Borreliosis symptoms, treatment and consequences. Lyme disease or tick-borne borreliosis - causes, symptoms, diagnosis, treatment and consequences. Domestic approaches to emergency prevention of tick-borne borreliosis

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

Damage to the articular apparatus occurs as reactive arthritis. There is often damage to several large joints, most often the knee or hip. In this case, pain during movement and slight swelling of the surrounding soft tissues dominate.

Liver damage occurs as an acute, usually anicteric, hepatitis. Patients complain of nausea, less often vomiting, enlargement of the liver and associated heaviness and sometimes pain in the right hypochondrium.

The second stage of borreliosis ( Lyme disease)

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

Damage to the nervous system in the second stage of borreliosis

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

Meningitis is manifested by severe headaches, nausea, vomiting, photophobia, stiff neck, and severe general weakness. There is usually no fever, but low-grade fever may occur ( body temperature less than 38 degrees). Brain damage in meningoencephalitis is often widespread and manifests itself in the form of decreased concentration, memory, emotional lability and insomnia.

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

Damage to the cardiovascular system in the second stage of borreliosis

Damage to the cardiovascular system in borreliosis is manifested by conduction and rhythm disturbances due to myocarditis and, less commonly, pericarditis. Conduction disorders are observed in the form of various blockades, among which partial and complete atrioventricular blockades predominate. Rhythm disturbances are manifested by attacks of supraventricular tachyarrhythmias, supraventricular and ventricular extrasystoles, etc. Patients then feel weakness, which reflects the degree of disturbance of hemodynamic parameters, increased heart rate, shortness of breath, chest heaviness and, less often, pain. With treatment, these symptoms usually regress completely. The only exceptions are complete blockades, which, in the absence of a response to drug treatment, require the installation of pacemakers.

Skin lesions in the second stage of borreliosis

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

The third stage of borreliosis ( Lyme disease)

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

Damage to the articular apparatus

Damage to the articular apparatus can occur in three scenarios.

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

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

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

Damage to nervous system structures

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

Atrophic changes in the skin

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

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

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

It should be noted that both of these diseases are transmitted to humans through the sucking of an infected tick. In addition, both diseases can cause neurological symptoms, so it can be extremely difficult to distinguish one from the other based only on clinical manifestations. These factors appear to be the reason why these diseases are often mistakenly lumped together among the population.

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

Diagnosis of borreliosis ( Lyme disease)

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

Which doctor should I contact if I suspect borreliosis? Lyme disease)?

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

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

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

What happens at a doctor’s appointment when a patient is treated with borreliosis ( Lyme disease)?

Since the main specialist involved in the management of patients with borreliosis is an infectious disease specialist, the specifics of his treatment will be discussed in this section.

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

The doctor then proceeds to examine the patient. First of all, using a magnifying glass or special optics, carefully inspect the area where the tick is attached. If the tick is still in the wound, the infectious disease specialist will refer the patient to a surgeon for careful and complete removal, after which the patient returns to the infectious disease specialist. As a rule, these manipulations take no more than one hour. If the tick is not in the wound, then the infectious disease specialist makes sure that after its removal there are no fragments of its body left in the wound that could subsequently fester. The skin directly around the site of tick suction must be thoroughly examined. Often, migratory ring-shaped erythema is found in this area - a specific sign of the first stage of borreliosis. Equally important is the examination of the rest of the skin, for which the patient may need to completely undress or, at a minimum, down to his underwear. In this case, the doctor is interested in the rarer skin symptoms of borreliosis, indicating later stages of the disease. These include secondary annular erythema, benign lymphocytomas, atrophic acrodermatitis, disseminated urticaria, etc. It is extremely important to examine the pharynx ( throat) for a sore throat or acute pharyngitis.

The next stage of clinical examination of a patient with suspected borreliosis is palpation ( palpation). First of all, the infectious disease specialist examines all accessible lymph nodes. If there are certain changes in them, such as pain, increase in size, adhesion to surrounding tissues, etc., he notes them for himself in order to subsequently take them into account in the process of differential diagnosis. In addition to the lymphatic vessels, muscles and joints, and subsequently organs, are palpated abdominal cavity. With borreliosis, you can expect muscle pain, especially in the neck muscles, which intensifies with fever. Palpation of the joints can reveal their pain, which increases with movement, as well as some limitation in their range of motion, combined with characteristic clicks. When palpating the abdominal organs, there may be an increase in the size of the liver and, less commonly, the spleen, combined with pain in the corresponding hypochondrium. Even less often, signs of inflammation of the kidneys and urinary tract, stomach, pancreas, gallbladder, intestines, etc. may be observed.

