Symptoms of Lyme disease in humans. Tick-borne borreliosis (Lyme disease) - symptoms, treatment and consequences of borreliosis. Pathogenesis of Lyme disease
Lyme borreliosis is widespread in the habitat of ixodid ticks, namely in the northern hemisphere. In our country, about 8 thousand new cases of the disease are registered annually; all age categories are affected, but more than 10% of the sick are children. Ixodid ticks can be carriers of several infections at the same time, so when bitten by one tick, a person is at risk of contracting several infections.
What kind of disease is this?
Lyme disease (tick-borne borreliosis) is an infectious natural focal vector-borne disease, which is caused by spirochetes and transmitted by ticks and has a tendency to recurrent and chronic course and predominantly damage the skin, nervous system, heart and musculoskeletal system.
Causes of Lyme disease
The causative agent of the disease is several species of Borrelia - B. garinii, B. burgdorferi and B. afzelii. These are gram-negative spirochetes that grow on media containing amino acids, animal serum, and vitamins.
- The natural hosts of Borrelia are rodents, deer, and birds. When bloodsucking, borrelia end up in the tick's intestines (where they multiply) and are then excreted in the feces. The circulation of the pathogen in natural foci occurs according to the following scheme: ticks - wild birds and animals - ticks.
- Infection with Lyme disease in humans occurs in natural foci of borreliosis through a tick bite. But there is a possibility of infection if tick feces come into contact with the skin during subsequent scratching. If the tick is removed incorrectly, if it ruptures, Borrelia can enter the wound. A nutritional route of transmission of the pathogen is also possible - through the consumption of raw cow's or goat's milk.
Infection with Lyme disease (borreliosis) occurs when visiting forests, forested areas inside cities, or when removing ticks from domestic animals.
The peak incidence of borreliosis occurs from May to June.
What happens in the human body
The causative agent of tick-borne borreliosis enters the body with the saliva of the tick. From the site of the bite, borrelia travel through the blood and lymph to internal organs, lymph nodes, and joints. The pathogen spreads along the nerve pathways, involving the membranes of the brain in the pathological process.
The death of bacteria is accompanied by the release of endotoxin, which triggers immunopathological reactions. Irritation of the immune system activates general and local humoral and cellular responses. The immediate production of IgM antibodies, and a little later IgG, occurs in response to the appearance of the flagellar flagellar antigen of bacteria.
As the disease progresses, the set of antibodies to Borrelia antigens expands, which leads to long-term production of IgM and IgG. The proportion of circulating immune complexes increases. These complexes are formed in the affected tissues and activate inflammatory factors. The disease is characterized by the formation of lymphoplasmatic infiltrates in the lymph nodes, skin, subcutaneous tissue, spleen, brain, and peripheral ganglia.
Classification
In the clinical course of Lyme disease, there is an early period (stages I-II) and a late period (stage III):
- I – stage of local infection (erythema and non-erythema forms)
- II – stage of dissemination (course options – febrile, neuritic, meningeal, cardiac, mixed)
- III – stage of persistence (chronic Lyme arthritis, chronic atrophic acrodermatitis, etc.).
According to the severity of pathological reactions, Lyme disease can occur in mild, moderate, severe and extremely severe forms.
Symptoms
The incubation period for Lyme disease from infection to symptoms is usually 1-2 weeks, but it can be much shorter (a few days) or longer (months to years).
Symptoms typically appear from May to September, as tick nymphs develop during this time, causing most infestations. Asymptomatic infections do occur, but statistically account for less than 7% of Lyme disease infections in the United States. The asymptomatic course of the disease is more typical for European countries.
The first symptoms of Lyme disease are nonspecific: fever, headache, chills, muscle aches, weakness. A characteristic symptom is stiffness of the neck muscles. A ring-shaped redness (erythema migrans) forms at the site of the tick bite. In the first 1–7 days, a macula or papule appears, then over the course of several days or weeks the erythema expands in all directions. The edge of the redness is intensely red, slightly raised above the skin in the form of a ring, in the center the redness is somewhat paler. Round erythema, 10–20 cm in diameter (up to 60 cm), is most often localized on the legs, less often on the lower back, abdomen, neck, axillary, and groin areas. In the acute period, symptoms of damage to the soft meninges may appear (nausea, headache, frequent vomiting, photophobia, hyperesthesia, meningeal symptoms). Pain in muscles and joints is often noted.
After 1–3 months, stage II may begin, which is characterized by neurological and cardiac symptoms. Systemic tick-borne borreliosis is characterized by a combination of meningitis with neuritis of the cranial nerves and radiculoneuritis.
The most common cardiac symptom is atrioventricular block; myocarditis and pericarditis may develop. Shortness of breath, palpitations, and compressive pain in the chest appear. Stage III develops rarely (after 0.5–2 years) and is characterized by damage to the joints (chronic Lyme arthritis), skin (atrophic acrodermatitis), and chronic neurological syndrome.
What Lyme disease looks like: photo
The photo below shows how the disease manifests itself in people.
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Chronic symptoms
If the disease is treated ineffectively or not treated at all, a chronic form of the disease may develop. This stage is characterized by alternating remissions and relapses, but in some cases the disease has a continuously relapsing nature. The most common syndrome is arthritis, which recurs over several years and acquires a chronic course through the destruction of bones and cartilage.
Changes such as osteoporosis, thinning and loss of cartilage, and less commonly degenerative changes are observed.
Among the skin lesions there is a benign lymphocytoma, which has the appearance of a dense, edematous, crimson nodule (infiltrate) and causes pain on palpation. A typical syndrome is acrodermatitis atrophica, which causes atrophy of the skin.
Diagnosis of Lyme disease
A thorough history is critical to diagnosing Lyme disease. It is important not to miss the facts indicating the possibility of infection with tick-borne borreliosis (country walks, tourist trips, etc.). Experts also pay attention to the presence of primary signs of the disease: skin erythema and general intoxication.
