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

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

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

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

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

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

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

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

The acute form is characterized by two options:

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

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

Specific erythema, which occurs in some cases at the site of tick suction, looks like this:

1. 1The area of ​​hyperemia has a round shape and clear boundaries.
2. 2The size of hyperemia can vary - from a few millimeters to several centimeters.
3. 3The erythema quickly becomes bright, and in its center there is an area of ​​clearing.
4. 4Gradually the size of the hyperemia decreases, and it itself turns pale.

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

Damage to the musculoskeletal system occurs in the form of pain in the muscles and joints, which intensifies when the weather changes. They can bother a person for several years, sometimes for life.

Pathology of the nervous system develops 5-7 years after the disease becomes chronic. Phenomena of encephalopathy and radicular lesions are observed. In some cases, paresis and paralysis of the limbs may develop.

Sometimes there is chronic skin damage in the form of areas of thickening and peeling. Redness resembling primary erythema may occasionally occur.

Vaccination against tick-borne infections is necessary for several reasons:

1. 1To avoid getting sick with encephalitis and borreliosis.
2. 2If the disease does develop, vaccination gives the disease a milder form.
3. 3To avoid serious complications.
4. 4To prevent the process from becoming chronic.

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

Who is at risk of contracting tick-borne infections?

1. 1Persons living in endemic regions.
2. 2People who often visit the forest: hunters, fishermen, tourists.
3. 3People whose profession involves visiting the forest: geologists, foresters, builders of roads, oil and gas pipelines, power lines.
4. 4The urban population may be attacked by ticks in forested areas and dachas.

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

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

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

At the moment, no specific protective vaccine against ixodid borreliosis has been created. There is only specific prevention of tick-borne encephalitis. A person can protect themselves from borreliosis only by nonspecific measures. They include:

1. 1Measures to protect against insect attacks - protective clothing and repellents.
2. 2Treat the bite site with antiseptics.
3. 3Test of the tick in a special laboratory.
4. 4Enzyme immunosorbent blood test to detect specific antibodies.
5. 5Take Doxycycline for several days.

Who should be vaccinated:

1. 1Any person can get vaccinated against tick-borne encephalitis and borreliosis.
2. 2Vaccination is mandatory for children and people at risk.

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

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

If you find an attached tick, you must carefully remove the insect so as not to damage it. The bite site is treated with an antiseptic. Ticks are examined in the laboratory to detect infectious agents.

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

After an insect bite, anti-encephalitis human immunoglobulin is administered intramuscularly. To prevent the development of borreliosis, Doxycycline is prescribed for several days.

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

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Prevention of borreliosis: is there a vaccination?

Borreliosis, or Lyme disease, is transmitted by ixodid ticks and is a serious infectious disease. The disease affects the nervous system, skin, heart, and musculoskeletal system. Prevention of borreliosis is of great importance, since any disease, especially one with serious consequences, is better to prevent than to treat.

Unlike encephalitis, for which vaccination is the main preventative measure in high-risk areas, there is no vaccine against Lyme disease. The carrier of these two diseases is the same - ixodid ticks, so sometimes a mixed infection is observed.

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

How to protect yourself from ticks

All measures to prevent tick-borne borreliosis or Lyme disease can be divided into three groups:

1.Use of protective clothing.

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

• Be sure to wear a hat with your hair covered.
• Shoes should be high, closed, and have trouser legs tucked into them.
• Sleeves and trouser legs should be long.
• The shirt and jacket must be tucked into the trousers.
• Clothing must be without buttons, with a zipper, or without a zipper at all. Cuffs should be tight-fitting or have elastic bands.
• The color of clothing should be light. On light-colored fabrics, mites are more noticeable. Slippery materials are preferred so that ticks cannot attach to them.
• Special protective clothing, for example, Biostop, Stop-Mite, Wolverine suits, which provide mechanical and chemical protection. The cut of the suit does not allow ticks to get under it, and the cuffs and special folds are equipped with special traps containing chemicals. Once caught in such a trap, the ticks die.

2.Use of chemicals

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

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

All drugs are divided into three groups:

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

3.Quick and correct removal of the tick

The likelihood of contracting borreliosis directly depends on how long the infected tick sucked blood. You need to remove the tick using tweezers or a loop of thread. Do not crush the tick or lubricate it with oil. These actions increase the likelihood of infection.

There is no vaccination against borreliosis, so nonspecific prevention is of utmost importance - preventing ticks from coming into contact with the skin.

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Features of vaccination against borreliosis

• How to remove an embedded tick?
• A little about Lyme disease
• Treatment of the disease and its consequences

Before the active season of ticks, many people get vaccinated, which are only effective against encephalitis. There are no vaccinations against borreliosis. To avoid contracting this unpleasant disease, it is better to take measures in advance to prevent insect bites.

Prevention of tick-borne borreliosis

There is no vaccine available for this disease at this time. Therefore, a person must take protective measures himself before visiting places where ticks may live.

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

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

You need to prepare for visiting insect habitats as follows:

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

Stores offer anti-encephalitis suits. This is good clothing for visiting the forest, it protects against insects. You can treat the top of the suit with anti-mite agents.

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

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

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

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If a tick has embedded itself, it is important to get rid of it correctly as quickly as possible. Do not smear it with oil under any circumstances - the risk of contracting borreliosis increases.

To remove, you can use tweezers to grab the insect’s body close to the proboscis. Rotating around the axis, slowly sip. After a couple of turns, the tick is easily removed.

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

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

There are a few rules to remember for getting rid of ticks:

• Do not apply caustic solutions (ammonia, gasoline, etc.) to the bitten area;
• do not burn the tick with improvised means (for example, a cigarette);
• when removing, do not pull sharply to prevent rupture;
• do not pick at the wound with anything;
• Do not crush the tick under any circumstances.

The extracted insect must be taken to the laboratory for analysis. This will help you understand whether the person bitten has a disease. The sanitary and epidemiological station examines the tick for 3 days.

You can check the tick yourself by having a special rapid test on hand.

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

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

The incubation period lasts about two weeks, sometimes up to a month. Where the tick has bitten, the skin turns red - this is the first sign of the disease. Gradually the red spot increases. Its size is up to 10 cm. There are cases of much larger spots - up to 60 cm. The shape of the spot is round, the outer layer is more red and convex. Gradually, the central part of the spot turns pale and may even acquire a bluish tint. A crust appears at the site of the bite, turning into a scar. If no treatment is performed, the spot disappears after 2-3 weeks.

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

Lyme disease is divided into 3 stages of development:

1. The first stage lasts about a month. The bite site turns red. Necrosis is possible. Gradually, secondary spots appear, rashes on the face in the form of rings, and conjunctivitis.
2. In the second stage, the pathogen penetrates other organs. The nervous system is affected. At the same time, the liver, kidneys, eyes, and skin may be affected.
3. After 3 months, the third stage begins. The disease becomes chronic. The patient experiences severe fatigue, sleep disturbances, and depression. Many organs begin to work poorly.

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

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

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

If the doctor has not yet received test results, but suspects the presence of a disease, then treatment is already prescribed. Patients with severe forms are hospitalized. Affected joints may require surgery.

Complications occur in the absence of treatment. These could be:

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

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

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

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

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

Tick-borne encephalitis

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

Borreliosis

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

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

Erythema migrans - Lyme disease rash

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

Diagnostics

To diagnose encephalitis, the doctor needs information about all the symptoms, as well as recent illnesses and risk factors (being near people suffering from viral infections, in areas where mosquitoes or ticks live, for example).