Percussion ( effleurage) for borreliosis is applicable mainly to detect pathology of the kidneys and urinary apparatus. It can also be used to exclude concomitant diseases lungs ( pneumothorax, hydrothorax, etc.) and bones ( osteomyelitis, osteoporosis, osteitis, fractures, etc.). Auscultation ( listening) for borreliosis, just like percussion, it is used rather to exclude concomitant diseases, mainly of the respiratory system ( pneumonia, bronchitis, tuberculosis, etc.).

After carefully collecting clinical information regarding the condition of the patient’s internal organs and systems, the infectious disease specialist resorts to prescribing additional paraclinical studies to confirm or exclude the diagnosis.

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

All studies that an infectious disease specialist prescribes for suspected borreliosis are divided into laboratory and instrumental. This section contains only those studies whose purpose is to confirm or exclude certain pathological conditions caused by borreliosis. The studies necessary for differential diagnosis with clinically similar diseases are not presented here.

Laboratory tests prescribed for borreliosis

Instrumental studies prescribed for borreliosis

Treatment of borreliosis

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

Treatment of the skin around the primary lesion for borreliosis ( Lyme disease)

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

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

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

After removing the tick and visually inspecting both the integrity of the insect itself and the wound it left, it is treated with antiseptic agents. First of all, it is necessary to generously apply an aqueous solution of hydrogen peroxide to it, and it is advisable to penetrate as deep into the wound as possible with a sterile bandage moistened with this solution. The foam that forms upon contact with blood mechanically pushes out particles of dust, dirt and even remains of the tick’s body ( If there are any). Then all foam is removed dry with a dry sterile bandage. After this, using another bandage moistened with alcohol or aqueous solution iodine, the wound itself is treated, and then the skin around it within a radius of 2 - 3 cm. The movements of the bandage should be made in a spiral from the center, which is the wound, to the periphery. This processing procedure is necessary to avoid introducing bacteria from the surrounding skin into the primary focus. For the best effect, iodine treatment can be carried out 2 to 3 times in succession. At the end of the treatment, the wound is not bandaged or sealed with an adhesive plaster, as this promotes weeping and prevents the formation of a protective crust.

If the treatment was carried out correctly, then the inflammation in the area of ​​the primary lesion will be minimal, and after 1 - 2 days there will be no trace of it left except for a small crust, which will fall off on its own in no more than 5 - 7 days. However, in the first days after a tick has been bitten, even after proper antiseptic treatment of the primary lesion, inflammation may occur, which is nothing more than a developing ring-shaped erythema, which can be mistaken for a developing abscess. However, after several hours, the differences become more obvious. The ring-shaped erythema expands, a pale area appears in the center, and, most importantly, it is only a superficial element. The abscess increases due to growth in depth, is more dense and hot to the touch. Often it is accompanied by an increase in body temperature of more than 38 degrees. If you suspect an abscess, you should immediately contact a surgeon to avoid more severe complications.

Drug treatment of borreliosis ( Lyme disease)

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

Antibiotics for the treatment of borreliosis are divided into:

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

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

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

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

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

Drugs used for symptomatic treatment of borreliosis are:

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

Surgical treatment of borreliosis

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

If drug-induced irreversible atrioventricular block develops, a pacemaker is surgically installed to normalize the heart rate.

With the development of meningitis with pronounced syndrome increased intracranial pressure, in some cases, a catheter is installed connecting the subdural space with jugular vein. The purpose of this catheter is to continuously drain excess cerebrospinal fluid. However, due to the large number side effects, especially with long-term use, resort to installing such a catheter extremely rarely.

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

Physiotherapeutic methods of treating borreliosis ( Lyme disease)

Physiotherapeutic methods for treating borreliosis are exclusively auxiliary and are used only during the recovery period. The purpose of such treatment is acute period the disease is fraught with aggravation of the patient’s condition and a greater likelihood of developing complications.

When the articular apparatus is damaged, electrophoresis with lytic enzymes is often used ( lidase), promoting the resorption of connective tissue deposits in the joints that impede normal movements. Balneotherapy can produce a similar effect ( mud baths) and physical therapy.