Depending on the stage at which the disease develops, various serological and immunological laboratory tests are used (PCR, RIF, ELISA, microscopic studies, etc.). In order to identify structural disorders of various organs and tissues, additional research methods are used, prescribing fluoroscopy, puncture followed by laboratory examination of the material, electrocardiogram, biopsy of epidermal tissue, etc.
A differential diagnosis should be made with diseases such as: encephalitis, rheumatoid arthritis, dermatitis of various origins, neuritis, rheumatism, Reiter's disease and others with similar symptoms. In patients suffering from syphilis and various autoimmune diseases (infectious mononucleosis or rheumatism), serological reactions can be false positive, which requires additional confirmation of the diagnosis.
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Complications
Among the likely negative consequences of borelliosis are irreversible changes in the nervous system, heart and inflammatory diseases of the joints, which, in the absence of proper treatment, lead to loss of ability to work, and in severe cases cause death.
Lyme disease treatment
If characteristic symptoms of Lyme disease are detected, comprehensive treatment is carried out in an inpatient infectious diseases hospital.
In stage I, antibiotic therapy is indicated for 2-3 weeks:
- Doxycycline 100 mg 2 times a day
- Amoxicillin 500 mg 3 times a day (children 25-100 mg/kg/day) orally
- Reserve antibiotic - ceftriaxone 2.0 g IM 1 time per day
Against the background of antibacterial therapy, the development of the Jarisch-Herxheimer reaction (fever, intoxication against the background of mass death of Borrelia) is possible. In this case, antibiotics are stopped for a short time, and then taken again at a lower dose.
For stage II Lyme disease, antibacterial therapy is prescribed for 3-4 weeks:
- If there are no changes in the cerebrospinal fluid, doxycycline 100 mg 2 times a day or amoxicillin 500 mg 3 times a day orally is indicated
- If there are changes in the cerebrospinal fluid - ceftriaxone 2 g 1 time / day, cefotaxime 2 g every 8 hours or benzylpenicillin (sodium salt) 20-24 million units / day IV
At stage III the following is used:
- Doxycycline 100 mg 2 times a day or amoxicillin 500 mg 3 times a day orally for 4 weeks
- If there is no effect, ceftriaxone 2 g 1 time / day, cefotaxime 2 g every 8 hours or benzylpenicillin (sodium salt) 20-24 million units / day intravenously for 2-3 weeks.
Early treatment usually leads to a person’s complete recovery. Chronic stages can lead to disability and death (irreversible changes in the nervous and cardiovascular systems). After completion of treatment, regardless of its effectiveness, the person is registered with an infectious disease specialist and specialized specialists.
Prevention
When visiting a forested area (park area), general prevention boils down to using repellents and wearing clothing that covers the body as much as possible. In case of a tick bite, you should immediately contact the clinic, where it will be correctly removed, the bite site will be examined and further monitoring of your health will be provided.
If a person is often at his own summer cottage, it would not be superfluous to carry out acaricidal measures. After walking your dog, you should carefully examine your pet for ticks on its body.
It is an infectious disease common in certain areas inhabited by the microorganism that causes it. The correct and full name of this infection is systemic tick-borne borreliosis, but in addition to this, the following names are used to designate the disease: tick-borne meningopolyneuritis, tick-borne borreliosis, ixodid borreliosis, chronic migratory erythema, erythemal spirochetosis, Bannowart's syndrome and Lyme disease. However, in everyday life the short names most often used are borreliosis, Lyme disease or Lyme borreliosis.
The infection occurs in stages, affecting the joints, nervous system and sometimes the heart, and is completely curable if antibiotic therapy is started within a short period of time after the onset of the disease.
A distinctive feature of borreliosis is that the infection is not transmitted from a sick person to a healthy person, and infection occurs only through the bite of a tick that carries the causative microbe. Borreliosis can affect people of any gender and age, including young children and the elderly.
Borreliosis - general characteristics, history of discovery and names of the infection
Systemic tick-borne borreliosis is an infection with a long-term relapsing course caused by the spirochete Borrelia burgdorferi. The infection is transmissible, since infection occurs only through the bite of ixodid ticks, which are carriers of Borrelia. Borreliosis is not transmitted from person to person, so the patient is completely safe for others.The infection received the name “borreliosis” from the Latin name of the spirochete – Borrelia burgdorferi, which is its causative agent. And the name Lyme disease was given by the name of the city of Lyme in Connecticut, where an outbreak of infection was first registered in 1975 and its main symptoms were described. All other names for this infection are derived either from borrelia (borreliosis), or from the leading clinical signs (tick-borne meningopolyneuritis), or from the name of ticks that carry spirochetes (ixodic or tick-borne borreliosis, etc.).
Lyme disease was discovered after a study of Connecticut teenagers, who had juvenile arthritis 100 times more often than their peers from other areas of the United States. Doctors and scientists became interested in this anomaly, examined the children, took samples of synovial fluid from the joints, from which they were able to inoculate the spirochete Borrelia burgdorferi, which turned out to be the causative agent of the disease.
Borreliosis occurs in three successive stages, developing at different intervals after infection. At the first stage (acute), a person develops general infectious symptoms of intoxication (fever, headaches and muscle pain, weakness, drowsiness, etc.) and erythema migrans. Erythema forms at the site of a tick bite and is a spot that is constantly increasing in diameter with a bright red outer rim and a light inner part. This first stage of borreliosis develops a few days or weeks after a tick bite and infection with spirochetes, and lasts up to 1 month. After completion of the first, acute stage of borreliosis, either recovery occurs, or the infection becomes chronic and stages 2 and 3 develop.
At the second stage of borreliosis, a person develops damage to either the nervous system or the heart. As a result of damage to the nervous system, a person develops peripheral neuropathies (numbness of the limbs, loss of sensitivity in certain areas of the arms and legs, etc.), meningitis, radiculitis, etc. And damage to the heart is characterized by the development of palpitations, pain in the heart, blockades, etc. The second stage of infection can last up to six months.