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

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

Diagnosing Lyme disease is much more difficult because it has a number of nonspecific symptoms that can accompany other diseases. If a rash characteristic of borreliosis is not observed, then to make a diagnosis, the doctor asks questions about the patient’s medical history, including stay in tick habitats where there is a high probability of infection.

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

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

Treatment

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

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

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

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

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

After an illness, restorative procedures may be necessary. These procedures may include:

• physical therapy;
• occupational therapy;
• speech therapy;
• psychotherapy.

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

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

Additional and alternative treatments may be used in conjunction with antibiotics:

• proper nutrition;
• consumption of probiotics;
• phytotherapy.

Prevention

The best prevention against tick-borne encephalitis and borreliosis is to comply with the following measures to protect against tick bites:

• When in the woods or areas with tall grass, wear long-sleeved shirts and long pants
• use repellents;
• Wear light-colored clothing, which makes ticks easier to spot, and check your skin carefully after being outdoors.
• If you find a tick, remove it with tweezers, making sure that all its parts (body and head) are removed.

Find out what to do if you are bitten by a tick.

Vaccination against tick-borne encephalitis and borreliosis

Vaccination against tick-borne encephalitis is possible. It is highly recommended for people who are regularly exposed to infections in contaminated areas. A variety of vaccines are available in health care settings. Full immunization can be achieved after three doses over three weeks. For long-term immunization, three initial doses are administered over 9-12 months. But they still need to be updated every three to five years. Immunization of children is also carried out.

How much does tick-borne encephalitis vaccination cost?

The causative agent of infection is spirochetes complex Borrelia burgdorferi sensu lato transmitted to a patient after a tick bite.

The infectious agent was first identified in the 80s in the USA, due to a massive outbreak of arthritis in children after visiting Lyme Park. The distribution area of ​​borreliosis currently covers almost the entire temperate zone of the Northern Hemisphere. The main natural reservoir of the causative agent of borreliosis are small rodents inhabiting anthropogenic landscapes (primarily forest parks and pastures).

The infectious agent is transferred mites of the kind Ixodes . In Western Siberia, the vector is the pasture or taiga tick Ixodes persulcatus- the same one that is a carrier of another dangerous infection - viral tick-borne encephalitis. In the European part of the country, the main vector is the forest tick Ixodes ricinus.

Borreliosis is one of the most common tick-borne infections in the world

Acute development of infection - fever, fever, headaches and muscle pain - is observed quite rarely. Much more often, the acute stage is practically absent, and the disease immediately becomes chronic. Under pressure from the immune system, borrelia go into tissues and organs where the activity of the immune system is reduced - nervous tissue, joints, tendons, heart.

One of the main primary symptoms of borreliosis is migratory erythema– redness of the skin around the bite site that expands over time.

Another defense mechanism for Borrelia is a change in the main antigens, which significantly weakens the effectiveness of the humoral immune response. Strains Borrelia burgdorferi, found in different parts of the range, differ markedly from each other both in antigenic composition and in the symptoms that can be observed during the development of the disease. So, for example, B.garinii, dominant in the Novosibirsk region, often does not produce clearly defined erythema, which makes the symptomatic diagnosis of borreliosis in Novosibirsk especially difficult.

Currently, the disease is divided into three stages

1. First stage, local, includes local manifestations and usually lasts up to one month - intense erythema is observed at the site of the initial lesion, a vesicle and necrosis appear. In place of the former erythema, increased pigmentation and peeling of the skin often persists, secondary erythema, rash on the face, urticaria, transient pinpoint and small ring-shaped rashes, and conjunctivitis occur.
2. After the initial manifestations, the disease progresses to second stage associated with the dissemination of the pathogen into various organs and tissues. In non-erythema forms, the disease often begins with manifestations characteristic of this stage of the disease and is more severe than in patients with erythema. During this period, serous meningitis, meningoencephalitis and syndromes of damage to the peripheral nervous system may be observed: sensory, predominantly algic syndrome in the form of myalgia, neuralgia, plexalgia, radiculoalgia; amyotrophic syndrome, isolated neuritis of the facial nerve, mononeuritis. The most common heart lesions are atrioventricular block (I or II degree, sometimes complete), intraventricular conduction disturbances, and rhythm disturbances.
3. After 3-6 months, borreliosis becomes third stage, associated with the persistence of infection in any organ or tissue (unlike stage II, it is manifested by predominant damage to any one organ or system). Recurrent oligoarthritis of large joints is typical. Late lesions of the nervous system include encephalomyelitis, spastic paraparesis, ataxia, memory disorders, axonal radiculopathy, and dementia. Polyneuropathy with radicular pain or distal parasthesias is often observed. Patients report headaches, increased fatigue, and hearing loss. Children experience slower growth and sexual development.

THE INFECTION IS NOT TRANSMITTED FROM A SICK TO A HEALTHY PERSON, however, TRANPLACENTAL TRANSMISSION of Borrelia during pregnancy FROM THE MOTHER TO THE FET is POSSIBLE, which may explain the rather high percentage of patients of preschool and primary school age.

Human susceptibility to borrelia is very high, and possibly absolute. Primary infections are characterized by spring-summer seasonality, determined by the period of tick activity. Infection occurs during a visit to the forest, in a number of cities - in forest parks within the city limits; summer residents, outdoor barbecue lovers, mushroom pickers, and tourists are at high risk of infection.

In terms of incidence, this infection occupies one of the first places in our country among all natural focal zoonoses. According to indirect estimates, more than 10 thousand people fall ill with borreliosis in Russia every year. As with other spirochetoses, immunity in Lyme disease is non-sterile. Those who have recovered from the disease may be re-infected after 5-7 years.

Manifestations

Over 30 years of careful study of the disease, a fairly good correlation was established between the strain of the pathogen and the pattern of development of chronic infection:

• B.burgdorferi sensu strictо(mainly a North American isolate, but also found in Europe) mainly manifests itself in the form of arthritis;
• B.afzelii(the main European isolate, in Western Siberia it accounts for about 20%) – most often causes skin manifestations, primarily chronic atrophic dermatitis;
• B.garinii(the main Siberian variant of Borrelia) - most often manifests itself in the form of neuroborreliosis (pain along the nerve fibers, perverted sensitivity, paralysis, damage to the central nervous system).

Almost always, chronic borreliosis is accompanied by various autoimmune manifestations. Establishing a diagnosis based on the described symptoms is complicated not only by their diversity and abundance, but also by its strong dependence on the individual characteristics of the patient, as well as cases of combined forms of infections.

Even one tick can infect two strains of Borrelia at once; with multiple bites this happens quite often. Due to the complexity and variability of the clinical picture B.burgdorferi received the epithet among clinical microbiologists "The Great Hoaxer".

Diagnostics

Unfortunately, in Novosibirsk clinics, diagnosing ticks for the presence of Borrelia is the exception rather than the rule. This is primarily due to the lack of certified diagnostic kits for Borrelia antigens. Using PCR tests to determine borreliosis in a patient immediately after a bite is difficult, as it involves taking pieces of skin. Immediately after a bite, there are practically no borrelia in the blood, however, analysis of the presence of borrelia in the blood using PCR reveals the pathogen in 25-30% of cases.

However, currently the only reliable way to diagnose tick-borne borreliosis is enzyme immunoassay based on the detection of specific immunoglobulins to major antigens Borrelia burgdorferi.

Class “M” immunoglobulins can appear in the patient’s blood within a week (usually 14 days) after infection, IgG - on average after 20-30 days. As the infection progresses, the spectrum of the main antibodies changes, but their overall titer remains high, which makes it possible to establish the presence of the disease with high reliability months and even years after the bite.

