Lyme disease: symptoms, diagnosis and treatment

Lyme disease is called a transmissible pathology, caused by pathogenic bacteria of the genus Borrelia.

It is very difficult to talk about the prevalence of pathology, which in many sources is called a "great imitator." This name is due to the polymorphism of clinical manifestations of Lyme disease, in connection with which patients arise symptoms that cause them to contact neuropathologists, dermatologists or rheumatologists, and not infectious disease specialists.

Lyme disease is very common in Europe, North America, Australia and Asia. In recent years, the number of patients with this diagnosis is increasing both in Russia and Ukraine. This is due to the high sensitivity of the human body to Borrelia. Many well-known people have been ill with the disease: Avril Lavigne, Ashley Olsen, Richard Gere, and others.

Causes

The causative agent of the disease are bacteria of the genus Borrelia from the family Spirochaetaceae. Carriers of pathogenic microorganisms are ixodid mites (I.ricinus, I.pacificus, I.damini). An infected tick is contagious at any stage of its development. This means that both larvae, and nymphs, and adult individuals of arthropods are quite capable of leading to human infection with Borrelia with the further development of Lyme disease.

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Infection of a person occurs when the mite's saliva hits the damaged areas of the skin. Another way of infection is possible - contamination, when the contents of a crushed mite are rubbed into the skin during combing of itching areas. In addition, there are cases of transmission of pathology by the placental pathway. A surge of pathology is observed in the spring-autumn period.

Stages of the course of the disease

Conditionally Lyme disease is divided into 3 stages:

The first stage continues for 30 days after the tick bite. At this time, the patient has a general malaise, flu-like symptoms are observed. During the crescent, the patient may have a body temperature of up to 40 degrees. Sometimes there may be signs of intoxication of the body. During this period, you can notice an increase in the spot at the site of the tick bite. Timely treatment started helps to get rid of the stain in a few days. If therapy has not been performed, it can remain on the body for up to 2 months.
At the second stage of development the disease passes in the absence of treatment. After a few weeks or months, there is a lesion of the nervous system, the patient develops a skin rash (like hives), heart pains arise. At this stage, angina frequently occurs, kidney, liver and eye pathologies develop. There can be relapses of bronchitis.
The third stage of Lyme disease develops approximately 2-3 (or 5-6) months after the end of phases 1 and 2. At this time, the pathology passes into the phase of chronization. The patient complains of constant fatigue and loss of strength, sleep disturbances and depressive conditions. At this stage, the process continues to affect various internal organs and systems.

Symptoms of Lyme disease

The incubation period of the disease is 1-2 weeks. The first symptoms of Lyme disease do not have specific features, and they are expressed:

increased body temperature;
cephalgia;
chills;
aching joints;
weakness of muscles;
general malaise and weakness.

Stiffness of the neck is one of the symptoms characteristic of Lyme disease. At the site of the bite, ring reddening is formed, which is the main manifestation of the migrating annular erythema. During the first days, a small macula or papule develops, and then erythema begins to spread, affecting extensive areas of the skin. At the edges reddening has a bright hue, it rises slightly above the epidermis. In the middle, the ring is paler.

Round erythema can reach 10-2 cm in diameter. It is often localized on the legs, less often in the lumbar region, neck, abdomen, axillae, or inguinal zone.

In the acute period of the course of the disease, the appearance of:

headaches;
nausea with vomiting;
photophobia;
hyperesthesia;
pain in muscles and joints;
meningeal symptoms.

In 1-3 months the disease can go to the 2 stage of development. At this time, neuralgic and cardiac symptoms are manifested.

Systemic tick-borne borreliosis is accompanied by the development of meningitis in combination with neuritis of the cranial nerves and radiculoneuritis. Among the most frequent cardiac symptoms is an atrioventricular block. Myocarditis and pericarditis may develop.

Over time, there is the emergence and buildup of shortness of breath, increased heart rate, pain in the chest. At the last, 3, stage of development, Lyme disease passes extremely rarely. It comes in about 6 months, or 1-2 years. With its development, joints (chronic Lyme arthritis), skin (atrofic acrodermatitis), nervous system (chronic neurologic syndrome) are affected.

Symptoms of chronic form

One of the most common symptoms of borreliosis is the development of arthritis, which can be accompanied by other chronic processes in the patient's body. In particular, this relates to the development of osteoporosis, thinning of the cartilage, and sometimes their complete loss, less often (in more severe cases) - degenerative changes.

Often there is a lesion of the skin, accompanied by the formation of a benign nodule - lymphocytoma, which has a crimson hue and a convex, rounded shape. When pressing on its surface, the tumor-like growth can become painful.

The most frequent location of such an infiltrate is the nipple of the breast and ear lobe. A lymphocytoma can persist on the human body for several months, or even years.