At the third stage of borreliosis, a person develops arthritis, which is combined with damage to either the nervous system or the heart, depending on which organ was involved in the pathological process at the second stage. In addition to arthritis, atrophic dermatitis often develops at the third stage of borreliosis.
A distinctive symptom of the first stage of borreliosis is erythema, which appears on the body at the site of the tick bite in 80% of cases. Erythema first appears as a small red nodule or vesicle, from which redness gradually spreads around the perimeter, forming a kind of rim. The surface of the skin inside the rim may be red or normal. The diameter of the erythema is constantly increasing, which is why it is called migratory. As a rule, the erythema is round in shape, but can sometimes be oval. Erythema usually increases to 20 cm in diameter, and in rare cases up to 60 cm. In the area of erythema, the skin is very itchy, there is a burning sensation and severe pain. Since erythema appears at the site of a tick bite, it is most often localized on the stomach, lower back, legs, armpits, neck or groin.
General infectious symptoms of intoxication in combination with erythema are specific for borreliosis, allowing one to suspect this infection. In addition to erythema, a rash, urticaria, as well as pinpoint and ring-shaped rashes may appear on the skin.
In 5–8% of people in the first stage of borreliosis, signs of brain damage appear, such as:
- Headache;
- Nausea;
- Vomiting more than 2 times a day;
- Photophobia;
- Increased sensitivity of the skin (even a light touch causes a burning sensation, pain, etc.);
- Tension of the neck muscles;
- Head thrown back;
- Legs pressed to stomach.
In very rare cases, the first stage of borreliosis is manifested by anicteric hepatitis with the following symptoms - loss of appetite, nausea, vomiting, pain in the liver, increased activity of AST, ALT and LDH in the blood.
Thus, the first stage of borreliosis can occur with the development of very diverse and polymorphic symptoms, among which erythema migrans is considered constant. Other symptoms (except erythema) may vary. In approximately 20% of cases, erythema migrans is the only clinical symptom of borreliosis.
The first stage lasts from 3 to 30 days, after which it either passes into the second or ends with recovery. The probability of complete recovery when adequate antibiotic therapy is started at the first stage is 80%. If recovery does not occur, then the infection enters the second stage. Moreover, the second stage will develop, even if the first was asymptomatic and was not properly treated.
Stage II of borreliosis
Stage II of borreliosis develops due to the spread of borrelia throughout the body through the blood and lymph. The beginning of the second stage of borreliosis occurs at the end of 1–3 months after the appearance of the first clinical symptoms of infection (erythema and intoxication). At the second stage of borreliosis, predominant damage to the nervous system or heart develops, and depending on which organ is involved in the pathological process, neurological or cardiac symptoms appear.
Damage to the nervous system in the second period of borreliosis is characterized by the development of meningitis or meningoencephalitis, combined with cranial nerve paresis and peripheral radiculopathy. With meningitis, a person develops a severe throbbing headache, repeated vomiting, neck tension, photophobia and elevated body temperature. And with meningoencephalitis, the indicated meningeal symptoms are accompanied by disorders of sleep, memory, concentration and emotional lability.
Peripheral radiculopathy is manifested by wandering pain from the neck to the arms and from the lower back to the legs, as well as impaired sensitivity in the extremities (numbness, tingling, burning, etc.) and a decrease in the strength of some muscles.
A distinctive feature of borreliosis is the combination of meningitis with cranial nerve palsies and radiculopathy. This most common symptom complex of neurological disorders at stage 2 of borreliosis is called Bannovart's lymphocytic meningoradiculoneuritis. If treatment with antibiotics is not started at the second stage, borreliosis meningitis can last up to several months.
In rare cases, damage to the nervous system during borreliosis is manifested by neuritis of the oculomotor, optic and auditory nerves.
At the second stage of borreliosis, in addition to the nervous system, the heart is also affected, which, however, is observed much less frequently. Heart damage can occur as a transient atrioventricular block, pericarditis or myocarditis. When borreliosis affects the heart, a person develops the following symptoms:
- Heartbeat;
- Chest pain of a compressive nature;
- Dizziness.
Damage to the nervous system and heart are most characteristic of the second stage of borreliosis. However, in addition to them, skin lesions may develop, occurring in the form of capillaritis, rashes and a single benign lymphocytoma.
Erythema and benign lymphocytoma of the skin are the most specific symptoms of borreliosis. Externally, such a lymphocytoma looks like a single convex nodule on the skin, painted in a bright crimson color and slightly painful when touched. Lymphocytomas can be localized on the face, genitals and groin area.
In addition to the above symptoms, at the second stage of borreliosis, nonspecific clinical manifestations may develop, such as:
- Conjunctivitis;
- Iritis;
- Chorioretinitis;
- Panophthalmos;
- Angina;
- Hepatitis;
- Splenitis (inflammation of the spleen);
- Orchitis (inflammation of the testicles);
- Microhematuria (blood in the urine);
- Proteinuria (protein in urine);
- Weakness;
- Severe fatigue.
III stage of borreliosis
Stage III of borreliosis begins 0.5–2 years after the appearance of the first clinical symptoms of infection (or 3–6 months after completion of stages 1 and 2) and continues for many years. In fact, the transition of the infection to the third stage means the chronicization of the pathological process and, accordingly, the development of chronic borreliosis. The third stage is characterized by the development of arthritis, atrophic acrodermatitis or neurological syndromes similar to neurosyphilis. Joint damage at the third stage of borreliosis can occur in three forms:
1.
Arthralgia (migrating pain moving from one joint to another);
2.
Benign recurrent arthritis;
3.
Chronic progressive arthritis.
