Lyme disease – (liberalis, Lyme borreliosis) – natural focal infectious disease, a carrier which is the Ixodes tick. Lyme disease is characterized by a complex of cutaneous and systemic manifestations, prone to chronic course. According to statistics, every third studied the tick is infected. Lyme disease is widely distributed in North America, Europe and Asia. The disease was named after the town of Lyme (Connecticut, USA), where in 1975 originated the outbreak, which included such manifestations as arthritis, carditis, meningitis. In Russia annually 6-8 thousand new cases of Lyme disease. Lyme disease can occur at any age, but is more often diagnosed in children and adolescents up to 15 years and adults aged 25-44 years. Due to the wide spectrum of clinical manifestations of Lyme disease is clinical interest not only to infectious disease, and dermatology, neurology, cardiology, rheumatology etc.
Causes of Lyme disease
Lyme disease is called gram-negative spirochaetes of the genus Borrelia of three species: B. burgdorferi (dominated by the USA), Borrelia garinii and Borrelia afzelii (mainly in Europe and Russia). Borrelii enter the human body mainly transmissible through bites of infected mites (pasture, forest, taiga), belonging to the genus Ixodes. The pathogen enters the blood with the saliva of the mite or its faeces (when scratching the bites). Less possible alimentary route of infection (e.g. ingestion of raw cow’s and goat’s milk), or transplacental transmission of Borrelia.
Reservoir and source of spread of Lyme disease serve domestic and wild animals. The risk of Contracting Lyme disease increases in spring and summer (the season of activity of pincers lasts from April to October). Risk factors are forest and grassland areas, as well as long-term (over 12-24 hours) in the presence of an infected mite on the skin. After suffering a Lyme disease produces unstable immunity; after a few years, perhaps re-infection with tick-borne Lyme disease.
Soon after the tick bite at the site of its introduction into the epidermis develops a set of inflammatory and allergic reactions in the form of migratory annular erythema. Of primary tumor with lymph flow and blood borrelii are distributed throughout the body by triggering a cascade of immunopathological reactions in various organs, mainly the Central nervous system, joints, heart.
Classification of Lyme disease
The clinical course of Lyme disease are divided into early period (I-II stage) and late period (stage III):
- I – the stage of local infection (erythema and basaltina form)
- II – the stage of dissemination (course options – feverish, neuroticeski, meningeal, cardiac, mixed)
- III – stage persistence (chronic Lyme arthritis, chronic atrophic acrodermatitis, etc.).
On the severity of pathological reactions Lyme disease can occur in mild, moderate, severe and very severe.
Lyme disease symptoms
After the end of the incubation period (about 7-14 days) the stage of local infection characterized by skin manifestations and intoxication syndrome. On the site of the tick bite appears itchy, slightly painful papule red, prone to peripheral growth (vernal migratory erythema). With the expansion of the zone of redness migratory UriTemplate the form of a ring with a diameter of 10-20 cm, with a bright red halo on the edges and lighter Central part. In most cases erythema migrans in Lyme disease spontaneously resolves within 1-2 months, and in its place is a weak pigmentation, and peeling. Local manifestations of Lyme disease are accompanied by obstipation syndrome: fever with chills, headache, arthralgia, pain in bones and muscles, severe weakness. Among other symptoms in stage I can meet urticaria, conjunctivitis, regional lymphadenitis, rhinitis, pharyngitis.
Over the next 3-5 months developing a disseminated stage of Lyme disease. When bezerianos form of infection Lyme borreliosis can manifest with systemic manifestations. Often in this stage, the lesion develops nervous and cardiovascular systems. Among the neurological syndromes for Lyme disease the most typical serous meningitis, encephalitis, peripheral radiculoneuritis, facial nerve neuritis, myelitis, cerebellar ataxia, etc. during this period manifestations of Lyme disease may include throbbing headache, photophobia, myalgia, neuralgia, significant fatigue, sleep disorders and memory disorders cutaneous sensitivity and hearing, lacrimation, peripheral paralysis and paresis, etc.
Cardiac syndrome in Lyme disease is in most cases presented atrioventricular block of various degrees, rhythm disturbances, myocarditis, pericarditis, dilated cardiomyopathy. For joint damage characteristic of the migratory myalgia and arthralgia, bursitis, tendinitis, arthritis (usually in the form of monoartrit major joints, less symmetric polyarthritis). In addition, during the disseminated stage of Lyme disease may include skin lesions (multiple erythema migrans, lymphocytoma), urinary system (proteinuria, microhematuria, orchitis), eye (conjunctivitis, iritis, chorioretinitis), respiratory tract (tonsillitis, bronchitis), digestive system (hepatitis, hepatolienal syndrome).
