma). The daily dose of the drug for adults is 200 mg per os for 10-30 days.

Penicillin is prescribed to patients with systemic tick-borne borreliosis with lesions of the nervous system in stage II, and in stage I for myalgia and fixed arthralgia. High doses of penicillin are used - 20,000,000 units per day intramuscularly or in combination with intravenous administration. However, ampicillin in a daily dose of 1.5-2.0 g for 10-30 days has recently been considered more effective.

From the group of cephalosporins, the most effective antibiotic for Lyme disease is ceftriaxone, which is recommended for early and late neurological disorders, high degrees of atrioventricular block, and arthritis (including chronic). The drug is administered intravenously at a dose of 2 g 1 time per day for 2 weeks.

Of the macrolides, erythromycin is used, which is prescribed to patients with intolerance to other antibiotics and in the early stages of the disease at a dose of 30 ml/kg per day for 10-30 days. In recent years, reports have been received on the effectiveness of sumamed, used in patients with migratory erythema annulare for 5-10 days.

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

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

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

During the period of convalescence, patients are prescribed general restoratives and adaptogens, vitamins A, B and C.

Treatment of tick-borne borreliosis is successfully carried out at the clinic of the Research Institute of Rheumatology of the Russian Academy of Medical Sciences.

The prognosis for life is favorable, but disability is possible due to damage to the nervous system and joints.

Those who have recovered are under medical supervision for 2 years and are examined after 3, 6, 12 months and after 2 years.

Preventing Lyme Disease

Leading value in the prevention of Lyme disease is the fight against ticks, where both indirect measures (protective) and direct extermination of them in nature are used.

Treating the area against ticks with insectoacaricides (for example, " ") is the most reliable way prevention tick-borne infections, since all ticks in the treated area are destroyed.

Protection in endemic areas can be achieved using special anti-tick suits. For these purposes, you can adapt regular clothing by tucking in your shirt and trousers, the latter in boots, cuffs tightly adjusted, etc.

Leading Russian entomologists have developed a special "". Today, thanks to the combination of mechanical and chemical protection principles, this suit is the most effective means against ticks. Special flounces located on the suit act as traps for ticks crawling upward. Inside the shuttlecock there is an insert impregnated with an acaricidal substance that is lethal to ticks. Under its influence, the tick dies within a few minutes and falls off the clothing.

According to the conclusion of the FGN Research Institute of Disinfectology of Rospotrebnadzor, the suit has a protection factor of 100% and “in terms of efficiency it significantly exceeds all known domestic and foreign samples.” Thus, using “ ”, there is no need to use repellents and conduct frequent inspections of clothing.

As soon as possible, you should go to the infectious diseases hospital with the tick removed to have it examined for the presence of Borrelia. In order to prevent Lyme disease after being bitten by an infected tick, it is recommended to take 1 tablet (0.1 g) of doxycycline 2 times a day for 5 days (not prescribed for children under 12 years of age).

Tick-borne borreliosis has many similarities with. In Russia, Lyme disease has been detected in 89 large administrative territories.

The incidence of Lyme disease in the Russian Federation is 1.7-3.5 per 100 thousand population. You can get sick at any age. Humans are infected with Borrelia by adult Ixodid ticks. Moreover, the incidence of Lyme disease is much higher than tick-borne encephalitis. Lyme disease It is dangerous because it often gives chronic forms. Adults and older people are more seriously ill, which is explained by the presence of concomitant chronic pathology (atherosclerosis, hypertension). No deaths have been reported to date.

Ixodid tick-borne borreliosis in children and adults: guidelines for doctors / ed. Honored Scientist of the Russian Federation, Academician of the Russian Academy of Medical Sciences Yu.V. Lobzin. - St. Petersburg, 2010. - 64 p.

Borreliosis, which is also defined as Lyme disease, Lyme borreliosis, tick-borne borreliosis and others, is a natural focal disease of a vector-borne type. The disease affects the skin, nervous and cardiac systems, musculoskeletal system, especially joints. With early detection and proper treatment With the help of antibiotics, in most cases it ends in recovery.

What is tick-borne borreliosis: description of the disease

Borreliosis is a transmissible infectious disease localized in natural foci, often with a tendency to become chronic and relapsing.

The infection received the name “borreliosis” from the Latin name of the spirochete – Borrelia burgdorferi, which is its causative agent. And the name Lyme disease was given by the name of the city of Lyme in Connecticut, where an outbreak of infection was first registered in 1975 and its main symptoms were described.

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

Classification

Forms	Tick-borne borreliolatent forms – absence of symptoms with a laboratory confirmed diagnosis of Lyme borreliosis; manifest – rapid development of the clinical picture.
Course of the disease	According to the course of the disease, the following forms are distinguished: Acute (disease duration up to 3 months) and subacute course (3-6 months): erythema form (redness develops in the area of ​​the bite, increasing in diameter over time); non-erythematous form (occurs without redness in the area of ​​the bite, the nervous system, heart, joints are affected). Chronic course: continuous; recurrent (repeated episodes of the disease with primary damage to the nervous system, joints, skin, heart).
Degree of expression in humans	According to the severity of pathological phenomena, 4 forms of the disease are distinguished: Lightweight; Medium-heavy; Heavy; Extremely severe form.