Treatment

Like most spirochetes Borrelia burgdorferi is sensitive to antibiotics, so treatment in the early stages is usually extremely effective and consists of a short course of antibiotic therapy. At the same time, “old” forms are quite difficult to treat, especially when organic changes begin to develop as a result of borreliosis.

It should be remembered that the earlier treatment is started, the simpler it is, the lower the required doses of antibiotics, the shorter the recommended course of therapy, the less the risk of developing the main symptoms of tick-borne borreliosis and its complications. Knowing about the presence of borreliosis infection is in the interests of the patient, therefore, after a tick bite, it is simply necessary to consult with a specialist and, at the appropriate time, analyze the presence of antibodies and DNA of the infectious agent in the blood.

Important to know!

Specialist consultation on tick-borne infections in Medical Center "Status" will help you respond competently to an encounter with a tick, minimize the risk of borreliosis, or start treatment on time.
All blood tests for diagnosis tick-borne borreliosis (antibodies to Borrelia classes M and G, PCR diagnosis of Borrelia DNA) in MC "Status" You can take it on the direction of your doctor or according to the plan prescribed by a specialist from the Status MC.

And remember:

1. Viral encephalitis and tick-borne borreliosis are two completely various infections, which require separate diagnostics and completely different treatment methods.
2. The so-called " tick vaccination”, which many wisely give themselves before the tick season, is a vaccination ONLY AGAINST VIRAL ENCEPHALITIS AND DOES NOT PROTECT FROM BORRELIOSIS IN ANY WAY. There are simply no vaccinations against tick-borne borreliosis.
3. Immunoglobulin injections, which are given after a tick bite, protect ONLY AGAINST VIRAL ENCEPHALITIS and are absolutely useless in the case of BORRELIOSIS.
4. The drugs that are prescribed for the treatment of viral encephalitis (viferon, iodantipirin, etc.) are almost USELESS AGAINST TICK-BORNE BORRELIOSIS.
5. The same tick can infect you with ENCEPHALITIS AND BORRELIOSIS AT THE SAME TIME (or even encephalitis and two different strains of borreliosis). Therefore, if an encephalitis virus is found in a tick, this does not mean that borreliosis is absent there.
6. According to long-term studies, the infection of ticks with encephalitis in the NSO rarely exceeds 5%, and the infection of ticks with BORRELIOSIS IS ABOUT 30% (in some areas it reaches 60%!).

Lyme disease, or Lyme borreliosis, is a tick-borne disease caused by a spirochete Borreliaburgdorferi. Although it is widespread throughout the world, the disease occurs in humans and dogs only in certain areas of the United States. Over 90% of human cases occurred in 10 states in the northeast of the country. Therefore, vaccination of dogs against Lyme disease should only be carried out in endemic areas. In addition, Lyme disease affects horses, cows and cats, but since vaccines for them do not yet exist, in this article we will limit ourselves to discussing vaccination of dogs.

With the increasing number of dog vaccines and thus the number of concerns about their adverse effects, the question arises as to whether every dog ​​should be vaccinated against Lyme disease. Although nearly 80% of dogs in endemic areas become infected, only 5% are found to be seropositive and exhibit the most common clinical symptom of the disease, lameness. Additionally, dogs respond well to antibiotic treatment and, unlike humans, rarely develop the antibiotic-resistant form of Lyme arthritis.

There are compelling arguments for vaccinating dogs against Lyme disease. After a tick bite and an animal becoming infected with borreliosis, the disease persists in the body for many years, perhaps even a lifetime. Vaccination carried out after infection is not able to eliminate the causative agent of the disease. As mentioned above, only 5% of seropositive dogs become lame. However, even in the absence of clinical lameness, histological examination of experimentally infected dogs revealed moderate polyarthritis, which can lead to lethargy and reluctance to move. In addition, several cases of fatal nephritis caused by B. burgdorferi. This was especially true for Labrador retrievers, for which antibiotic treatment is ineffective.
Although it is commonly believed that antibiotics cure dogs of this disease, this may not be true. The most commonly used antibiotics are doxycycline and amoxicillin. In a recent study on dogs experimentally infected B. burgdorferi, Treatment with these antibiotics for 4 weeks reduced joint damage, but infection B. burgdorferi and didn't disappear. Therefore, even after treatment with antibiotics, the disease can recur.

It is for these reasons that it is recommended to vaccinate dogs that may become infected with ticks in endemic areas. However, the question remains about which vaccine should be used.
There are currently two types of Lyme disease vaccines. One of them, used for several years, consists of dead B. burgdorferi and patented adjuvants. Immediately after vaccination, dogs experience several side effects, so it is very undesirable for the vaccine to be multicomponent, which do not directly affect the infection and may cause adverse reactions in the future. Hamsters inoculated with this vaccine and then infected with infected mites developed arthritis weeks or months later. This fact raises the need to develop this vaccine based on a human model, that is, based on a whole cell.

Another type of vaccine consists of recombinant protein A (OspA) taken from the outer surface of the virus B. burgdorferi, which stimulates the body's production of specific borreliacidal antibodies. This vaccine became available for dogs in 1996 and was later tested and found suitable for humans.

The protective properties of this vaccine appear to be due to the fact that it kills spirochetes in ticks. In addition, it stimulates the production of borreliacidal antibodies in dogs. When a tick attaches itself to a dog's skin and becomes engorged, it takes Borrelia 24-48 hours to move from the tick's midgut to its salivary gland before moving on to its new host. If the tick becomes engorged with blood containing borreliacidal antibodies, this movement is blocked and invasion of a new organism becomes impossible.

But why don’t borreliacidal antibodies rid the dog’s body of an existing infection? This appears to be due to a change in expression OspAV. burgdorferi when moving from the body of a tick, which has a low temperature, to the body of a mammal, whose temperature is much higher. After entering the mammalian body, expression OspA is replaced by OspC expression, as can be observed in Western blots with serum from mammals, including dogs. Enabling OspC In a vaccine against Lyme disease may seem very desirable, since it can strengthen the body's resistance to infection. However, antibodies OspC are not as borreliacidal as antibodies OspA, and experiments on mice showed that they are also unable to rid the body of an infection that had previously entered it. Moreover, in the bodies of dogs and other mammals, after infection with ticks, a rapid and strong reaction occurs in the form of the production of antibodies to OspC. Obviously, these antibodies are not able to rid the body of such resistant Borrelia.

Against vaccines containing OspA And OspC, is also evidenced by the fact that there are different variants of antigens both among different serotypes B. burgdorferisensustricto, and between different types of Borrelia. In Europe, where it dominates B. burgdorferisensulato (B. garinii and B. afzelii),OspA And OspC are heterogeneous proteins. For North America this is less of a problem since there appears to be only B. burgdorferisensustricto, over 90% of which contain one serotype for OspA. Apparently, OspC shows greater diversity.

Another experimental approach to the vaccination problem seems more promising. Antibodies produced in mice against B. burgddorferi-binding protein, protect them from infection. These antibodies limit the migration of spirochetes. However, these research data are still in their early stages.

Several attempts have been made to take advantage of the immune response of cells to protect against infection. However, the results were less convincing than in the case of antibody production. It is very likely that the cellular response limits the spread of infection. It is well known that macrophages destroy spirochetes, so the T cell response is very important. However, it has been established that the infection remains in the bodies of cats and dogs. Thus, only partial cleansing of the body from spirochetes occurs.

Equally important are questions about the duration of immunity after vaccination and methods of vaccination. According to existing recommendations, revaccination is necessary every year. However, the research conducted so far is clearly insufficient. We tested and found that six months after OspA vaccination, dogs are completely protected from infection. It is wise to suggest vaccination in early spring before ticks begin to appear.