Migrating arthralgia is recorded in 20–50% of cases and is almost always combined with muscle pain. Moreover, the most severe pain develops in the neck muscles. With arthralgia, there are no inflammatory changes in the joints, but the pain is so severe that the person is literally immobilized. Such joint pain continues for several days in a row, is combined with weakness, fatigue and headache, after which it suddenly and independently disappears. From time to time a person experiences similar attacks of arthralgia.
When benign recurrent arthritis develops, it usually affects the knees or other large joints. The pathological process involves one or a maximum of 3 joints. Arthritis occurs with alternating relapses and remissions. Relapses last 1–2 weeks and are characterized by pain in the affected joints, swelling and limited mobility. Remissions last from several weeks to months. Moreover, as the disease progresses, the frequency of relapses decreases, and the duration of remissions increases. Within 4–5 years, relapses completely disappear, and arthritis ceases to bother the person. Due to the fact that arthritis can go into remission for a long time, it is considered benign.
Chronic arthritis affects several joints at once (more than three) and occurs as a constant inflammatory process. With this type of arthritis, a person experiences pain, swelling, poor mobility and limited movement in the affected joints, as well as erosion of cartilage and bones. Very often, the tissues surrounding the joint are involved in the pathological process, as a result of which arthritis is complicated by bursitis, ligamentitis, enthesopathies, osteoporosis, thinning of cartilage, as well as osteophytosis (layering of a loose inflammatory mass on the bone). Sometimes chronic borreliosis arthritis is combined with pannus (inflammation of the cornea of the eye).
In addition to joint damage, in the third period of Lyme disease, a pathological process develops in the skin, occurring as atrophic acrodermatitis or focal scleroderma.
Acrodermatitis atrophica begins with the appearance of red-blue patches on extensor surfaces such as the knees, elbows, dorsum of the hands, and soles. In the area of the spots, a dense inflammatory infiltrate, swelling and impaired lymph outflow in the affected area can form. This inflammatory phase continues for years and slowly turns into a sclerotic phase. In the sclerotic phase, the skin on which there were red and blue spots atrophies and becomes like crumpled thin paper.
In the third stage of borreliosis, atrophic acrodermatitis in 30% of cases is combined with damage to the joints, and in 45–50% with late neurological complications, such as disturbances of sensitivity or movement. The most characteristic late neurological complications of stage III borreliosis are chronic encephalomyelitis, spastic paraparesis, chronic axonal polyradiculopathy, memory loss, and dementia.
Chronic encephalomyelitis is characterized by constant headaches, fatigue, dizziness, nausea, periodic vomiting, convulsions, hallucinations, as well as impaired memory, attention, speech, coordination of movements, sensitivity, etc.
Spastic paraparesis is characterized by an increase in muscle tone of various parts of the body with the development of uncontrolled pathological reflexes and movements.
Chronic axonal polyradiculopathy is characterized by the following manifestations:
- Muscle weakness in the lower extremities (hands, feet). With severe weakness of the leg muscles, stepping develops - “cock gait”;
- Decreased or complete loss of tendon reflexes;
- Impaired sensitivity in the final parts of the arms and legs, covering areas of the skin like “socks” and “gloves”. Sensitivity disturbance manifests itself in the feeling of goosebumps, burning, tingling, loss of the ability to feel temperature, vibration, touch, etc.;
- Violation of the coordinated functioning of blood vessels, as a result of which a person experiences attacks of palpitations, hypotension, impotence, etc.
Chronic Lyme disease
Chronic borreliosis is the third stage of infection, the clinical manifestations of which are described above. Chronic borreliosis develops if the infection is not treated or if ineffective therapy is used. The disease occurs with alternating remissions and exacerbations.With chronic borreliosis, joint damage (arthritis), atrophic acrodermatitis or benign skin lymphocytoma develops. Arthritis can lead to complete destruction of the cartilage and bone of the joint, as a result of which the latter becomes functionally inferior and must be replaced with a prosthesis to maintain mobility.
Borreliosis (Lyme disease): incubation period, symptoms and manifestations of the disease - video
Borreliosis in children
Borreliosis usually affects children over 7 years of age. Preschool children (under 7 years old) very rarely become ill with borreliosis, even if they are bitten by an infected tick carrier.The course of the disease and clinical signs in children are exactly the same as in adults. However, children are characterized by the development of meningitis as a manifestation of damage to the nervous system, while adults more often develop peripheral nephropathies (nerve paresis, radiculitis, etc.).
Due to the predominant damage to the central nervous system, after recovery from borreliosis, children may remain asthenovegetative reactions, such as mood instability, increased excitability and sleep disorders. These reactions disappear completely after some time.
Diagnosis of borreliosis
General diagnostic principles
To diagnose borreliosis, specific epidemiological data are taken into account - the presence of a tick bite during the previous 1 - 3 months. If there was one, then the body is examined to identify migrating erythema. Then, regardless of whether erythema was detected, the following signs specific to borreliosis are actively identified:- Serous meningitis, meningoencephalitis, polyradiculoneuritis or neuritis of the cranial nerves;
- Arthritis of one or more joints;
- Impairment of atrioventricular conduction of the heart II or III degrees, myocarditis or pericarditis;
- A single benign lymphocytoma on the earlobe or nipple;
- Chronic atrophic acrodermatitis.
Analysis for borreliosis (blood for borreliosis)
Borrelia is detected in the blood using the following blood tests:- Indirect immunofluorescence reaction (IRIF);
- Enzyme-linked immunosorbent assay (ELISA);
- Polymerase chain reaction (PCR);
- Immunoblotting.
When performing an ELISA test, the result can be positive or negative. Positive means that antibodies to borrelia have been detected and, accordingly, the person is infected with borreliosis. A negative test result means that a person does not have Borrelia in his blood.
When carrying out PCR and immunoblotting, Borrelia are detected directly and their quantity per unit volume of blood (most often 1 ml) is determined. Accordingly, if the analysis indicates that borrelia have been detected and their quantity is indicated, then this means the presence of borreliosis in a person.