Causes of borreliosis

Tick-borne borreliosis (Lyme borreliosis) is a natural focal infection with transmissible transmission. It has been established that the cause of tick-borne borreliosis is 3 species of borrelia - Borrelia burgdorferi, Borrelia garinii, Borrelia afzelii. These are very small microorganisms (length 11-25 microns) in the shape of a convoluted spiral.

The disease usually begins to appear approximately 7-14 days after the actual bite.

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

The period from the end of spring to the very beginning of autumn is especially dangerous for infection. During this period, such ticks are especially active. It is worth remembering that a patient infected with a tick is not infectious to other people around him.

Tick-borne borreliosis and tick-borne encephalitis are two different infectious diseases caused by ixodid ticks.

Stages of the disease

Tick-borne borreliosis is a dangerous infectious disease that can develop unnoticed by the patient. Especially if the tick bite was not noticed.

Stages 1 and 2 are considered early borreliosis. They are characterized by an acute period of manifestations. Late or chronic is 3. This period is characterized by a smoothing of symptoms and a periodic stage of exacerbation. A chronic form of the disease appears, which lasts for several years.

Stage 1 of tick-borne borreliosis

The first stage lasts up to 40 days and is characterized by the development at the site of introduction of the pathogen of primary affect in the form of chronic migratory erythema of Afzelius-Lipschütz.

The main symptom of the disease at this stage is a single (sometimes several) rounded red spot at the site of the bite, which over the course of several weeks, gradually growing centrifugally, reaches 15–20 cm or more in diameter.

On average, the duration of the first stage is one week. The symptoms correspond to an infectious disease, with skin lesions observed.

Stage 2

In the second stage of the disease, the pathogen spreads throughout the body. When Borrelia spread throughout the body through the bloodstream or lymphatic vessels, Borrelia primarily affects the heart, nervous system, or joints. Symptoms of damage to these organs develop 1.5 months after the tick bite. The duration of the 2nd phase is about six months.

Damages to the cardiovascular system are manifested by severe arrhythmias up to complete atrioventricular block. In addition, myocarditis or pericarditis may occur, which is manifested by shortness of breath, chest pain, palpitations and dizziness.

Stage 3 borreliosis

In the third stage characteristic consequence borreliosis is an inflammation of the joints. Untreated borreliosis can lead to severe disability and even death of the patient. Late stages of borreliosis can be treated, but it takes longer, is less effective and is fraught with serious complications for the body.

If you identify the signs of borreliosis in time and begin treatment with antibiotics, then the chances of a problem-free recovery will be quite high. If the diagnosis determines Lyme disease at a late stage and then illiterate therapy is carried out, borreliosis can develop into a difficult-to-treat chronic form.

Symptoms of tick-borne borreliosis in humans, photo

Borreliosis begins to manifest itself clinically, although about 30% of patients cannot remember or deny a history of the bite. The infection occurs in stages, affecting the joints, nervous system and sometimes the heart, and is subject to complete cure if you start antibiotic therapy within short term after the onset of the disease.

So, the first symptoms of borreliosis are common occurrences intoxications that develop with any other infection, such as:

• Increased body temperature;
• Chills;
• Headache;
• Body aches;
• Joint pain;
• Muscle pain;
• General weakness;
• Fatigue;
• Malaise.

Redness spreads in all directions (see photo). The edges are redder than the center and slightly raised above the rest of the skin.

• enlargement of regional lymph nodes;
• itching or pain in the area of ​​erythema;
• other skin manifestations. conjunctivitis;
• in some cases, symptoms of meningitis may appear.

If symptoms characteristic of tick-borne borreliosis occur, you should immediately contact an infectious disease specialist.

Stages 1 and 2 are considered the early period of disease development, and stage 3 is defined as the late period. Moreover, this division is conditional, since there is no clear moment of transition between them.

Stage of tick-borne borreliosis	Description and symptoms
Stage 1	Symptoms of borreliosis in the first stage can last from 3 to 30 days. The first and typical sign of borreliosis is the formation of red, ring-shaped skin at the site of the tick bite (ring-shaped erythema). Other manifestations may be absent.
Stage 2	Loss of reflexes and sensory impairment (loss of reaction and sensitivity to pain, heat and other stimuli). Weakening of voluntary movements (that is, all kinds of movements regulated by the centers of the brain, such as, for example, the movement of limbs while walking, running).
Stage 3	Several months (or years) from the onset of the disease, late manifestations of tick-borne borreliosis develop. Chronic borreliosis develops in a tenth of patients. During this period, developed arthritis and heart damage are often combined with damage to the nervous system.

Why is the chronic form of borreliosis dangerous?

Chronic borreliosis is characterized by the following manifestations: frequent colds, pinpoint rash or different sizes erythema, various other skin changes, intense or moderate headache, various chest pains, significant heart rhythm disturbances, arthritis and steady memory loss.