One of the disadvantages of vaccination is that it is very difficult to interpret the results of serological studies. Unvaccinated dogs test positive ELISA or antibody titer on a fluorescence test indicates the presence of infection. In vaccinated dogs, these tests are insufficient because it is impossible to determine whether a dog testing positive for B. burgdorferi, Was she just vaccinated, or is she infected with a tick? To find out, a Western blot test is needed. Although after infection with a tick, the dog’s body produces a wide range of antibodies to various Borrelia-proteins, vaccinated dogs only have a reaction to OspA if they were vaccinated OspA-containing vaccine, or a limited number of Woggey-specific antibodies, including OspA, if vaccinated with a dead vaccine.

The question remains about vaccinating seropositive dogs: is it harmful, beneficial, or has no effect at all? So far, we only know that an animal already infected with Lyme disease cannot be cured by any vaccination. We don't even know most of the effects it will have on the animal's health. We can only recommend mandatory serological testing of dogs before vaccination. If the reaction is positive, the dogs should be treated with antibiotics before vaccination.

A frequently asked question is whether a dog with Lyme disease can be seronegative. Since the production of antibodies in humans and dogs begins after 3-4 weeks, early symptoms of the disease (erythema wandering) in humans are often observed with a seronegative reaction. The first symptom of Lyme disease in dogs is usually arthritis, which occurs after antibodies have begun to be produced. Under experimental conditions, we have not observed seronegativity in dogs with Lyme arthritis. Another reason for a seronegative reaction in people with Lyme disease may be previous treatment with antibiotics, which can suppress the production of antibodies, but is not able to rid the body of the spirochetes. In addition, other infections can mimic Lyme disease, such as granulocytic ehrlichiosis. It is caused by a bacterium Ehrlichiaequi, carried by the same ticks that cause Lyme disease.

To know how to prevent the development of the disease, it is necessary to study the mechanism of its development and the route of infection. The carriers of the infection are animals, mostly rodents -,. feeds on the blood of a sick animal, does not become infected itself, but becomes a spreader.

It is provoked by borreliosis or a certain type of bacteria – borrelia. They are concentrated in the saliva of the arachnid and are in an inactive state. When a person is bitten, the bacteria enters the skin through saliva. Initially they develop there, forming swelling, inflammation, and redness. After some time, they enter the systemic bloodstream and spread throughout the body.

Note!

The incubation period of tick-borne borreliosis lasts on average 14 days. Initially, a large spot appears on the skin, up to 60 cm in diameter. And after a couple of days, bright symptoms of Lyme disease appear. During this period, the death of Borrelia begins, in the process they release toxic substances that cause a number of negative consequences.

The danger of tick-borne borreliosis

The first symptoms of Lyme disease are a consequence of toxicosis. Body temperature instantly rises, muscle aches bother you, nausea, vomiting, weakness, and headache appear. The clinical picture resembles the flu, but there are specific symptoms - photophobia, lacrimation, sour eyes, limited neck movements, tense facial muscles. The condition returns to normal even without special treatment within a week; further development of borreliosis after a tick bite follows one of two scenarios:

• the human body produces antibodies, immunity stops the disease;
• bacteria continue to multiply, affecting the brain, central nervous system, muscles, internal organs - liver, spleen, heart, kidneys.

In the absence of qualified therapy, borreliosis develops into a severe form that is difficult to treat. Complications – loss of vision, deafness, osteoporosis, arthrosis, disability, paralysis, dementia, death.

Note!

The main method of treatment is. Drugs are selected individually in each case; with timely treatment, they stop the development of the disease and eliminate symptoms. The immunity developed is unstable, a person can get sick again the next year. There is no vaccine against borreliosis, so nonspecific methods of prevention must be followed.

Preventing Lyme Disease

Cloth

There is, but it is used mainly by specialists who perform work in dangerous places - timber harvesters, archaeologists, border guards, agricultural workers. And also fishermen and hunters. Modern suits have traps - pockets, places impregnated with insecticides. Since the cost of protective clothing is at least 1,800 rubles, ordinary nature lovers are in no hurry to use it.

Note!

If you do not have a special suit, you must wear trousers, a long-sleeved jacket, socks, and a hat. Sleeves should be cuffed, trousers tucked into socks. In this case, the tick will not be able to reach the skin and will fall to the ground after a while.

Inspection

Repellents

Note!

Public prevention of tick-borne borreliosis consists of informing the population about the danger of the disease, the epidemic state of parks, forests, public gardens, and the destruction of rodents - mice, rats. Since there is no vaccine against Lyme disease, nonspecific preventative measures are the main method of protection.

What to do after a bite

the vaccine is only against the latter disease. Tick-borne encephalitis is a viral infection; when detected, antiviral drugs are administered to activate the immune system. To prevent the disease, 3 vaccines are given with an interval of 1 month, 1 year. The effect lasts for 3 years.

Encephalitis can be primary, as an independent disease, and secondary, as complications of infectious diseases of other organs and systems.

Encephalitis can be infectious, infectious-allergic, or allergic.

According to localization, encephalitis can be brainstem, cerebellar, subcortical, mesencephalic, or diencephalic.

Leukoencephalitis occurs with primary damage to fibers, polioencephalitis occurs with damage to neurons, panencephalitis occurs with damage to the entire substance of the brain.

This acute primary viral disease of the central nervous system is caused by a filterable virus. Refers to neuroinfections with natural focality.

The first epidemic outbreaks of tick-borne encephalitis were observed in the Far East, in Primorye. They were studied in 1935 by A.G. Panov. In 1937, a team of doctors worked there under the leadership of L.A. Zilbera. In subsequent years, the virus was isolated and the disease caused by it was described in detail. Since 1937, this disease began to be officially called tick-borne, or spring-summer encephalitis.

Etiology and epidemiology

The disease is caused by a specific virus with pronounced neurotropism. The virus multiplies in nerve cells. The virus is pathogenic for humans, monkeys, white mice, guinea pigs, goats, and dogs. Cattle do not get tick-borne encephalitis. The virus is small in size, its diameter does not exceed 30 nm. It retains its viability at low temperatures. It is unstable to high temperatures. When boiled, it dies within 2 minutes. The following strains of the virus have been identified: the eastern one is Sofiin and Aina, and the western one.

The virus enters the human body through a tick bite, i.e., through transmission. Most often these are I. ricinus and I. persulcatus. In ticks, the virus accumulates in the salivary and reproductive glands. This causes its transmission to humans through a bite, as well as to the offspring of ticks. Ticks live in taiga, mixed forests, and where there is dense undergrowth. However, in recent years, cases of bites by infected ticks have been observed even in cities. Tick ​​infestation varies from 0.5 to 15%. Female ticks are more often infected. The natural reservoir of pathogens are rodents: field mice, chipmunks, rabbits, hedgehogs, moles, hares. By biting them, ticks suck in the virus, which penetrates all organs of the tick.

Tick-borne encephalitis occurs from the Far East to the foothills of the Alps. The Urals and Western Siberia account for up to 80% of all cases. The incidence of tick-borne encephalitis in the Irkutsk region in 1998 was 12.1 in children and 20.6 in adults per population. In 2000, 539 patients with tick-borne encephalitis were registered in the Irkutsk region, 78 of them were children; in the city of Irkutsk, 215 people were treated in the infectious diseases hospital, of which 33 were children. The mortality rate in the region was 12 people, in the city of Irkutsk – 4.

1. Attacks and bites by ticks account for up to 80% of all cases.

2. Drinking raw goat milk.

3. Laboratory contamination.

There is a rare incidence of morbidity from tick bites of Aboriginal people. Visitors and city residents get sick more often.