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

Traditional methods of treating borreliosis ( Lyme disease)

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

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

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

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

Decoctions of St. John's wort and thyme have a certain immunostimulating effect. If the liver is damaged, an improvement in the condition is observed after consuming herbal decoctions that have a choleretic effect by reducing the viscosity of bile. Among such herbs, yarrow definitely takes the leading position.

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

Prevention of borreliosis ( Lyme disease)

Prevention of borreliosis is divided into primary and secondary. Primary prevention involves preventing infection, and secondary prevention means treating the disease in the early stages in order to avoid its progression and the development of complications from the nervous, cardiovascular and articular systems.

To methods primary prevention include:

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

Methods of secondary prevention include:

• correct removal of the tick, without leaving parts of its body in the skin ( preferably a surgeon);
• empirical treatment ( carried out without establishing the exact cause) tetracycline or doxycycline when ring-shaped erythema appears;
• empirical treatment with tetracycline or doxycycline even in the absence of ring-shaped erythema, if the tick bite occurred in an endemic focus of borreliosis.

Is borreliosis dangerous in pregnant women?

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

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

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

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

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

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

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

What are the differences between borreliosis in children?

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

Congenital borreliosis can be asymptomatic or cause severe defects of internal organs, and in some cases, stillbirth. During pregnancy this bacterium penetrates into all tissues of the newborn’s body, most severely affecting the nervous and cardiovascular system. Lymphoplasmic infiltrates that form in tissues interfere with the normal development of internal organs, which is why they are not fully formed at the time of birth, thereby reducing the viability of the newborn. Clinically, congenital borreliosis can manifest itself as mental retardation and physical development, deformation of the musculoskeletal system, concomitant autoimmune diseases, etc.

Acquired borreliosis in children is in many ways similar to that in adults. Some researchers note a slightly earlier susceptibility to damage to the meninges with the development of meningitis. Also, children are more likely to experience the phenomenon of meningism - the clinical picture of meningitis with sterile cerebrospinal fluid.

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

The causative agent of borreliosis is one of the bacteria most prone to spread throughout all organs and tissues. However, cases of transmission of this infection from person to person have not been reported.

Despite the fact that a patient infected with borreliosis may contain the pathogen in all biological fluids ( blood, breast milk, saliva, sperm, gonads, etc.), infection does not occur when these liquids are transferred to the skin and mucous membranes. This happens due to the fact that the means nonspecific protection skin and mucous membranes are an almost insurmountable barrier to Borrelia. Even if these shells are damaged ( scratches, erosions, ulcers, etc.) the pathogen cannot penetrate deep enough and in sufficient quantities to contribute to the further development of the disease.

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

Is there a vaccine against borreliosis?

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

In addition, the likely risks from side effects of a potential vaccine, if used on a mass scale, could be equal to or even exceed those severe cases borreliosis. Thus, the feasibility of developing a vaccine against this disease is currently in question.

Is immunity created after suffering from borreliosis?

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

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

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

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

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

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

Some people treat the phenomenon of a tick bite quite carelessly. But if you delve a little into the topic of the risk of infection from such bites, you can conclude that there is something to worry about. Walking along forest paths can result in a disease called borreliosis. In children and adults it can cause the same dangerous symptoms, which without proper treatment can even lead to disability.

What is meant by tick-borne borreliosis?

Tick-borne borreliosis, also called Lyme disease or Lyme borreliosis, is an infectious disease. It is transmitted through a bite. The development of this disease leads to damage to various systems and organs. This could be the heart, nervous system, skin or joints. This natural focal chronic infection took its name from the causative agent of the disease - the microorganism Borrelia. This diagnosis was first established in 1975 among residents of the town of Lyma in the United States.

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. Therefore, you should not take a tick bite lightly.

Causes

The tick (borreliosis infects this particular insect) is a carrier of three types of microorganisms that can be causative agents of an infectious disease. Those who want to protect themselves from such a diagnosis as Lyme disease should be attentive to the bites of ixodid ticks, which become infected while sucking the blood of animals with an infection. Such ticks are most often found in areas with temperate climates, especially in areas occupied by mixed forests. The central and western regions of Russia can be identified as endemic zones where there is a risk of getting a dangerous bite: Western Siberia, Ural, Far East. The causative agent of borreliosis is also found in some areas of Europe and the USA.