The simplest, most accessible and quite effective tests for borreliosis are ELISA and RNIF, for which it is necessary to donate blood from a vein. However, for a reliable diagnosis, two studies should be performed with an interval between them of 4–6 weeks to determine not only the presence of infection, but also its dynamics.
Borreliosis - treatment
Treatment of borreliosis involves taking antibiotics to which Borrelia burgdorferi is sensitive. At the same time, antibiotics, duration and scheme of their use are different for the treatment of borreliosis at different stages and with different predominant clinical manifestations. Let's consider what antibiotics are used at different stages of borreliosis to treat damage to certain organs and systems. So, for the treatment of borreliosis at the first stage(within a month after the onset of clinical symptoms), the following antibiotic treatment regimens are used:
- Amoxicillin (Amosin, Ospamox, Flemoxin Solutab, Hiconcil, Ecobol) - take 500 mg 3 times a day for 10 - 21 days;
- Doxycycline (Xedocin, Unidox Solutab, Vidoccin, Vibramycin) - take 100 mg 2 times a day for 10 - 21 days;
- Cefuroxime (Axetin, Antibioxime, Zinnat, Zinacef, etc.) – take 500 mg 2 times a day for 10 – 21 days;
- Azithromycin (Sumamed, etc.) – take 500 mg once a day for a week (the least effective antibiotic);
- Tetracycline - take 250 - 400 mg 4 times a day for 10 - 14 days.
If neurological symptoms are present
- Doxycycline (Xedocin, Unidox Solutab, Vidoccin, Vibramycin) - take 100 mg 2 times a day for 14 - 28 days;
- Benzylpenicillin – administer 5,000,000 units intravenously every 6 hours (4 times a day) for 14–28 days;
- Chloramphenicol (Levomycetin) - taken orally or administered intravenously 500 mg 4 times a day for 14 - 28 days.
- Ceftriaxone (Azaran, Axone, Biotraxone, Ificef, Lendacin, Lifaxone, Medaxone, Rocephin, Torocef, Triaxone, etc.) - administered intravenously at 2000 mg 1 time per day for 2 - 4 weeks;
- Penicillin G – administered intravenously at 20,000,000 units once a day for 14–28 days;
- Doxycycline (Xedocin, Unidox Solutab, Vidoccin, Vibramycin) - take 100 mg 2 times a day for 21 days;
- Amoxicillin (Amosin, Ospamox, Flemoxin Solutab, Hiconcil, Ecobol) - take 500 mg 3 times a day for 21 days.
- Amoxicillin (Amosin, Ospamox, Flemoxin Solutab, Hiconcil, Ecobol) - take 500 mg 4 times a day for 30 days;
- Doxycycline (Xedocin, Unidox Solutab, Vidoccin, Vibramycin) - take 100 mg 2 times a day for 30 days (can be taken in the absence of neurological symptoms);
- Ceftriaxone (Azaran, Axone, Biotraxone, Ificef, Lendacin, Lifaxone, Medaxone, Rocephin, Torocef, Triaxone, etc.) - administered intravenously at 2000 mg 1 time per day for 2 - 4 weeks;
- Penicillin G – administered intravenously at 20,000,000 units once a day for 14–28 days.
- Amoxicillin (Amosin, Ospamox, Flemoxin Solutab, Hiconcil, Ecobol) - take 1000 mg once a day for 30 days;
- Doxycycline (Xedocin, Unidox Solutab, Vidoccin, Vibramycin) - take 100 mg 2 times a day for 30 days.
During treatment with antibiotics, a person may develop multiple rashes or several erythemas on the body, as well as develop a temporary exacerbation of symptoms. This should not be feared, since such a response from the body is called the Jarisch-Gersheimer reaction and indicates the success of the treatment.
If borreliosis has been detected in a pregnant woman, then she should take Amoxicillin 500 mg 3 times a day for 21 days. No other therapy is required, since this course of antibiotic therapy is sufficient to prevent transmission of the infection to the fetus.
In addition to antibiotic therapy, which is aimed at destroying borrelia in the human body, in the complex treatment of borreliosis, symptomatic treatment methods are used to help eliminate the painful manifestations of the infection. Symptomatic methods are used to improve the general condition and relieve symptoms that are poorly tolerated by a person.
itching
Prevention of infection
Unfortunately, there is no specific prevention of borreliosis (vaccination). Therefore, the only possible prevention of infection is nonspecific, which consists in minimizing the risk of ticks getting on the human body.Since ticks live in grass and leaves, it is necessary to avoid being in places where you will have close contact with vegetation (forests, parks, etc.). If a person is going “out into nature,” then he should dress in light-colored clothing that covers the body as much as possible: a long-sleeved shirt, pants with an elastic band at the ankle, a scarf around the neck, a hood or cap on the head, etc. In addition, exposed areas of the body should be treated with tick repellents.
While in a forest or park, you should inspect your body for ticks every two hours. Also, while in nature, you need to sit in the grass as little as possible and have contact with the foliage of bushes and trees.
Prevention of borreliosis after a tick bite
After a tick bite, to prevent borreliosis, you must take a combination of the following antibiotics:- Doxycycline – 100 mg 1 time per day for 5 days;
- Ceftriaxone - 1000 mg 1 time per day for three days.
Lyme disease (borreliosis): prevalence and causative agent of infection, signs and manifestations (symptoms), complications, diagnosis (rapid test), treatment (antibiotics), prevention - video
Consequences of borreliosis
The consequences of borreliosis are various neurological and cardiac symptoms that remain as a result of irreversible changes in these organs during the active course of the infection. Before use, you should consult a specialist.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, and muscle pain are observed. The joints are hot, swollen and painful (the knee joints are most often affected), pain in the 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 misdiagnosed as rheumatoid arthritis, meningitis, or multiple sclerosis.
Weakness, mood changes and neurological symptoms are common causes of misdiagnosis of mental illness and 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.