The highest incidence is observed in May and especially in the 1st and 2nd ten days of June. Therefore, the disease is called spring-summer encephalitis.

Penetrating into the human body, the tick enters the central nervous system by hematogenous route. It is detected in brain tissue on days 2-3.

Pathological picture characterized by edema and hyperemia of the membranes of the brain. The most significant changes are found in the medulla oblongata and cervical spinal cord. The anterior horns of the cervical enlargement of the spinal cord and the nuclei of the cranial nerves are affected. There are changes in the cortex and nearby subcortical white matter. Often the spinal roots, peripheral nervous system and autonomic nerve ganglia are involved in the process.

The incubation period lasts 7-14 days for transmissible infection, 4-7 days for nutritional infection.

One third of patients have symptoms of prodrome - headache, fever, fatigue.

Most often, the disease begins acutely. The temperature rises by several degrees, chills, severe headache, and vomiting appear. There may be muscle pain and radicular pain. In the first days of the disease, there is hyperemia of the skin, injection of the sclera, gastrointestinal disorders and catarrhal phenomena of the upper respiratory tract are possible. From the first days, general cerebral symptoms are expressed (headache, vomiting, epileptic seizures), consciousness is upset up to the point of coma, and meningeal symptoms appear. Many patients have mental disorders.

The following clinical forms of tick-borne encephalitis are distinguished:

1. Inapparent, or subclinical. There are no clinical signs of damage to the nervous system. The diagnosis is made on the basis of serological tests.

2. Erased form. The febrile period lasts 2-3 days. There may be meningeal symptoms. There are no changes in the cerebrospinal fluid. According to serological reactions, the presence of an antibody titer to the tick-borne encephalitis virus is noted. The titer is determined twice with an interval of days. Upon repeated examination, an increase in AT titer is noted.

3. Feverish form. Severe fever lasts more than 4 days. Phenomena of toxicosis are noted. An increase in pressure is detected in the cerebrospinal fluid. According to serological reactions, an increase in AT titer is detected.

4. Meningeal form. The clinical picture shows severe fever, the consciousness of the patients is altered. Meningeal symptoms are well expressed. In the cerebrospinal fluid there may be pronounced lymphocytic pleocytosis, the amount of protein is increased to 1 g/l.

5. The focal form occurs with an acute onset, severe fever. A characteristic feature is focal damage to the nervous system.

 When the anterior horns of the spinal cord are damaged, the poliomyelitis form develops. On days 3-4, flaccid (peripheral) paresis or paralysis appears in the muscles of the neck, shoulder girdle, and proximal arms. The symptom of “dangling head” develops. In the lower extremities there may be manifestations of spastic paresis.

 When the nuclei of the cranial nerves are damaged, the polioencephalitic form develops. When nuclei IX, X, XI, XII are damaged, disturbances in swallowing, phonation and pronunciation of words appear. The muscles of the tongue undergo atrophy.

 In the encephalitic form, patients exhibit hemiparesis and violent movements. Impaired consciousness and epileptic seizures are possible.

 The polyradiculoneuritic form occurs with damage to the roots and peripheral nerves.

6. With the alimentary route of infection, two-wave viral meningoencephalitis develops. The onset of the disease is acute, the temperature rises to several degrees, and cerebral and meningeal symptoms appear. After 5-7 days, the temperature drops to normal and remains this way for 6-10 days, after which it rises again and lasts up to 10 days.

The disease ends with either complete recovery or recovery with a defect, when neurological defects remain in the form of weakness, loss of weight in the muscles of the neck, shoulder girdle and upper limbs. In some cases, the disease can take a chronic course.

Among the chronic forms, the most common is Kozhevnikov epilepsy, characterized by generalized epileptic seizures against the background of constant myoclonic hyperkinesis in a certain muscle group. The development of amyotrophic lateral sclerosis syndrome, syringomyelitic syndrome, and myoclonus epilepsy is possible.

Diagnostics tick-borne encephalitis is based on:

 Based on epidemiological history data. Previous tick bite.

 Virological examination of blood and cerebrospinal fluid for tick-borne encephalitis virus. Detection of the virus by PCR.

 Serological reactions: RPGA, RNGA, RN, RTGA. Abs appear in the blood by the end of the first week of the disease. It is necessary to examine the antibody titer in paired sera, with an interval of 2-3 weeks, in order to determine the presence of an ongoing pathological process.

Treatment of tick-borne encephalitis

Bed rest is required throughout the febrile period plus another 7 days. It is necessary to exclude overwork and alcohol intake, because an increase in the inflammatory process may occur.

Human immunoglobulin is prescribed against tick-borne encephalitis. The dose depends on the form of tick-borne encephalitis. For erased and abortive form, a single dose of 0.1 mg/kg body weight is administered daily for 3-5 days until symptoms regress. The course dose is at least 21 ml. For the meningeal form, the daily single dose is 0.1 ml/kg with an hourly interval of at least 5 days. The course dose for an adult is at least 70 ml. For focal forms, the drug is administered at a dose of 0.1 ml/kg with an interval of 8-12 hours for at least 5 days. The course dose is no less than ml. The drug is administered INTRAMUSCULARLY ONLY. Immunoglobulin is contraindicated in bulbar and respiratory disorders.

It is possible to administer RNase 50 mg 6 times a day for 6-8 days.

For therapeutic purposes, the drug Yodantipirin is taken after a tick has been sucked on: for the first three days, 300 mg (3 tablets) 3 times a day for 2 days, then 200 mg 3 times a day for 2 days, then 100 mg 3 times a day for 5 days.

It makes sense to prescribe GCS at a dose of 1 mg/kg body weight.

Dehydration is carried out (Lasix, mannitol, Diacarb).

Sedatives, cardiac drugs, analgesics, vitamins.

During the recovery period, prozerin, multivitamins, and anabolic drugs are prescribed.

Prevention of tick-borne encephalitis

It includes measures to control and destroy ticks and rodents in endemic areas. When working in forests, special clothing is used to reduce the risk of tick bites. After being in the forest, it is necessary to inspect the body and clothing.

Specific prevention of the disease is carried out by administering an anti-encephalitis vaccine.

Previously, the vaccine used was A.A. Smorodintseva. It was an emulsion of the brains of mice infected and sick with tick-borne encephalitis. The vaccine is harmless because a virus killed by formaldehyde does not cause disease, but promotes the development of immunity.

The vaccination schedule is as follows: in September-October 1 ml is injected, after 10 days another 1 ml, after 10 days another 1 ml, in April another 1 ml is injected. Repeated vaccination is carried out after a year. Revaccination is carried out once every 3-5 years.

Currently, human immunoglobulin against tick-borne encephalitis, containing class G immunoglobulins, is used for prevention. The drug is administered intramuscularly at the rate of 0.1 ml per 1 kg of body weight. It is advisable to administer the drug no later than the 4th day after the bite or 48 hours before possible stay in an endemic area. The effect of the drug lasts for 4 weeks.

Specific prevention of the disease is carried out by administering anti-encephalitis vaccines.

A cultural purified inactivated concentrated dry vaccine (GUP ITSVE, Moscow) is used twice with an interval of at least 2 months.

The “FSME immune-inject” vaccine (IMMUNO, Austria) is prescribed 3 times according to the scheme: 0, 1-3 months (possibly shortened to 14 days) and the third vaccine 9-12 months after the second.

The Encepur vaccine (Cairon-Behring, Germany) is prescribed 3 times according to the schedule 0, 1-3 months and 9-12 months after the second vaccination.

Cultural inactivated sorbed liquid vaccine against tick-borne encephalitis (Tomsk NPO Virion) three times.