In late spring and early summer, ticks are most active. For this reason, the maximum number of people becomes infected with borreliosis during this period. It is also worth knowing that the infection can enter the bloodstream not only through a bite, but also during a tick rupture, which occurs as a result of improper removal.

There are also chances of catching the disease through food transmission. We are talking about the consumption of dairy products without preliminary heat treatment. Particularly dangerous in this regard is raw goat milk. However, the disease borreliosis is not transmitted from one infected person to another. But if a tick bites a pregnant woman, intrauterine transmission of the infection can lead to miscarriages, various congenital anomalies, and even the death of the baby. Therefore, for those who are expecting a child, it is better to keep their distance from potential infection zones in the spring and summer.

Mechanism of disease development

As mentioned above, the actual infection itself occurs only after the tick has been bitten. Borreliosis, or to be more precise, the causative microorganism, enters the nearest lymph nodes and begins to multiply there. A few days later, borrelia enter the bloodstream and are spread throughout the body.

Damage to the nervous system at this stage can be determined by the following signs: destructive processes occur in the cranial nerves and spinal nerve roots (defined as radiculopathy).

It is also possible to develop serous meningitis, which is nothing more than an inflammation of the meninges. It manifests itself as increased sensitivity to irritants, moderate headache, photophobia, severe fatigue and muscle tension in the back of the head. Another symptom of meningitis may be insomnia.

As for the cranial nerves, the facial nerve is most often affected. The fact of the lesion will be indicated by paralysis of the facial muscles: food falls out of the mouth, the eyes do not open completely, and the face looks noticeably distorted. Often a bilateral lesion is recorded, in which the functioning of one side of the face is initially disrupted, and a few days or weeks later - the other. In addition to the facial, destructive processes can affect the auditory and optic nerves. This can be expressed in the form of strabismus, deterioration of hearing, vision and impaired movement of the eyeballs.

Considering tick-borne borreliosis, the consequences of which can be more than noticeable, it is worth noting that the roots of the spinal nerves, when affected, make themselves felt by a noticeable shooting pain, which in the area of ​​the extremities is directed from top to bottom, and in the area of ​​the torso takes on a girdling character.

Third stage

This period of development of the disease can occur even several years after the bite. At this stage, borreliosis has the following consequences: atrophic acrodermatitis, damage to the nervous system (encephalopathy, polyneuropathy and encephalomyelitis), chronic arthritis.

In most cases, one specific system is affected: the joints, nervous system or skin. But if the disease is not fought, then in the process of development it can lead to combined damage to systems.

When chronic arthritis develops against the background of an infection such as ixodid tick-borne borreliosis, a devastating effect can be had on both large and small joints. In this case, the cartilage tissue will most likely begin to thin out, deforming processes will appear in the joints, and osteoporosis will develop in the bone structure. Those nearby will also be involved in the process of stable destruction muscle fibers(chronic myositis).

Damage to the nervous system in the third stage can manifest itself in different ways. It is possible to develop paresthesia, increase or decrease sensitivity, the occurrence of various pains and even paresis. It makes sense to expect disturbances in mental (memory, intelligence) and coordination functions (balance). Hearing may also be affected. Disorders of the pelvic organs and the occurrence of epileptic seizures should not be ruled out. It is also worth noting that most patients experience lethargy, extreme fatigue and emotional disorders.

Chronic Lyme disease

If you ignore the treatment process and allow the infection to unimpededly affect the body, then tick-borne borreliosis will enter the chronic stage. With this form of the disease, a stable wave-like deterioration of the condition will be observed. If we highlight the most common clinical syndromes that develop in the chronic form of borreliosis, then it is worth paying attention to the following diseases:

Atrophic acrodermatitis;

Various forms of arthritis;

Damage to the nervous system involving any of its structures in the process (there may be many foci of destruction);

Lymphocytomas.

Treatment

If tick-borne borreliosis is suspected, the patient must be immediately hospitalized in an infectious diseases hospital. Especially if a child was injured. Borreliosis in children can lead to serious complications. And only with the participation of professional doctors is it possible to carry out complex therapy, the purpose of which is to destroy the causative agents of Lyme disease. It is worth remembering that without proper and timely treatment, borreliosis can lead to disability.