The meninges in the first stage of the disease are rarely affected, as a rule, in patients with a damaged 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 types of meningitis, meningoencephalitis, cranial nerve palsy 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 of the facial nerve, which is often bilateral. In addition, a number of patients experience radiculoneuritis, mainly in the cervical and thoracic regions. Their manifestations include characteristic acute pain 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 types of Borrelia, and tick-borne encephalitis is caused by the 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 are palpated, and subsequently the abdominal organs. 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 pulmonary diseases ( 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
| Laboratory research (analysis) | Methodology | Interpretation of results |
| General blood analysis | For this analysis, up to 5 ml of venous blood or up to 2 ml of blood from a finger prick is used ( in children). |
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| General urine analysis | The analysis requires collecting, mainly, an average portion of morning urine after a thorough toilet of the external genitalia in an amount of 20 to 100 ml. |
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| Blood chemistry | For this analysis, up to 20 ml of venous blood is required. |
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| Bacteriological examination of biological samples | This study requires a minimum amount of biological medium that potentially contains a pathogen. Suitable samples include blood, the skin of the marginal zone of erythema migrans, a fragment of benign lymphocytoma, a fragment of a skin area of atrophic acrodermatitis, and, less commonly, cerebrospinal fluid, sputum, joint fluid and urine. For prenatal diagnosis, amniotic fluid or cord blood obtained by cordocentesis is used. |
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| Serological blood test (method of paired sera, enzyme immunoassay, indirect immunofluorescence reaction, etc.) | For this study, 5 - 10 ml of venous blood is collected. The method is applicable no earlier than two weeks after infection ( time required for the first antibody peak to form). |
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| PCR (polymerase chain reaction) | For this study, a minimal amount of any biological medium potentially containing Borrelia is used. Dense media ( leather) it is preferable to homogenize before testing. The principle of the method is to detect in the sample at least one DNA fragment corresponding to Borrelia DNA. PCR is one of the most modern and highly accurate express methods for diagnosing borreliosis. |
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| Histological examination of the biopsy specimen | This study requires a small piece of tissue ( better at least three fragments), presumably containing Borrelia. The most suitable substrate is altered skin ( erythema migrans, benign lymphocytoma, acrodermatitis atrophicus), as well as pathologically altered organ fragments. Histological examination has almost absolute diagnostic accuracy. |
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Instrumental studies prescribed for borreliosis
| Instrumental research | Methodology | Interpretation of results |
| X-ray of joints | During this examination, the patient is in the position assigned to him by the radiologist or his assistant. As a rule, not only the disturbing composition is examined, but also the second one, which does not cause inconvenience. The photographs are taken in at least two mutually perpendicular projections. |
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| Chest X-ray | During this study, the patient is in a standing position, pressing his chest against the plane of the X-ray table. The picture is taken at the height of inspiration. If suspicious lesions are detected, an additional image is taken in the lateral projection, and, if necessary, a targeted image is taken. |
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| Magnetic resonance imaging of the brain and internal organs | During this study, the patient is in a supine position on the machine table. The table itself is fed into a tunnel, the walls of which are a powerful electromagnet. During the examination, the patient must remain motionless for at least 30 minutes, and in some cases more. The principle of the magnetic resonance imaging method is to register a stream of photons of certain wavelengths, which are emitted by hydrogen atoms in the patient’s body in a powerful alternating magnetic field. |
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| Electrocardiography | During electrocardiography, the patient is in a supine position or sitting on a chair. Electrodes connected to an electrocardiograph are attached to his limbs and chest according to a certain pattern. When the device is turned on, the electrical activity of the heart muscle is recorded. The information is output in the form of numerous curves printed on paper tape or displayed on the monitor screen. |
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| Echocardiography | During this study, the patient is in a supine position. The researcher applies a special gel to the heart area that reduces interference from air between the sensor and the skin. He then applies an ultrasound probe to various control points on the chest and visualizes the various cavities of the heart, along the way noting their size, wall thickness and their mobility. In conclusion, the doctor describes the pathological changes that he identified during the study. |
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| Electrophysiological study of the heart | During this study, the patient is in a supine position, completely undressed, as during a regular surgical intervention. Through an incision in the radial or femoral artery or vein ( depending on which cavity of the heart needs to be entered) a special probe is inserted into the heart cavity. Its special feature is the ability to read the electrical activity of the heart directly from its cavity with the highest accuracy. With the help of targeted low-power discharges, this probe causes the appearance of paroxysmal tachycardias, which it itself subsequently stops. The purpose of the method is to identify additional intracardiac conduction pathways that provoke the development of attacks of paroxysmal tachycardia and their destruction by ablation ( burning). |
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| Ultrasound (ultrasonography) internal organs | During this study, the patient's position is arbitrary. However, more often he is lying on his back. A special gel is applied to the abdominal area to reduce interference caused by air getting between the emitter and the skin. Then the researcher alternately applies the ultrasound emitter tube to different parts of the abdominal cavity, alternately visualizing certain organs, determining their size and composition. Upon completion of the study, a record of all measurements and observations taken is made. At the end of the recording, the doctor makes a conclusion regarding the pathological changes he observed in the patient and the possible causes of the latter. |
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| Dermatoscopy | During this study, the patient is in a random position. Using special magnifying optics, the doctor examines all suspicious skin formations, noting those changes that are not visible to the naked eye. |
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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 physical therapy are effective mainly during the recovery period when the articular apparatus and nervous system are damaged. 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 an alcohol or aqueous solution of 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. Conventionally, antibiotics for the 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 severe syndrome of increased intracranial pressure, in some cases a catheter is installed connecting the subdural space with the jugular vein. The purpose of this catheter is to continuously drain excess cerebrospinal fluid. However, due to the large number of side effects, especially with long-term use, it is extremely rare to install such a catheter.
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. Prescribing such treatment during the acute period of 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, fresh salads made from parsley, sorrel, soaked dandelion leaves, and sauerkraut are extremely beneficial. 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 for the use of 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.