Lyme borreliosis is a group of infectious transmissible natural focal diseases caused by Borrelia and transmitted by ticks.

Clinically it occurs with primary damage to the skin, nervous system, musculoskeletal system, heart and is characterized by a tendency to chronic and latent course.

The first description of acrodermatitis chronica atrophica, characteristic of borreliosis, was made by Buchwald in 1883. In 1902, this syndrome was named Pick-Hexheimer disease. In 1909, Swedish dermatologist Arvid Afzelius reported a case of erythema migrans in an elderly woman and associated its occurrence with mite suction. Erythema in Lyme borreliosis still bears his name. Over the years, attempts have been made to treat ring-shaped erythema with the antibiotic penicillin, which were successful. In 1975, A. Steere described an outbreak of rheumatoid arthritis in children in the city of Lyme, Connecticut (USA) and associated its occurrence with a tick bite. Based on the name of this town, the disease is called Lyme disease. The pathogen was discovered 7 years later; in 1982, W. Burgdorfer discovered spirochetes in the intestines of adult I. Scapularis ticks. In 1984, the spirochetes were identified as Borrelia.

The causative agent of the disease is Borrelia burgdorferi, a gram-negative spirochete micrometer long, representing a convoluted spiral. Currently, 10 gene species of Borrelia are identified, of which 3 are pathogenic for humans: B. burgdorferi sensu stricto, B. garinii, B. afzelii. In Russia there is 1 species. Electron microscopy revealed that the pathogen has a thick amorphous mucoid layer, a cytoplasmic membrane, a periplasmic space, an endoflagellar complex, and a protoplasmic cylinder on its surface. There are 853 genes on the chromosome, consisting of nucleotide pairs. There are about 30 proteins.

Lyme borreliosis (LB) belongs to the group of natural focal zoonoses with a transmissible mechanism of pathogen transmission.

Cases of the disease are recorded over a vast territory of Eurasia and are widespread in the forest and forest-steppe zones of Russia. In natural foci, pathogens circulate between ticks and wild animals, becoming infected from each other through a tick bite. Sometimes the reservoir can be domestic animals - large and small livestock.

Ticks transmitting pathogens are I. Ricinus and I. Persulcatus. In the life cycle of these mites, transmission from eggs to larvae, nymphs and adults is possible. Ticks live along the sides of forest roads and paths, in overgrown clearings, and along river valleys. Tick ​​infection rates range from 10 to 70%. Infection of animals and humans occurs through the bite of nymphs or adult female or male ticks. On human skin, mites most often stick to the scalp, neck, axillary and groin areas, in the navel, perineum, under the shoulder blades along the spine (where clothing fits less tightly to the surface of the body). Males can attach themselves briefly several times, females - once for several days. The feeling of itching appears 6-12 hours after suction.

The incidence of LB in Russia is 4.52-5.71 per population. In 2000, 338 adults and 88 children suffered from Lyme disease in the Irkutsk region. In the city of Irkutsk, 71 adults and 26 children were ill.

There is a pronounced seasonality of incidence: starting from the 2-3rd decade of April, May, June, July. Sometimes cases of illness are possible in September-October. Up to 80% of cases occur in April-July.

During the course of borreliosis infection, three stages of disease development are distinguished:

 Stage of local infection. Phagocytosis of microorganisms occurs. Some bacteria are lysed and specific immune defense mechanisms are activated, and a local inflammatory reaction occurs. Bacteriophages begin to produce IL-1 beta, 6, 8, tumor necrosis factor. Diapedesis of monocytes and granulocytes from the vascular bed and activation of the inflammatory process occurs. Some pathogens are capable of reproducing inside the skin.

 The stage of dissemination of the pathogen occurs when Borrelia penetrates the vascular bed.

 The stage of organ damage occurs no less than 6 months from the moment of infection, sometimes months and years later. It is characterized by a clinical picture of damage to various systems and organs.

Most often, the following stages are distinguished during the course of the disease:

1. Stage of annular migratory erythema at the site of the bite. At this stage, 90% of patients undergo independent elimination of the pathogen. Patients complain of a flu-like condition with muscle and joint pain. General infectious intoxication syndrome includes fever, general weakness, headache, increased fatigue, irritability, sleep disturbance. The development of benign skin lymphocytoma is possible. Sometimes signs of liver enlargement and increased activity of liver enzymes are detected.

2. Stage develops 2-10 weeks after the onset of the disease. The disappearance of ring-shaped migrating erythema is characteristic. Signs of damage to internal organs develop: the nervous system, joints, heart, eyes, etc. From the nervous system, the development of bilateral neuritis of the facial nerves, meningitis, meningoradiculoneuritis, is possible. Myositis occurs on the part of the muscular system. Joint damage affects mono- and oligoarthritis. The cardiovascular system is characterized by the occurrence of endomyo-pericarditis. Hepatitis occurs. Eye damage is caused by retinitis, inflammation of the optic nerve or uveitis. If the exocrine and internal secretion glands are affected, strumitis may develop – if the thyroid gland is affected, or mumps – if the parotid gland is affected.

3. The stage of late organ damage, or chronic, is considered when the clinical picture persists for more than 6 months. Characterized by the development of progressive chronic inflammation in the skin, joints or nervous system. Atrophic acrodermatitis develops in association with mono(poly)neuritis, progressive encephalomyelitis, and cerebrovascular disorders. With skin manifestations, isolated development of atrophic dermatitis, skin limadenomas, and plaque atrophic scleroderma is possible. Joint damage is caused by mono(poly)arthritis.

Neurological symptoms most often appear at 4-12 months of illness.

Sometimes there are mild, moderate and severe forms according to severity. According to the course: acute (up to 3 months), subacute (3-6 months) and chronic stages (more than 6 months).

Neurological diagnosis in stages 2 and 3 is accompanied by lymphocytosis and an increase in the amount of protein in the cerebrospinal fluid.

With an active process in the central nervous system, a high titer of IgG antibodies to B. burgdorferi is detected in the serum. The titer is usually positive in stage 2 of the disease and may be negative in stage 3. The methods of RNGA, RSK, ELISA are used.

Due to the presence of cross antigens in LB, there may be false-positive serological reactions to syphilis and vice versa.

In the second stage of the disease, with isolated damage to the facial nerve and normal CSF, the following is administered:

 Tetracycline 500 mg orally 4 times a day or doxycycline 100 mg orally 2 times a day for days. Pregnant, lactating, children under 8 years of age and those with an allergy to tetracycline are administered amoxicillin 500 mg orally 3 times a day and probenecid 500 mg 3 times a day. For allergies to penicillins, use erythromycin 250 mg orally 4 times a day.

If there is a change in the CSF, polyradiculoneuropathies, or parenchymal damage to the central nervous system, large doses of penicillin are administered parenterally;

 Benzylpenicillin million IU/day IV every 4 hours for 2-3 weeks or ceftriaxone 2 g IV once a day, or cefotaxime 2 g IV three times a day for 14 days.

In addition to etiotropic therapy, pathogenetic therapy is carried out: detoxification, dehydration, anti-inflammatory, physiotherapy for neuropathies and arthritis. For heart damage - panangin, riboxin. Vitamin therapy C, E. Nootropics. Vasoactive drugs.

With these encephalitis, the white matter of the brain in the subcortical regions is mainly affected, which leads to disruption of associative connections and the appearance of mental disorders.