Also, the patient often experiences osteoporosis, the cartilage may become thinner, and rarely occur degenerative processes. Chronic borreliosis often requires a repeated course of long-term and intensive antibiotic therapy.

The chronic form of tick-borne borreliosis can lead to human disability if not treated in a timely manner.

Complications and consequences for the body

If the disease is detected in stage 1 and adequate treatment is carried out, then in most cases full recovery. Stage 2 is also cured in 85-90% of cases, leaving no consequences.

So, we list the main complications of Lyme borreliosis:

• violation of higher mental functions, up to the development of dementia;
• peripheral nerve palsies;
• hearing and vision loss;
• severe cardiac arrhythmias;
• multiple arthritis;
• benign skin tumors at the site of tick penetration.

In general, the prognosis for life is favorable, complications arise with untreated borreliosis - arthritis, carditis and multiple sclerosis are formed. This leads to disability and decreased quality of life.

Diagnostics

Early diagnosis of the disease is carried out, however, on the basis of the obtained clinical and epidemiological indicators. The presence of a typical manifestation of borreliosis in the patient in the form of erythema ensures registration of the disease without the need for clarification in the form of laboratory confirmation, and also without the need for specific data regarding the tick bite. Laboratory diagnostics are carried out, in particular, on the basis serological study blood.

Dynamic laboratory monitoring is important: tests should be taken 10 days after the bite and again after 2-3 weeks to determine the effectiveness of therapy. In parallel, a study is being conducted for tick-borne encephalitis, since tick bites can transmit both diseases at once.

You should be tested for borreliosis in the following cases:

• when ticks are found on the body;
• to confirm the primary analysis;
• for differentiation from other diseases, especially of a neurological nature (including, etc.);
• during therapy to assess the effectiveness of treatment.

How is a blood test done for tick-borne borreliosis?

A blood test for borreliosis is carried out by taking a sample from a vein. Samples are taken in the morning on an empty stomach, and it is necessary not to smoke at least 1 hour before blood collection. Blood is taken from a vein, then it is placed in an empty test tube; sometimes test tubes with a special gel are used.

The purpose of the analysis is to identify immunoglobulins of protective proteins M and G class, which are produced by the body to protect against the borreliosis virus.

If Ig M class antibodies are significant in the analysis:

• less than 0.8 U/ml - this means that the result is negative, that is, the person is not infected;
• from 0.8 to 1.1 U/ml – the result is questionable, then the analysis is taken again;
• equal to or greater than 1.1 U/ml – the result is positive, that is, there is an infection in the body.

Other diagnostic methods necessary to determine the severity of organ-specific lesions:

• X-ray examination of joints;
• lumbar puncture;
• skin biopsy;
• joint puncture.

Observation of persons who have recovered from borreliosis lasts 2 years. The frequency of examination of patients is: 3, 6, 12 months and then examination of the patient is carried out after two years.

Treatment of borreliosis

If borreliosis is suspected, the patient is immediately hospitalized in the infectious disease ward of the hospital. Therapy includes the whole complex therapeutic measures with a leading emphasis on etiotropic antimicrobial therapy. With early, timely suppression of the development of borreliosis with antibiotics, there is every chance of avoiding complications.

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

Selection of drugs and duration of their use for pathogenetic therapy depends on variations in clinical manifestations and the degree of their severity.

For general infectious phenomena:

1. intravenous and oral detoxification therapy - infusion of glucose, saline, vitamins, taking antipyretics.
2. For joint damage: anti-inflammatory and analgesic therapy - Analgesics, NSAIDs.
3. For meningitis: intravenous dehydration therapy - Trisol, Ringer's solution.
4. In case of severe clinical course diseases: hormonal therapy.

In case of a chronic course of the disease, the course of treatment with penicillin according to the same regimen lasts 28 days. It seems promising to use long-acting penicillin antibiotics – extencillin (retarpen) in single doses of 2.4 million units once a week for 3 weeks.

After the complete extinction of all symptomatic manifestations The patient should not weaken the duration. If signs of repeated deterioration of the condition appear, you must contact your doctor again and indicate a history of a case of acute borreliosis. If the disease relapses, targeted antibacterial therapy and selection of drugs to eliminate symptoms are again required.

Prevention

Specific prevention of tick-borne borreliosis has not been developed. The correct use of personal protective measures is the basis for the prevention of diseases caused by tick bites - tick-borne borreliosis and tick-borne encephalitis.

Nonspecific prevention of borreliosis includes the following:

• fight against ixodid ticks;
• knowledge about the danger of infection;
• usage special means protection (repellents, properly selected clothing).

Prevention of borreliosis after a tick bite

After a tick bite, to prevent borreliosis, you must take a combination of the following antibiotics:

• Doxycycline – 100 mg 1 time per day for 5 days;
• Ceftriaxone - 1000 mg 1 time per day for three days.

Taking these two antibiotics is an effective measure to prevent the development of borreliosis after the bite of an infected tick, since it prevents Lyme disease in 80–95% of cases.