Chronic (stage persistence) Lyme disease goes through 6 months — 2 years after the acute stage. In the late period of Lyme disease often have skin lesions in the form of atrophic acrodermatitis or benign lymphopenia or defeat of the joints (chronic arthritis). Atrophic acrodermatitis is characterized by the appearance of edematous erythematous lesions on the skin of the extremities that develops over time atrophic changes. The skin becomes thin, wrinkled, it appears telangiectasia and sklerodermopodobnaya changes. Benign, lymphocytoma has the appearance of a reddish-cyanotic node or plaque with rounded shapes. Usually localized on the face, ears, axillary or inguinal region; in rare cases it may transform into malignant lymphoma.
For chronic Lyme arthritis is characterized not only by the defeat of the synovial membrane of joints, but also periarticular tissues, leading to the development of bursitis, tendinitis, ligamentitis, entezopatii. By its clinical course of arthritis in the later stages of Lyme disease resembles rheumatoid arthritis, Reiter’s disease, ankylosing spondylitis, etc. In the late stages of chronic arthritis radiological findings revealed thinning of the cartilage, osteoporosis, regional Uzury.
In addition to skin and joint syndromes, for chronic stage Lyme disease can develop neurological syndromes: encephalopathy, chronic encephalomyelitis, polyneuropathy, ataxia, chronic fatigue syndrome, dementia. When transplacentary infection in pregnancy can result in intrauterine fetal death and miscarriage. Have live births fetal ineccepibili to prematurity, causing the formation of congenital heart defects (aortic stenosis, coarctation of the aorta, the endocardial fibroelastosis), delay of psychomotor development.
Diagnosis of Lyme disease
During diagnosis of Lyme disease should not be underestimated epidemiological history (visiting forests, parks, the fact that the tick bites) and early clinical manifestations (migratory erythema, flu-like syndrome).
Depending on the stage of Lyme borreliosis, to identify the causative agent in biological fluids (serum, synovial fluid, cerebrospinal fluid, skin biopsies) are used with microscopy, serological tests (ELISA or RIF) and the PCR study. To assess the severity of organ-specific lesions can be performed radiography of the joints, ECG, EEG, a diagnostic puncture of the joints, lumbar puncture, skin biopsy, etc.
Differential diagnosis of Lyme disease is conducted with a wide range of diseases: serous meningitis, tick-borne encephalitis, rheumatoid and reactive arthritis, Reiter’s disease, neuritis, rheumatism, dermatitis, erysipelas. It should be borne in mind that false-positive serological reactions may occur in patients with syphilis, infectious mononucleosis, relapsing fever, rheumatic diseases.
Treatment of Lyme disease
Patients with Lyme disease be hospitalized in the infectious hospital. Drug therapy takes into account the stage of the disease. At an early stage are usually assigned the tetracycline antibiotics (tetracycline, doxycycline) within 14 days, you can receive amoxicillin. In the transition of Lyme disease in the II or III stage and the development of articular, neurological and cardiac lesions it is advisable the use of penicillins or cephalosporins the course of 21-28 days. On the background of antibiotic therapy may be a reaction Arisa-Herxheimer a deterioration of the symptoms of spirochetes in connection with the death of Borrelia and the blood of endotoxins. In this case, antibiotic therapy for a short time stopped and then resumed at a lower dosage.
Pathogenetic treatment of Lyme disease depends on clinical manifestations and their severity. So, when obstipation symptoms shows detoxification therapy; arthritis – NSAIDs, analgesics, physical therapy; in meningitis, dehydration therapy. At a severe systemic course of Lyme disease appointed corticosteroids orally or in the form vnesustavnykh injection (with synovitis).
Forecast and prevention of Lyme disease
Early or preventive antibiotic prevents Lyme disease in disseminirovanne or chronic. If delayed diagnosis or development of severe CNS lesions occur persistent residual effects, leading to disability; it may be fatal. During the year after treatment ill with Lyme disease must be registered with infectious diseases specialist, neurologist, cardiologist, astrology to exclude chronic infection.
To prevent infection with tick-borne borreliosis when visiting the forest are required to wear protective clothing; use repellents against ticks; after a walk through the woods to inspect the skin for possible implementation of blood-sucking insect. If you find a tick it should be removed manually with tweezers or go to the nearest emergency room for appropriate manipulation by the surgeon. Extracted the tick should be delivered in a public health laboratory for rapid test on borrelii method darkfield microscopy. Not valid prophylactic tick treatment forests and grassland areas.