At the same time, treatment of borreliosis with antibiotics can be defined as the most effective method of influencing harmful microorganisms. The good news is that if the infection is suppressed with antibacterial drugs at the first stage, there is every chance of avoiding the development of cardiac neurological and arthrological complications.

For this reason, treatment of borreliosis with antibiotics should begin as early as possible.

If we talk about the early stage of infection, it is worth noting that during this period the drug Amoxicillin is used to neutralize the disease. This therapy lasts about 20-30 days. Actively used in initial stage and "Tetracycline". If you do not act on the erythema, it may go away within a month, but when borreliosis is treated with antibiotics, the ring redness may go away much earlier.

A drug such as Doxycycline has repeatedly proven its effectiveness. It is most relevant for those patients who have developed skin diseases (benign skin lymphoma, migratory annular erythema).

Those who have had damage to the nervous system at the second stage are prescribed penicillin. At the first stage, it is effective in the occurrence of fixed arthralgia and myalgia. Ceftriaxone can be identified as the most relevant antibiotic from the group of cephalosporins. Its use is recommended for both early and late neurological disorders. This drug is also relevant for those patients who, as a result of Lyme disease, have developed a high degree of artrioventicular blockade or arthritis, including chronic arthritis.

In general, treatment of borreliosis with antibiotics has proven to be extremely effective.

Preventive measures

Lyme disease is too serious a diagnosis to ignore. Therefore, if possible the best option will avoid infection and prevent the unpleasant process of a serious infection affecting the body.

Prevention of borreliosis involves staying in areas where ticks can live, wearing closed shoes and clothing that completely covers the body (long trousers, drawstrings, sleeves with cuffs). It will not be superfluous to use repellents that can repel ticks.

If it happens that a tick gets on the skin and manages to be absorbed, then you need to visit immediately infectious diseases department the nearest hospital. There they will take blood for borreliosis and determine whether infection has occurred. Carrying out tests, and without delay, is a necessary measure that cannot be ignored. Otherwise, you will have to face very serious symptoms. Therefore, you need to immediately use the recommended medications. Prevention of borreliosis will be more effective if after the bite you take 2 tablets of the drug Doxycycline per day for 5 days.

It is obvious that Lyme disease, with all its destructive potential, can be defeated without any particular complications if the infected person quickly seeks help from doctors and follows their recommendations.

So, we looked at tick-borne infection and the treatment of this infection and possible preventive measures. Be careful about your health!

It is characterized by a tendency to chronic and recurrent course and predominant damage to the skin, nervous system, musculoskeletal system and heart.

Infection occurs when bitten by an infected tick. The pathogen Borrelia burgdorferi enters the skin with the saliva of the tick and multiplies for several days, after which it spreads to other areas of the skin and internal organs (including the heart, brain, joints). Pathogens can persist in the human body for a long time (years), causing a chronic and recurrent course of the disease. The chronic form of the disease can develop many years after infection. Lyme disease is diagnosed based on special blood testing and symptoms.

There are now techniques that can recognize the disease faster than previously used antibody tests.

Causes

The bite of the Ixodia dammini tick, which carries the spirochete Borrelia burgdorferi.

Symptoms of Lyme disease

The appearance of redness of the skin at the site of the tick 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 redder and rises slightly above the skin level. Over time, the central part of the spot turns pale or acquires a bluish tint, creating a characteristic 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 lasts for 2-3 weeks, then disappears.

After 1-1.5 months, signs of damage to the nervous system, heart or joints develop. Flu-like symptoms such as headache, weakness, fever, fatigue, muscle pain. Joints are hot, swollen, and painful (most commonly affected knee joints), pain in muscles and tendons.

Neurological symptoms - paralysis (most often on the face), disorders of skin sensitivity, insomnia, hearing loss.

From the heart: arrhythmia, increased heart rate, bradycardia, dizziness, shortening of breathing.

Psychiatric changes are also possible: depression, dementia.

Complications and possible consequences of Lyme disease

Lyme disease most often occurs in late spring or early summer. After 1-2 weeks, flu-like symptoms, which may be accompanied by a rash, usually disappear. Recent studies have shown that bacteria can invade the brain and spinal cord early in the disease.

If left untreated at an early stage of the disease, complications from the heart, joints, and nervous system develop after a few weeks or months. However, even in patients treated early, complications develop in 15% of cases.

Because symptoms are nonspecific, Lyme disease is often misdiagnosed and considered rheumatoid arthritis, meningitis, multiple sclerosis.