The clinic unfolds gradually after the infection. Children become lethargic, euphoric, performance and memory decrease. Violations of higher brain functions are possible: apraxia, agnosia, writing and counting disorders develop. Dementia gradually increases, and a mosaic pattern of impairment of intellectual functions is observed: impairment of some while some preservation of others. Schizophrenia-like symptoms may occur: negativism, isolation, loss of social contacts and skills. Epileptiform seizures occur. There is a rapid disintegration of personality. The neurological status may reveal spastic paralysis, paresis, hyperkinesis, pseudobulbar, and bulbar disorders. The progression of the disease is characteristic. The duration of the disease is 1-2 years. Death occurs from respiratory failure, status epilepticus, or decerebrate rigidity.

The following forms of leukoencephalitis are distinguished:

 Schilder's periaxial encephalitis. Diffuse demyelination of fibers is observed with preservation of the axial cylinder, proliferation of glia with the formation of foci of sclerosis. Foci occur in the cerebellum, cerebral hemispheres, and brainstem. The disease begins at school age, less often in adults. Mental disorders, spastic tetaraparesis, choreoathetoid hyperkinesis, decreased hearing and vision occur. Patients become immobilized. The duration of the disease is 2-3 years.

 Subacute sclerosing leukoncephalitis Van Bogart. Multiple nodules of glial proliferation and foci of demyelination appear in various parts of the brain. Onset in childhood. The following symptoms of the disease are distinguished: emotional and mental disorders, epileptic seizures, disorders of higher brain functions, decreased vision, myoclonic convulsions in the face and limbs, polymorphic hyperkinesis, ataxia, spastic paresis, decerebrate rigidity, vegetative-trophic disorders.

Treatment of leukoencephalitis is carried out with anti-inflammatory, anticonvulsants, desensitizing drugs, vitamins, and corticosteroid hormones. An important role belongs to the prevention of infectious diseases.

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Tick-borne borreliosis (Lyme disease) - description and prevalence of the disease, causative agent of infection, infection and development, symptoms and stages, diagnostic methods, treatment and prevention, consequences, photos

Borreliosis - general characteristics, history of discovery and names of the infection

Borreliosis – photo

These photographs show various types of erythema migrans.

This photograph shows a benign skin lymphocytoma, characteristic of the third stage of borreliosis.

Encephalitis and borreliosis

Prevalence of Lyme disease

The causative agent of infection

The tick is a carrier of borreliosis

Infection with borreliosis

Development of Lyme disease (pathogenesis)

Tick-borne borreliosis (Lyme borreliosis) - symptoms (signs)

Stage I

In addition, stiffness of the neck muscles develops, and in some cases nausea and vomiting occur. In some cases, in addition to symptoms of intoxication, the onset of borreliosis is characterized by catarrhal symptoms - runny nose, sore throat, pharyngitis, conjunctivitis.

• Headache;
• Nausea;
• Vomiting more than 2 times a day;
• Photophobia;
• Increased sensitivity of the skin (even a light touch causes a burning sensation, pain, etc.);
• Tension of the neck muscles;
• Head thrown back;
• Legs pressed to stomach.

In very rare cases, the first stage of borreliosis is manifested by anicteric hepatitis with the following symptoms - loss of appetite, nausea, vomiting, pain in the liver, increased activity of AST, ALT and LDH in the blood.

Stage II of borreliosis

Against the background of such symptoms, the ECG shows only a prolongation of the PQ interval. Cardiac (heart) symptoms usually last 2 to 3 weeks.

The second stage of borreliosis can last up to six months.

III stage of borreliosis

1. Arthralgia (migrating pain moving from one joint to another);

2. Benign recurrent arthritis;

3. Chronic progressive arthritis.

• Muscle weakness in the lower extremities (hands, feet). With severe weakness of the leg muscles, stepping develops - “cock gait”;
• Decreased or complete loss of tendon reflexes;
• Impaired sensitivity in the final parts of the arms and legs, covering areas of the skin like “socks” and “gloves”. Sensitivity disturbance is manifested in the sensation of goosebumps, burning, tingling, loss of the ability to feel temperature, vibration, touch, etc.;
• Dry skin;
• Violation of the coordinated functioning of blood vessels, as a result of which a person experiences attacks of palpitations, hypotension, impotence, etc.

Chronic Lyme disease

Borreliosis (Lyme disease): incubation period, symptoms and manifestations of the disease - video

Borreliosis in children

Diagnosis of borreliosis

General diagnostic principles

• Serous meningitis, meningoencephalitis, polyradiculoneuritis or cranial nerve neuritis;
• Arthritis of one or more joints;
• Impairment of atrioventricular conduction of the heart II or III degrees, myocarditis or pericarditis;
• Single benign lymphocytoma on the earlobe or nipple of the breast;
• Chronic atrophic acrodermatitis.

If a person has any of the listed symptoms, then to confirm the diagnosis of borreliosis, the blood is examined for the presence of antibodies to borrelia. A positive blood test is considered complete confirmation of borreliosis.

Test for borreliosis (blood for borreliosis)

• Indirect immunofluorescence reaction (IRIF);
• Enzyme-linked immunosorbent assay (ELISA);
• Polymerase chain reaction (PCR);
• Immunoblotting.

When conducting RNIF, a positive test result is considered to have an antibody titer in the blood of 1:64 or higher. If the antibody titer is below 1:64, then the test result is negative and, therefore, the person is not infected with borreliosis.

Borreliosis - treatment

• Amoxicillin (Amosin, Ospamox, Flemoxin Solutab, Hiconcil, Ecobol) - take 500 mg 3 times a day for 10 - 21 days;
• Doxycycline (Xedocin, Unidox Solutab, Vidoccin, Vibramycin) - take 100 mg 2 times a day for 10 - 21 days;
• Cefuroxime (Axetin, Antibioxime, Zinnat, Zinacef, etc.) – take 500 mg 2 times a day for 10 – 21 days;
• Azithromycin (Sumamed, etc.) – take 500 mg once a day for a week (the least effective antibiotic);
• Tetracycline - take 250 - 400 mg 4 times a day for 10 - 14 days.

The most effective antibiotic for the treatment of borreliosis at the first stage is Tetracycline. That is why it is recommended to start therapy with this particular antibiotic, and only if it is ineffective, switch to others, choosing any of the above.

• Doxycycline (Xedocin, Unidox Solutab, Vidoccin, Vibramycin) - take 100 mg 2 times a day for 14 - 28 days;
• Benzylpenicillin - administered intravenously in units every 6 hours (4 times a day) for 14 - 28 days;
• Chloramphenicol (Levomycetin) - taken orally or administered intravenously 500 mg 4 times a day for 14 - 28 days.

In case of heart damage, the following antibiotic treatment regimens are most effective for the treatment of borreliosis:

• Ceftriaxone (Azaran, Axone, Biotraxone, Ificef, Lendacin, Lifaxone, Medaxone, Rocephin, Torocef, Triaxone, etc.) - administered intravenously at 2000 mg 1 time per day for 2 - 4 weeks;
• Penicillin G – administered intravenously 0 units 1 time per day for 14 – 28 days;
• Doxycycline (Xedocin, Unidox Solutab, Vidoccin, Vibramycin) - take 100 mg 2 times a day for 21 days;
• Amoxicillin (Amosin, Ospamox, Flemoxin Solutab, Hiconcil, Ecobol) - take 500 mg 3 times a day for 21 days.

For arthritis, the following antibiotic treatment regimens are most effective for treating borreliosis:

• Amoxicillin (Amosin, Ospamox, Flemoxin Solutab, Hiconcil, Ecobol) - take 500 mg 4 times a day for 30 days;
• Doxycycline (Xedocin, Unidox Solutab, Vidoccin, Vibramycin) - take 100 mg 2 times a day for 30 days (can be taken in the absence of neurological symptoms);
• Ceftriaxone (Azaran, Axone, Biotraxone, Ificef, Lendacin, Lifaxone, Medaxone, Rocephin, Torocef, Triaxone, etc.) - administered intravenously at 2000 mg 1 time per day for 2 - 4 weeks;
• Penicillin G – administered intravenously 0 IU 1 time per day for 14 – 28 days.