Methods of 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. There have even been isolated cases of 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 test 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 a higher incidence of 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 all tissues of the newborn’s body, most severely affecting the nervous and cardiovascular systems. 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 retardation in mental 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 nonspecific protection products for the 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 widely used, could be equal to or even exceed the rates of severe cases of 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, the determination of 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 is 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.
Tick-borne borreliosis, Lyme borreliosis, Lyme disease are the names of one pathology that affects the nervous, cardiovascular systems, skin and musculoskeletal system. The disease occurs over a long period of time in acute or chronic form with different variants of clinical manifestations. Symptoms of Lyme pathology are caused by the immune system’s reaction to the penetration of bacteria into the human body.
What is Lyme disease
Tick-borne borreliosis is an infectious vector-borne disease that is caused by five species of bacteria of the spirochete genus Borrelia. Lyme disease is a common tick-borne infection in the Northern Hemisphere. Early manifestations of the disease are headaches, fever, and skin rash. If there is a genetic predisposition, then after a bite from an infected ixodid tick, the heart, nervous system, joints, and eyes are involved in the pathological process.
The outcome of Lima disease largely depends on the correctness and timeliness of the diagnosis. In most cases, symptoms are completely relieved by antibacterial drugs. Late initiation of treatment and/or incorrect therapy can lead to a chronic course of the disease, which is difficult to cure. The late stage of the disease can result in disability or even death for a person.
Causes
Lyme disease is caused by a spirochete, a gram-negative bacterium that has a spiral shape with a rotating slow movement. In addition to infected ticks, birds, dogs, rodents, small and cattle can become carriers of the pathogen. The main mechanism of infection transmission is transmissible. The pathogen enters the bloodstream with the feces or saliva of the carrier. Sometimes the alimentary route of infection occurs when consuming raw milk (mostly goat milk). Transplacental transmission of infection from a pregnant woman to the fetus has also been proven.
Classification
Lyme syndrome is distinguished by the form of the disease: latent and manifest. The first is diagnosed accidentally only based on the results of laboratory tests. In this case, the disease does not show any symptoms. The manifest form is confirmed by the presence of clinical signs. According to the nature of the pathological process, tick-borne borreliosis is divided into types. There is a chronic, subacute and acute course of the disease.
If the pathological process lasts more than 6 months, affecting the nervous system, heart, joints, then this is a chronic type of disease. In the subacute course of the disease, symptoms similar to acute ones last from 3 months to six months. If damage to the skin, central nervous and cardiovascular systems is observed for up to 3 months, this is an acute period of infection. Lyma disease is also classified according to signs of infection (seronegative, seropositive) and by stages:
- the first is a local infection that occurs in an erythema or non-erythema form;
- the second is dissemination (spread of the pathogen throughout the body);
- the third is persistence (degeneration into arthritis, acrodermatitis and other diseases).
Symptoms of Lyme disease in humans
The incubation period for Lyme disease lasts from 2 to 50 days. In rare cases, the disease manifests itself over several months and sometimes years. After the incubation period, symptoms of the disease begin to appear, caused by a combination of immunopathological reactions. Tick-borne borreliosis is characterized by a staged course, therefore three degrees of infection are distinguished, each of which has its own clinical picture. The early period of the pathological process is stages 1 and 2, which manifest themselves in an acute form. The late phase of the disease is stage 3, which can last for years.
First stage
A distinctive sign of the first stage of borreliosis is erythema that appears at the site of the tick bite. First, a small bubble appears, from which redness spreads around the perimeter, forming a rim. The diameter of the erythema gradually increases, so doctors call it migratory. Sometimes the oval or round inflamed area itches, there is a burning sensation, and pronounced pain.
In addition to erythema, urticaria, rash, ring-shaped and pinpoint rashes sometimes appear on the skin. Vesicles and areas of necrosis may occur. At the first stage, 8% of patients exhibit symptoms of encephalopathy (damage to brain cells):
- nausea, vomiting;
- chills;
- headache;
- mild photophobia;
- increased sensitivity of the skin;
- legs pressed to the stomach;
- the head is thrown back due to strong tension in the neck muscles.
Second stage
Between 1 and 3 months after the first symptoms of Lyme disease appear, the second stage of infection develops, affecting the heart or nervous system. Depending on which organ is involved in the pathological process, cardiac or neurological problems appear. Damage to the central nervous system is characterized by the development of meningitis, meningoencephalitis, which are combined with peripheral radiculopathy and cranial nerve paresis.
The person experiences repeated vomiting, severe headache, and tense neck muscles. These symptoms are accompanied by memory, sleep, attention, and emotional lability disorders. If the heart is affected, the disease proceeds as pericarditis, myocarditis or atrioventricular block. Against the background of cardiac problems, the patient develops the following symptoms:
- dizziness;
- compressive pain in the sternum;
- dyspnea;
- heartbeat.
Third stage
Lyme disease enters the third stage 3-6 months after the completion of stage 2 of the pathological process. At its core, this transition means incomplete phagocytosis and chronic infection, which can last for several years. The third stage is characterized by the occurrence of atrophic acrodermatitis, arthritis, and neurological syndromes similar to manifestations of neurosyphilis. Joint damage occurs in three forms: migrating pain (arthralgia), benign recurrent arthritis and chronic progressive osteoporosis.
Over time, chronic axonal polyradiculopathy develops, which is characterized by the following symptoms:
- decrease or loss of tendon reflexes;
- weakness of the muscles of the lower extremities;
- dry skin;
- impaired sensitivity in the limbs;
- disruption of the coordinated functioning of blood flow, resulting in attacks of hypotension, palpitations, and impotence.
