Tick borreliosis (Lyme disease, Lyme-borreliosis) is an infectious disease transmitted through the bite of an ixodic tick. It is characterized by the defeat of various organs and systems: skin, nervous system, heart, joints. With early detection and proper treatment with antibiotics, in most cases it ends in recovery. Diagnosis of the disease at a late stage, inadequate therapy can promote the transition of the disease into a chronic, intractable form. From this article you can learn about the symptoms, diagnosis, treatment and consequences of tick-borne borreliosis.
The name of the disease originated from the pathogen - a microorganism called Borrelia, which is carried by mites. The second name "Lyme disease" appeared in 1975, when cases of the disease were registered in the small town of Lime in the USA.
- 2How does the disease develop?
3Symptoms of tick borreliosis
- 3.1Stage I
- 3.2II stage
- 3.3III stage
- 4Chronic borreliosis
- 5Analyzes for borreliosis
- 6Treatment of borreliosis
- 7Consequences of borreliosis
It is established that the cause of tick-borne borreliosis is 3 species of Borrelia, Borrelia burgdorferi, Borrelia garinii, Borrelia afzelii. These are very small microorganisms (length 11-25 microns) in the form of a twisted spiral. In natural conditions, the natural reservoir of Borrelia are animals: rodents, deer, cows, goats, horses, etc. Ixodid mites serve as a carrier, which become infected when sucking blood from infected animals. Ticks can transmit Borrelia to their next generations. Ixodes ticks live mainly in temperate zones, especially in mixed forests. Endemic areas of tick-borne borreliosis are the northwestern and central regions of Russia, the Urals, Western Siberia, the Far East, the USA, and some parts of Europe. During studies of mites in endemic areas, it was found that infection of mites is up to 60%.
The peak incidence falls at the end of spring - early summer, which is associated with an increase in the activity of ticks in this period. A person has a high susceptibility to Borrelia, which means a high risk of illness "at a meeting".
How does the disease develop?
Infection occurs when the tick is bitten. The causative agent with saliva penetrates the skin, multiplies there. Then he gets into a number of located lymph nodes, where he continues to multiply. A few days later Borrelia penetrate into the bloodstream and are carried throughout the body with blood flow. So they fall into the central nervous system, the heart, joints, muscles, where they can stay for a long time, continuing to multiply. The immune system produces antibodies against Borrelia, but even their high titers are not capable of completely destroying the pathogen. Immune complexes that are formed as a result of tick-borne borreliosis can trigger the development of an autoimmune process (and then the production of antibodies is produced against the body's own tissues). This fact can cause a chronic course of the disease. The death of the pathogen is accompanied by the release of toxic substances, which worsens the patient's condition.
A sick person is not contagious to others, can not become a source of infection.
Symptoms of tick borreliosis
The disease occurs in several stages:
- The incubation period (the period from the moment of infection to the appearance of the first symptoms) lasts from 3 to 32 days;
- I stage - coincides in time with the reproduction of borrelia at the site of penetration and in the lymph nodes;
- II stage - corresponds to the phase of the pathogen spreading with blood through the body;
- III stage - chronic. During this period, it appears that one or more of the body systems (for example, nervous or locomotor) is affected.
I and II stages are called the early period of infection, and stage III is late. There is no clear transition between the stages, the separation is somewhat arbitrary.
It is characterized by common and local manifestations. Common symptoms include: headache, pain and aches in muscles, joints, fever to 38 ° C, chills, nausea, vomiting, general malaise. Rarely can there be catarrhal phenomena: pain and sore throat, a small runny nose, coughing.
Local symptoms are as follows: painfulness, swelling, itching, redness appear at the site of the tick bite. The so-called annular erythema is formed - a specific symptom of tick borreliosis. Is found in 70% of patients. At the site of the bite, a red dense formation appears-the papule, which gradually expands in a few days to form a ring. In the center, the place of the bite remains somewhat more pale, and the rim has a more intense red color, it rises above the unaffected skin. In general, the reddening zone has an oval or round shape with a diameter of 10-60 cm. Sometimes smaller ringlets may form inside the ring, especially if the size of the erythema is large. Quite often erythema does not give the patient unpleasant sensations, but it happens that this place itches, bakes. It happens that ring-shaped erythema becomes the first manifestation of the disease and is not accompanied by general reactions. Perhaps the appearance of additional annular erythema, secondary, ie, in places where there were no bites.
Erythema lasts for several days, sometimes - months, on average 30 days. Then it disappears on its own, in the place of erythema there is peeling and pigmentation.
Of the other skin manifestations, the appearance of a rash as a type of urticaria, the development of conjunctivitis.
Local symptoms are accompanied by an increase and soreness of the regional lymph nodes, rigidity of the neck muscles, fever, migrating joint-muscle pains.
The first stage is characterized by the disappearance of symptoms even without medication.
It is characterized by damage to the nervous system, joints, heart, skin. Can last from several days to several months. By this time, all local and general manifestations of stage I have disappeared. There are such situations when tick-borne borreliosis begins immediately from stage II, bypassing the ring erythema and the general infection syndrome.