Fatigue, mood changes and neurological symptoms are common causes of misdiagnosis mental illness, other rare diseases that may be accompanied by similar symptoms.

The disease is rarely fatal, but cardiac complications can include life-threatening arrhythmias, infections during pregnancy, which can lead to miscarriage.

Borreliosis- this is a transmission type infection, localized in natural foci, often with a tendency to become chronic and relapsing. The causative agents of borreliosis are borelia spirochetes. The disease mainly affects the skin, nervous and cardiac systems, musculoskeletal system, especially joints.

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

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

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

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.

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

According to the forms, borreliosis is distinguished:

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

— Stormy manifesto. Includes both a complete symptom complex and a laboratory enriched picture.

The stages of borreliosis, according to symptoms, have subtypes:

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

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

What is tick-borne borreliosis?

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

The disease has relatively recently been identified as a separate nosology; it was first described in 1975 as an outbreak of arthritis.

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.

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

The main mechanism of infection in 89% of cases is the result of the suction of a female tick. From the moment it hits the body from clothing and the bite, a short period of time passes, about 1 - 2 hours. Favorite places are the cervical area, chest, armpits, groin area, for children - this is the scalp, that is, places with thin, easily bitten skin with a rich blood supply.

The very moment the tick attaches to the body goes unnoticed for the most part, since the saliva of females contains analgesic, vasodilating and anticoagulant substances. Discomfort or itching occurs only after 10-12 hours or much later. The process of blood sucking can last up to a week, however, transmission of pathogens through saliva occurs in the first few hours. Borrelia multiply in the blood and migrate, penetrating into various areas of the skin and internal organs, through the lymph, blood and perineural pathways, penetrating the membranes of the brain.

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

Cellular immunity reacts as it progresses, mononuclear cells follow to target tissues, the level of T-helpers, T-suppressors and the lymphocyte stimulation index increases.

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

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

borreliosis: photo on the human body

Causes of borreliosis

The causative factors in the development of a disease such as borreliosis in humans are pathogenically dangerous four types of single-celled protozoan microorganisms. These species are represented by the spirochete Borrelia burgdorferi sensu stricto, the bacteria Borrelia garinii, Borrelia afzelii and B.miyamatoi.

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

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

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

B. burgdorferi is tropic to the musculoskeletal system in general, especially the articular tissue, the so-called Lyme arthritis is most often noted when identifying this pathogen.

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

Symptoms and signs of borreliosis

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

→ Stage I of borreliosis can be counted from the moment the pathogen enters the body, when Borrelia begins the process of active reproduction in the lymph nodes. Can last several months, but often ranges from 3 to 30 days. The first symptoms disappear completely even without treatment, the only permanent one is ring-shaped migrans.

The first stage of borreliosis includes the following symptoms:

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

— Enlargement of regional lymph nodes — generalized;

— Skin manifestations on the face such as urticaria, urticarial rash, pinpoint or small ring-shaped rashes, conjunctivitis, sometimes false erysipelas;

— 10% of patients exhibit severe symptoms of meningitis: headaches, nausea, vomiting, irritability, photophobia, hyperesthesia;

- hepatitis without jaundice of the skin, .

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

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

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

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

- First to appear destructive processes The central nervous system, in particular the cranial and spinal nerve roots. The roots give shooting pain in the extremities, which is directed from top to bottom or encircling in nature when the torso is affected. It is advisable to distinguish symptoms syndrome by syndrome. Sensory myalgia syndrome - myalgia, pain along the nerve, plexalgia, radiculoalgia. Myotrophic syndrome is a consequence of segmental radiculoneuritis, isolated neuritis n.facialis, myelitis. Less common is widespread paralytic syndrome.

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

— Cardiac lesions in the form of severe arrhythmias, most often 1-2 degree AV block, ventricular conduction disorders, dilated myocardiopathy, pancarditis. General symptoms: shortness of breath, rapid heartbeat, compressive chest pain.

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

→ III stage of borreliosis, or late chronic, occurs several years after the penetration of the infectious agent into the body; all the time it persists in a specific organ system. With ineffective or no treatment at all, persistent chronic borreliosis develops with short remissions and constantly relapsing combined lesion organs.