In chronic atrophic acrodermatitis, the following antibiotic treatment regimens are most effective for the treatment of borreliosis:

• Amoxicillin (Amosin, Ospamox, Flemoxin Solutab, Hiconcil, Ecobol) – take 1000 mg once a day for 30 days;
• Doxycycline (Xedocin, Unidox Solutab, Vidoccin, Vibramycin) - take 100 mg 2 times a day for 30 days.

The minimum duration of antibiotic therapy is 10 days. This period can be limited if a person has only general infectious symptoms of intoxication and erythema, but there is no damage to the joints, nervous system and heart. In all other cases, you should try to take antibiotics for the maximum recommended time.

• Non-steroidal anti-inflammatory drugs (Indomethacin, Naproxen, Nimesulide, etc.) - to relieve pain and reduce the severity of the inflammatory process in the joints during arthritis;
• Immunosuppressors (Plaquenil) - to suppress the inflammatory process in joints during arthritis;
• Analgesics (Analgin, Indomethacin, Ketorol, Ketanov, etc.) - to relieve any pain;
• Antihistamines (Erius, Telfast, Suprastin, Diazolin, Zyrtec, Cetrin, etc.) - to relieve allergic manifestations, such as rashes, itchy skin, etc.;
• Intravenous administration of detoxification solutions (saline solution, Ringer's solution, Hartmann's solution, etc.) at a temperature;
• Diuretics (Furosemide) – to reduce swelling of the meninges during meningitis;
• Drugs that improve neuromuscular conduction (Oxazil, Cerebrolysin, Proserin, Galantamine) - to eliminate disturbances in signal transmission from nerves to muscles (paresis, paralysis, etc.).

Pathogen, routes of infection, clinical picture of Lyme disease, complications, methods of diagnosis and treatment of borreliosis - video

Prevention of infection

Prevention of borreliosis after a tick bite

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

Lyme disease (borreliosis): prevalence and causative agent of infection, signs and manifestations (symptoms), complications, diagnosis (rapid test), treatment (antibiotics), prevention - video

Consequences of borreliosis

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Reviews

Borreliosis is transmitted from spouse to spouse and vice versa. This can be multiple reinfections.

The presence of Borrelia DNA in sperm has been reliably established.

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Symptoms and signs of encephalitis and borreliosis after a tick bite

One famous scientist, world-famous domestic microbiologist and virologist called ticks “a piggy bank of viruses.” This is true. Ticks are capable of transmitting more than two dozen known diseases, not only of viral, but also of bacterial etiology. What is this connected with? First of all, with the feeding habits of ticks.

Ticks drink the blood not only of humans, but also of all warm-blooded animals, and even birds. Tick ​​“youth” feed on “pasture”, so it is difficult to even imagine what kind of “panopticon” is inside the tick. Therefore, symptoms after a tick bite in a person can be very diverse. For example, infections carried by ticks include:

• Rocky Mountain spotted fever;
• tsutsugamushi fever;
• Japanese river and Marseilles fevers;
• Q fever;
• Crimean and Omsk hemorrhagic fevers.

As you can see, from the very names of these exotic diseases it follows that the main symptom is an increase in temperature, as a general reaction of the body to the introduction of infection. But we have little interest in exotic diseases. What symptoms occur when a person living in Russia is bitten by a tick? Since diseases such as tick-borne encephalitis and Lyme disease, or tick-borne borreliosis, are most common in the middle zone, you need to deal with them first.

About the first signs of illness

Despite the fact that encephalitis is a viral disease, and Burgdoffer's Borrelia is a close relative of syphilis, the initial symptoms may be the same. Even the timing may be approximately similar. How long does it take for a person to experience symptoms after a tick bite? For encephalitis, this is an average of one day; if the tick bit the head, and the bites were multiple, then the period is shorter and the onset is more acute. The shortest incubation period for tick-borne encephalitis is 2 days.

How long does it take for a person to develop symptoms if they are bitten by a tick infected with Lyme disease? The shortest period is 5 days, the usual time is 2 weeks. The maximum duration of the period of latent disease is 1 month or more.

Symptoms after a tick bite in humans are varied, many of them specific. We will talk about them further. Now let’s list the general symptoms characteristic of tick-borne encephalitis, since this disease is more severe, and even sometimes fatal, especially in weakened patients who have experienced multiple bites.

Encephalitis

Symptoms of encephalitis after a tick bite in humans begin acutely. Even with the mildest, febrile form, weakness, fatigue occurs, a headache appears, and the temperature rises.

Myalgia, that is, muscle pain in the limbs and torso, often occurs. In rare cases, nausea occurs, but vomiting occurs only in young children. The temperature with tick-borne encephalitis rises sharply, less than 39 degrees, and rarely lasts more than a week.

Symptoms of an encephalitis tick bite in humans also include a characteristic appearance. The person resembles someone who has just come out of a bathhouse: a slightly swollen, puffy face, reddened eyes and hyperemic scleral vessels. Most often, patients are lethargic, but sometimes they experience agitation.

If, after a tick bite, a person develops symptoms of more severe forms of encephalitis, then the febrile form is supplemented by a picture of serous meningitis, with a very severe headache and meningeal symptoms. But you can read about meningitis in other articles in this section. In the case of the development of encephalitis itself, on the 3-5th day of illness, paralysis, convulsions, episyndrome, strabismus and other signs of focal brain damage occur.

Unfortunately, it is impossible to show many symptoms in a person after a tick bite in a photo, so it is better to carefully monitor the development of the disease on days 3–5.

Lyme disease

With tick-borne encephalitis, everything is more or less clear. The onset of the disease is acute; on days 3-5, in addition to fever, signs of encephalitis or meningitis may appear. what about borreliosis? What symptoms do a person get after a tick bite when they are infected with borreliosis?

First of all, this is the phenomenon of ring erythema. This is such a characteristic sign that if you see a red ring that appears 3-18 days later around a tick bite, you don’t have to carry out any diagnostics. Most often, erythema forms after 3-5 days and appears as a pink ring with clear boundaries. There is a moderately firm area in the center of the ring that is bluish, then peeling occurs in the center.

Symptoms of borreliosis in humans after a tick bite do not end there: the erythema is hotter to the touch, its temperature can be 2 degrees higher than the surrounding tissues. Next to it you can see inflamed lymph nodes that are enlarged, mobile, and painful on palpation and movement. Sometimes patients complain of a feeling of itching and heat both above the surface of the erythema and “inside”. The erythema gradually becomes wider and can reach the size of cm. in diameter.

Nothing similar occurs with encephalitis. Borrelia simply has the ability to induce mild immune inflammation, which is a specific feature of this infection.

As for general well-being, borreliosis is more sluggish and “smeared”. There is no high fever. Patients are concerned about low-grade fever, slight chills, and headaches.

Sometimes it happens that erythema does not form. Therefore, in case of any ailment that arose several days after visiting forests, parks, and even more so after removing a tick, you need to contact an infectious disease specialist. After all, it sometimes happens that one tick can “reward” a person with both borreliosis and the tick-borne encephalitis virus.

Ticks are rapidly spreading to the north of the Komi Republic; if last year about twenty bites were recorded in the Pechera area, then this year, 2017. A tick attacked a dog a hundred kilometers from Vorkuta. Luckily the dog didn't get sick.