The defeat of the nervous system is manifested by three typical syndromes:
- serous meningitis;
- defeat of cranial nerves;
- lesion of roots of spinal nerves (radiculopathy).
Serous meningitis (inflammation of the meninges) manifests a mild headache, photophobia, hypersensitivity to irritants, mild tension of the occipital muscles, considerable fatigue. Typical symptoms of meningitis Kernig and Brudzinsky may generally be absent. There may be emotional disorders, insomnia, impaired memory and attention. In the cerebrospinal fluid (cerebrospinal fluid), the content of lymphocytes and protein increases.
Of the cranial nerves most often afflicted facial. This is manifested by paralysis of facial muscles: the face looks distorted, the eye does not fully close, the food is poured out of the mouth. Quite often defeat is bilateral, sometimes one side is struck first, and in a few days or even weeks - another. In tick-borne borreliosis, the lesion of the facial nerve has a good prognosis for recovery. Of the other cranial nerves, the visual, auditory, oculomotor nerves are involved in the process, which is expressed respectively in the deterioration of eyesight, hearing, the development of strabismus and violation of eye movements.
The defeat of the roots of the spinal nerves clinically makes itself felt by the expressed pains of the shooting character. In the field of the trunk, the pains are shrouded in nature, and in the region of the extremities are directed downwards along the length. In a few days or weeks, the pain is associated with muscle damage (weakness develops - paresis), sensitive disorders (increase or decrease in overall sensitivity), tendon reflexes.
Sometimes the defeat of the nervous system in tick-borne borreliosis can be accompanied by speech impairment, shakiness and instability, the appearance of involuntary movements, trembling in the limbs, a violation of swallowing, epipripeds. Similar symptoms are observed in 10% of patients with tick-borne borreliosis.
The defeat of the joints in this stage is manifested as a relapsing monoarthritis (one joint) or oligoarthritis (two or three joints). More often it concerns knee, hip, elbow or ankle joints. They cause pain and limited mobility.
The defeat of the heart is also a few clinical forms. This may be a violation of the conduction of the heart (most typical are atrioventricular blockades), possible myocarditis and pericarditis, manifested by palpitation, dyspnea, pain behind the sternum, cardiac insufficiency.
Skin disorders in the II stage are quite diverse: a rash in the form of urticaria, secondary small ring erythema, lymphocytoma. Lymphocytoma is a rather specific sign of tick-borne borreliosis. It is a bright red nodule from a few millimeters to several centimeters, projecting above the level of the skin. Most often formed on the earlobe, in the nipple, in the groin. The lymphocytoma is an accumulation of lymphatic cells in the thickness of the skin.
II stage of tick borreliosis can manifest itself as a lesion of other organs and systems, but much less frequently. Since Borrelia carry blood around the body, they can "settle" anywhere. Cases of damage to the eyes, bronchial tubes, liver, kidneys, and testicles are described.
It develops in a few months, and sometimes even years after the onset of the disease. Has several typical and well-known medicine manifestations:
- chronic arthritis;
- atrophic acrodermatitis (skin damage);
- defeat of the nervous system (encephalomyelitis, encephalopathy, polyneuropathy).
More often the disease chooses some one of the systems of the body, i.e., develop lesions or joints, or skin, or nervous system. But over time, a combined defeat is possible.
Chronic arthritis affects both large joints and small ones. Since the course of the disease is characterized by relapses, the joints gradually deform, the cartilaginous tissue is thinned and destroyed, osteoporosis develops in the bone structures. A number of located muscles are involved in the process: chronic myositis develops.
Atrophic acrodermatitis is characterized by the appearance of bluish-red spots on the extensor surfaces of the knees, elbows, on the back of the hands, on the soles. The skin in these areas swells, thickens. When the process recurs, with a prolonged existence of the disease, the skin becomes atrophied, resembling a cigarette paper.
The defeat of the nervous system in the III stage is very diverse. It manifests itself in the motor (paresis), and in the sensitive (decrease, increase in sensitivity, various kinds pain, paresthesia), and in the coordinator (imbalance), and in the mental (violation of memory, thinking, intellect) spheres. Possible visual, hearing, epileptic seizures, disorders of the pelvic organs. Patients almost always feel weakness, lethargy, they do not leave emotional disorders (in particular, depression).
If tick borreliosis is not treated, then it goes into a chronic form characterized by recurrence of the process. The disease proceeds with a gradual wave-like deterioration of the condition. Of the known clinical syndromes developing in the chronic course of the disease, the most common are:
- atrophic acrodermatitis;
- multi-focal lesion of the nervous system (any structure of the nervous system may be involved in the process).
Analyzes for borreliosis
The diagnosis of tick-borne borreliosis is based on clinical data (a tick bite in history, the presence of ring-shaped erythema) and data from laboratory research methods. But since the tick bite can go unnoticed, and the disease can proceed without annular erythema and manifest itself only in the II stage, the methods of laboratory diagnosis sometimes become the only way to confirm the tick borreliosis.