The late stage symptom complex includes:

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

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

- The motor system of the body. Bone, muscle, tendon and periarticular bursa pains are noted. With the development of chronic arthritis, the destructive effects affect both large and small joints. The cartilage tissue becomes thinner and deforming and destructive processes develop in the joints. In the skeletal system - subarticular sclerosis, cortical abnormalities, adjacent muscle fibers are involved.

The following joint lesions are distinguished:

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

Secondly, benign recurring arthritis, with accompanying abdominal pain, migraine, and polyadenitis. Most common symptom- asymmetrical mono- or oligoarthritis of large joints: 50% - knees, 30% - shoulders, 20% - elbows and ankles. Hands and feet, small joints, account for 10%, and Baker's cysts are much less common. The pain lasts for 2-3 weeks, mobility is limited and the periarticular tissue swells. The lesion is equally often unilateral and symmetrical.

Thirdly, chronic progressive arthritis occurs in 10%; this is a benign variant of the disease, lasting up to 5 years. Articular syndrome includes pannus formation, cartilage erosion, and damage to the synovial membrane and periarticular tissues.

— There are also many concomitant disorders of the whole organism, for example, borreliosis in children causes a slowdown in the child’s growth and puberty, mental disability, and impaired coordination functions are observed. In adults, borreliosis provokes disorders of the pelvic organs and epileptic seizures, strong emotional changes in behavior.

borreliosis: photo of an adult

Diagnostics and analysis for borreliosis

The diagnostic complex consists of the following stages:

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

— Laboratory research indicators are important. Using microscopic methods, it is possible to determine the morphology of an etiopathogenetic agent, but not its pathogenic properties. Borrelia are isolated from biological fluids and tissues: from the marginal part of erythema, biopsy samples from the skin of lymphocytoma and atrophic acrodermatitis.

— The amount of Borrelia in the blood is insignificant and it is almost impossible to isolate them. A laboratory technician in a blood test for borreliosis can distinguish general signs inflammation, with an increase in indicators: leukocytes, ESR (in children 80%, in adults 50%), C-reactive protein, transaminase activity. There is gross hematuria in the urine.

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

— False-positive reactions occur in the following diseases: typhus, other spirochetoses, rheumatic lesions, . Western blot is used for differentiation.

— When performing a puncture of the spinal cord, an increase in cerebrospinal fluid pressure of 280 mmH2O, lymphocytic pleocytosis of 250 cells/μL, protein up to 1 g/L, and glucose are slightly increased. If the composition does not change, this is regarded as meningism.

— The most reliable method is considered to be the treatment of an existing sample with special fluorescein-labeled antibodies.

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

— CT and MRI scans reveal atrophy of the cerebral cortex, expansion of the ventricular system, .

— Arthrocentesis shows polymorphonuclear cell count 100,000 cells/μl, protein growth to 0.8 g/l, CEC of 50%, fibrin deposits, lymphocytic infiltration, and vascular proliferation. The main diagnostic factors are the detection of borreliosis antibodies and the absence of rheumatic factor.

— Ultrasound diagnostics of the affected joint reveals thickening of the synovium, increased fluid, changes in surrounding tissues—thickening and swelling, tendinitis.

— X-ray acute stage will show changes in soft tissues; in chronic cases, loss of cartilage tissue, Baker's subchondral cysts and osteoporosis with urticaria.

— When taking an ECG, hypoxic changes are observed ( Q-T prolongation, T wave inversion), AV block, conduction disturbances in the bundle branches, .

borreliosis: photo of the bite site in a child

Treatment of borreliosis

If borreliosis is suspected, the patient is immediately hospitalized in the infectious disease ward of the hospital. Treatment includes a 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.

For mild cases of borreliosis, oral medication is sufficient; the tetracycline series (Doxycycline) is preferable. In case of moderate and severe course, the addition of neurological and cardiac disorders, II-III generation cephalosporins (Ceftriaxone, Cefobide and Cefoperazone) and semi-synthetic penicillins (), but with intramuscular or intravenous administration, are more appropriate. It is rational to add synergistic drugs (Eufillin, Sodium Caffeine Benzoate) to increase the permeability of the blood-brain barrier in order to create maximum concentrations in the central nervous system.

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

When allergic reaction, intolerance to the above drugs, Levomycetin or Clarithromycin are used. If the disease recurs, the duration of therapy is doubled. After completing the main course, maintenance and final, for 1 month, antibiotic therapy with long-acting drugs (Retarpen, Extensillin).