Atrophic acrodermatitis is characterized by the appearance of cyanotic-red spots in the region of extensor sites of the hands and feet. They are prone to peripheral enlargement and fusion. This, in turn, can lead to the development of systemic inflammation.

Over time, the skin in the spot zone atrophies and becomes similar to papyrus. The development of such a pathological process can continue for several months or years.

Lyme disease - photos

On the photos below you can see what Lyme disease looks like.

Diagnostics

The diagnosis is made on the basis of carefully collected history and analysis of the clinical picture observed in the patient. Since the mole spreader is a mite, the patient must remember whether a visit to the forest, forest belt, parks took place in the recent past. However, not all people notice the tick bite, so timely treatment to a doctor is a rare phenomenon.

To confirm or refute the diagnosis of "Lyme disease", a specific diagnosis is carried out, consisting in the use of serological methods for the study of blood - ELISA and ELISA. The implementation of such diagnostic manipulations helps to identify in the patient's biomaterial immunoglobulins (antibodies) classes IgG and IgM.

However, in the first phase of the disease, serological methods of research are not informative in 50% of cases. For this reason, the blood serum is re-examined after 20-30 days.

By conducting PCR, it is possible to accurately detect Borrelia DNA in a sample of skin tissue, cerebrospinal fluid, or blood.

Differential diagnostics

It is very important to conduct differential diagnosis of Lyme disease from diseases with similar symptoms. This list includes:

tick-borne encephalitis;
erysipelas of the skin;
erizepeloid and others.

From these diseases it is necessary to distinguish borreliosis at the first stage of development. In the second phase, differential diagnosis should be performed in order to exclude different forms of tick-borne encephalitis, rheumatic carditis or cardiopathy. At the 3 stages of progression, pathology should be differentiated from rheumatoid arthritis, rheumatism, Reiter's disease and reactive arthritis. To carry out this diagnosis, synovial fluid is used for further morphological studies.

Treatment of Lyme disease

Patients with this diagnosis must be hospitalized in the hospital of the infectious disease department. Pharmacological drugs are prescribed taking into account the phase of the pathology.

Patients with a mild degree of borreliosis are prescribed, as a rule, antibiotics of the tetracycline series (Tetracyclin, Doxycilin). The medication is administered for 14 days. If necessary, the drug Amoxicillin may be prescribed.

The transition of Lyme disease to the 2nd and 3rd stage of development, accompanied by affection of the joints, nervous system and heart, requires the use of antibiotics of the cephalosporin or penicillin series. The course of therapy lasts from 3 to 4 weeks.

During the passage of antibiotic therapy, the patient may experience or worsen the symptoms of spirochetosis. This is due to the process of destruction and removal of Borrelia from the body, as a result of which endotoxins are actively released into the blood. Under such circumstances, the intake of antibiotics stops for a while, after which it resumes.

Treatment of Lyme disease largely depends on the accompanying symptoms. So, with joint damage, NSAIDs, analgesics, and physiotherapy courses are used. If there are common infectious symptoms, detoxification therapy is performed, and meningitis is resorted to dehydration treatment. If there is a development of severe systemic inflammation, the patient is prescribed SCS for oral administration, or intraarticular injections are made (with the development of synovitis).

Complications

Lyme disease can lead to:

Brain complications. The most severe course is characterized by pathological processes that have affected the central nervous system. Inflammation of the meninges, peripheral or cranial nerve fibers may develop.
Cardiac complications. Untreated borreliosis is fraught with the development of endocarditis or pericarditis.
Joint complications, in particular, their inflammation.

Prevention

To date, there are no specific measures to prevent Lyme disease. Therefore, it is important to be cautious in places where people are most prone to tick bites.

When leaving for forest park areas, forest belts or forests, it is necessary to carefully protect the body. The easiest way is to wear a shirt with a long sleeve and a high collar, as well as long pants. If a tick was found on the body, it must be carefully removed. Do this with gloves, using pre-disinfected tweezers. If the manipulation was successful, the tick must be clamped behind the head and removed by twisting movements.

Do not press a tick - this can lead to the ingestion of its pathological contents on healthy skin areas. After the procedure, the wound should be rinsed with an antiseptic, and then thoroughly washed with hands.

If there are pets in the house, they should be inspected after each walk, as mites often attach to animals.

Forecast

A favorable prognosis is possible only with the timely detection and treatment of the disease. There are cases when systemic tick-borne borreliosis stopped at an early stage of development, leaving behind the so-called "serological tail".

Adverse is the prognosis in patients who have abnormally high immunoglobulin IgG titres for a long time. In this case, repeated antibiotic treatment along with symptomatic treatment is indicated. Patients who have undergone pathology should be on dispensary supervision in the conditions of the KIZ for a year. During this time, clinical and diagnostic studies are necessarily conducted every 14-21 days, 3, 6 and 12 months.

With the preservation of skin, neurological or rheumatic symptoms, the patient is referred to specialized medical specialists. Further studies are conducted taking into account the patient's history.