Complications
If the bacterium is not killed by antibiotics at the first stage of the disease, when the pathological process has spread only to the skin, then over time the infection penetrates through the blood and lymph into all systems and organs of the human body. The difficulty of diagnosis lies in the fact that the symptoms of borreliosis often appear only at a late stage of the disease. In some cases, the consequences become irreversible. The most severe complications of infection:
- inflammation of the meninges;
- damage to the facial nerve;
- chronic inflammation of the brain;
- psychosis;
- photophobia;
- dementia;
- impaired concentration;
- deterioration of vision, hearing;
- loss of appetite, anorexia
- development of benign skin lymphocytoma.
Diagnostics
To make a diagnosis, it is necessary to collect an epidemiological history and study the early symptoms of tick-borne borreliosis. The doctor takes into account the following factors:
- visit by the patient to epidemic areas where ticks are spread (parks, forests);
- the fact of a tick bite;
- presence of rashes, erythema;
- spring-summer period;
- increased body temperature;
- neck muscle tension;
- inflammatory processes in the joints.
In addition to collecting anamnesis, laboratory tests are needed:
- General blood analysis. In the acute course of the disease, the ESR rate is increased.
- Cerebrospinal fluid examination. If the patient has nausea, vomiting and stiffness of the neck muscles, a puncture is performed for bacteriological analysis of the cerebrospinal fluid.
- Serological ELISA method. Enzyme immunoassay helps to detect latent and acute infections in the body and identify antibodies to Borrelia.
- PCR diagnostics. Polymer chain reaction can identify bacterial DNA for research purposes.
Lyme disease treatment
In mild forms of the pathological process, etiotropic and pathogenetic therapy is carried out on an outpatient basis. Lyme disease of the third degree requires hospitalization of the patient. In both cases, continuous use of antibiotics is prescribed for 14 to 21 days. If the first course of antibiotic therapy does not give the desired result, then re-treatment is prescribed, but with a different antibacterial drug, which can last another 30 days.
With long-term use of antibiotics, an exacerbation of the symptoms of spirochetosis may occur due to the release of endotoxins into the blood and the death of borrelia. In this case, taking antibacterial drugs should be stopped for a while. After a few days, the course of antibiotic treatment is resumed, but the drugs are prescribed in a lower dosage.
When a mixed infection is detected (Lyme borreliosis and tick-borne encephalitis), immunoglobulin (anti-tick gamma globulin) is used along with antibiotics. To speed up the elimination of toxins, doctors additionally prescribe antioxidants (Resveratrol, Bifidum), vascular drugs (Ginkgo biloba, Vinpocetine). For optimal rehabilitation, the patient is recommended to undergo a course of massage, physical therapy and oxygenation.
initial stage
In the first degree of the disease, which passes without damage to internal organs and in the presence of erythema, aminopenicillins (Amoxiclav, Amoxicillin) and tetracyclines (Doxycycline, Oxytetracycline) are prescribed orally. Antibiotic therapy started at an early stage will prevent further progression of borreliosis. Antibiotics are prescribed in a course on an individual basis. The average dosage is 100-200 mg/day, divided into two doses. The course of treatment is from 14 to 21 days.
In case of dysfunction of the nervous system
Almost half of patients with Lyme borreliosis experience damage to the nervous system when the disease enters the second stage. Treatment with antibiotics is carried out by intravenous administration. Penicillin and cephalosporins (Ceftaroline, Ceftobiprole) are prescribed. Course duration is 2-3 weeks. With antibacterial therapy, neurological symptoms almost always undergo regression.
Additionally, drugs are prescribed that affect the metabolism of brain cells, microcirculation and vascular tone (Cellex, Carnitex). They are taken orally or administered subcutaneously for 10 days (for moderate pathologies). If necessary, the course can be repeated after 10 days. To control the pain syndrome for up to 5 days in a row, analgesics (Baralgetas, Spazmalgon) and/or non-steroidal anti-inflammatory drugs (Ketonal, Nurofen) are used.
With cardiac damage
If cardiac myocardial damage develops against the background of Lyme borreliosis, then, in addition to antibiotic therapy (Doxycycline, Vancomycin), it is advisable to use cardiac glycosides (Strophanthin, Korglykon). To avoid thromboembolic complications, anticoagulants (Warfarin, Curantil) are prescribed. To improve metabolism in the myocardium, metabolic therapy is needed (Asparkam, Riboxin, Potassium Orotate). If this therapy does not produce the desired results, the patient is prescribed immunosuppressants (Cyclosporine) and glucocorticosteroids (Prednisolone).
For arthritis
In Lima disease, arthritis most often affects the hips, ankles, wrists, and elbows. It is treated with oral antibiotics (Doxycycline, Amoxicillin) for 4 weeks. If arthritis persists after antibiotic therapy, then it is necessary to carry out antirheumatic treatment, which consists of prescribing non-steroidal anti-inflammatory drugs (Movalis, Celebrex) and corticosteroids (Celeston, Decdan), which are injected directly into the joint. The dosage and course of treatment are prescribed by the doctor individually.
Forecast
Tick-borne borreliosis, diagnosed at an early stage, has a favorable prognosis. Preventive antibiotic therapy prevents the disease from becoming chronic or disseminated. With late diagnosis and severe damage to the central nervous system, persistent residual effects develop, which can lead to disability or death. After completion of treatment, patients who have recovered from Barreliosis must be registered with a neurologist, infectious disease specialist, arthrologist and cardiologist for a year in order to exclude chronicity of Lyme pathology.
Preventing Lyme disease
Measures to prevent infection with spirochetal infection:
- when visiting forests, you should wear clothing that maximally protects the entire body;
- use repellents that repel blood-sucking insects;
- after a walk, you need to carefully examine your skin for the presence of flares;
- if an insect is found, it must be removed using tweezers;
- if you cannot remove the tick yourself, you need to go to the nearest emergency room for appropriate manipulation by a doctor;
- even in the absence of any manifestations of infection, it is necessary to take a blood test for the presence of antibodies to the pathogen no later than 3-4 weeks after the bite.
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