By themselves, Borrelia is difficult to identify in humans. They can be found in affected tissues or body fluids. This may be the outer edge of annular erythema, areas of the skin with lymphocytoma and atrophic acrodermatitis (biopsy), blood or cerebrospinal fluid. But the effectiveness of these methods does not exceed 50%. Therefore, at present, indirect methods of diagnostics are used:
- polymerase chain reaction (search for Borrelia DNA in blood, CSF, synovial fluid);
- serological diagnosis - indirect immunofluorescence (RNIF), enzyme immunoassay (ELISA), immunoblotting (allow to detect antibodies to borrelia in serum, cerebrospinal fluid and synovial liquid). To confirm the diagnosis, the initial antibody titer should be at least: 0 or a 4-fold increase in 2 sera taken at intervals of not less than 20 days.
Of course, the search for DNA fragments is somewhat more accurate than serological reactions. The latter can give false positive results in patients with syphilis, with rheumatic diseases, infectious mononucleosis. There are also seronegative variants of tick-borne borreliosis, and in the early stages, serological testing does not confirm infection in 50% of cases. Such situations require research in dynamics.
Treatment of borreliosis
Treatment of tick-borne borreliosis depends on the stage of the disease. Of course, it is most effective in the first stage.
Apply two directions:
- etiotropic - effect on the pathogen (antibiotic therapy);
- symptomatic and pathogenetic - treatment of damage to organs and systems (nervous system, heart, joints, etc.).
As an etiotropic treatment in the first stage, antibiotics are administered orally (at the doctor's choice): Tetracycline 500 mg 4 r / day, Doxycycline (Vibramycin) 100 mg 2 r / day, Amoxicillin (Flemoxin, Amoxiclav) 500 mg 3 r / day, Cefuroxime 500 mg 2 p / day. The period of application is 10-14 days. In no case can you reduce the dosage or shorten the duration of the application, as this leads to the survival of a part of the Borrelia that will multiply again.
The second stage shows parenteral use of antibiotics to ensure a harmful concentration of the drug in the blood, CSF, synovial fluid. Use: Penicillin 20-24 million units / day, Ceftriaxone 1-2 g / day. The duration of antibiotic use in this case is 14-21 days. In 85-90% of cases this cures tick borreliosis.
In the III stage, the duration of antibiotic use is recommended for at least 28 days. Usually penicillin series is used. Since the frequency of administration of Penicillin is up to 8 r / day and for 28 days the patient will need to perform 224 injections, then, to date, use the extended form -Extensillin (Retarpen) to, million ED once a week for 3 weeks.
If there is no effect from the use of this or that antibiotic, there is no positive dynamics in the study of cerebrospinal fluid, then it is recommended to change the antibiotic to another.
Also, preventive therapy with antibiotics is carried out. It is indicated to people who have applied for medical assistance within 5 days of the tick bite, provided that the mite was brought with them (or withdrawn already in a medical facility), and when examined at the mite, Borrelia (under a microscope) were found. In such cases, appoint tetracycline 500 mg 4 r / day 5 days, or Doxycycline 100 mg 2 r / day 10 days, or Amoxiclav 375 mg 4 r / day 5 days, or Retarpen, million ED 1 time intramuscularly. Such preventive measures allow to avoid the disease in 80% of cases.
Symptomatic and pathogenetic treatment involves the use of antipyretic, detoxifying, anti-inflammatory, antiallergic, cardiac, general health, vitamin and other drugs. It all depends on the clinical form and stage of the disease.
Consequences of borreliosis
If the disease is identified in stage I and adequate treatment is carried out, then in most cases a complete recovery will occur. II stage also in 85-90% of cases is cured, not leaving after itself consequences.
With late diagnosis, incomplete course of treatment, with defects of immune response, the disease can go to stage III or chronic form. Such a course of tick-borne borreliosis, even with repeated courses of antibiotic therapy, full-fledged pathogenetic and symptomatic treatment, does not allow the patient to fully recover. The condition improves, but there are functional disorders that can cause disability:
- persistent paresis - decrease in muscle strength in the legs or hands;
- sensitivity disorders;
- deformation of the face due to lesion of the facial nerve;
- hearing and vision impairment;
- marked shakiness when walking;
- epileptic seizures;
- deformation of the joints and a violation of their function;
- heart failure;
Of course, not all these symptoms will necessarily be for every patient with stage III or chronic form. Sometimes, even in neglected cases, a significant improvement is possible and, albeit slow, recovery.
Tick borreliosis is a dangerous infectious disease that can develop unnoticed for the patient. Especially if the tick bite was not seen. Characterized by a specific symptom in the initial stage - annular erythema and a very diverse clinical picture of the damage of various organs and systems (mainly nervous, cardiac and joints). It is confirmed, mainly, by laboratory methods of diagnostics. Effectively treated with antibiotic courses provided early application. Otherwise, it can pass into the chronic form and leave after itself irreversible functional disorders.
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Medical animation on the topic "Tick-borne borreliosis (Lyme disease)
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