The development of the Jarisch-Herxheimer reaction often occurs in 25% on the first day in the acute form of the disease from the start of taking an antibiotic, or on the 3rd day in a chronic course. The symptom complex includes: fever, chills, headaches and muscle pain, increased erythema, swelling and soreness. Such a reaction is not a reason to discontinue the antibiotic, since the symptoms resolve on their own, or, less commonly, detoxification therapy can be resorted to.

Borreliosis in children has its own nuances of treatment, because the dissemination of the pathogen is much faster, which means that the oral route of taking medications does not make sense due to slow absorption. To eliminate the infection as quickly as possible, we will use a parenteral two-stage route of etiotropic therapy, including Ceftriaxone, Cefaperazone, and Retarpen. To improve the effect and increase the concentration in the affected area in children, it makes sense to prescribe enzyme therapy: Wobenzym or Flogenzym. And, of course, in parallel, prevent disorders of the intestinal microflora with probiotics.

Pathogenetic therapy of borreliosis is determined by the lesion syndrome. It is mandatory to use drugs that correct the functioning of internal organ systems:

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

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

For cerebral edema: Mannitol, Lasix, Methylprednisolone, Prednisolone, Dexazone.

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

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

Drugs to support heart function: Panangin, Asparkam, Riboxin.

For allergic manifestations, desensitizing drugs in usual dosages: Fenkarol, Loratadine, Tavegil, Diazolin.

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

Consequences of borreliosis

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

The consequences of borreliosis include:

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

— weakening of memory or partial amnesia;

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

- dementia or acquired dementia; delayed childhood puberty, impaired functioning in adults pelvic organs, accompanied by convulsions;

- poorly treatable paralysis and paraparesis;

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

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

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

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

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

The cause of the disease is tick-borne borreliosis (Lyme 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.

Geographical distribution of tick-borne borreliosis (Lyme disease) extensive, it is found 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 (Lyme disease) is not contagious to others.

The process of development of Lyme disease. 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 redness of the skin at the site of the tick 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.

Recognizing Lyme disease. 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 of tick-borne borreliosis should be carried out in an infectious diseases hospital, where, first of all, therapy is carried out aimed at destroying borrelia. Without such treatment, the disease progresses, becomes chronic, and in some cases leads to disability.

Treatment of tick-borne borreliosis (Lyme disease). If the titer of specific antibodies increases and there are no clinical manifestations of the disease after the bite of an infected tick, antibiotic therapy is not carried out. For early infection (in the presence of migratory erythema), 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.

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. The leading role in the prevention of Lyme disease is the fight against ticks, where both indirect (protective) measures and their direct extermination in nature are used.

Protection in endemic foci can be achieved with the help of special anti-tick suits with rubber cuffs, zippers, etc. For these purposes, you can adapt ordinary clothing by tucking a shirt and trousers, the latter into boots, tightly fitting the cuffs, etc. Various repellents can protect against tick attacks on exposed areas of the body for 3-4 hours.

If you are bitten by a tick, you should go to the infectious diseases hospital with the tick removed as soon as possible - preferably the next day - 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).

Test for tick-borne borreliosis (Lyme disease)- the test is quite simple, it can be performed in a doctor’s office, without resorting to a laboratory, and you will get the result within an hour; it is approved by the US Food and Drug Administration.

Test " Preview"based on the drug manufactured by the company" Chembio Diagnostic Systems", allows you to timely identify the presence of infection and diagnose correct diagnosis, the FDA said in a statement. The test "recognizes" antigens produced by Borrelia burgdorferi, the bacterium that causes the infection. The appearance on the market of this test is especially relevant for those areas where ticks that carry the infection are found.

Tick-borne borreliosis, or Lyme disease, shares many features with tick-borne encephalitis. In Russia in 1999, Lyme disease was detected in 89 large administrative territories, writes AiF. Health. This means that a significant, or perhaps even large, part of the global range of infections currently identified as common name "tick-borne borreliosis", are located within Russia.
The incidence of Lyme disease in the Russian Federation is 1.7-3.5 per 100 thousand population. You can get Lyme disease 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 is dangerous because it gives much more often than tick-borne encephalitis chronic forms. Adults and older people are more seriously ill, which is explained by the presence of concomitant chronic pathology (atherosclerosis, hypertonic disease). No deaths from Lyme disease have been reported to date.