Lyme disease is a transmissible pathology, the causative agents of which are pathogenic bacteria of the genus Borrelia.
It is very difficult to talk about the prevalence of pathology, which in many sources is called the "great imitator." This name is due to the polymorphism of the clinical manifestations of Lyme disease, in connection with which patients have symptoms that cause them to turn to neuropathologists, dermatologists or rheumatologists, and not to infectious diseases.
Lyme disease is very common in Europe, North America, Australia and Asia. In recent years, the number of patients with this diagnosis has increased in Russia and Ukraine. This is due to the high sensitivity of the human body to borrelia. Many well-known personalities have been ill with this disease - Avril Lavigne, Ashley Olsen, Richard Gere and others.
The causative agent of the disease are bacteria of the borrelia genus from the Spirochaetaceae family. Carriers of pathogens are Ixodes ticks (I.ricinus, I.pacificus, I.damini). An infected tick is contagious at any stage of its development. This means that both the larvae, the nymphs, and the adults of arthropods are fully capable of causing human infection with borrelia with the further development of Lyme disease.
Infection of a person occurs when tick saliva enters the damaged areas of the skin. There is another way of infection - contamination, when the contents of a crushed tick is rubbed into the skin during scratching it itchy areas. In addition, there are cases of transmission of pathology by the placental route. A surge in pathology is observed in the spring and autumn period.
Stage of the disease
Conventionally, Lyme disease is divided into 3 stages:
- The first stage continues for 30 days after the tick bite. At this time, the patient has a general malaise, there are flu-like symptoms. During the crescent, the patient may increase body temperature to 40 degrees. Sometimes signs of intoxication can be observed. During this period, an increase in the spot at the site of the tick bite can be noticed. Early treatment helps to get rid of the spot in a few days. If the therapy has not been performed, it can remain on the body for up to 2 months.
- At the second stage of development, the disease passes in the absence of treatment. After a few weeks or months, the nervous system is damaged, the patient has a skin rash (like urticaria), heart pain occurs. At this stage, a sore throat often occurs, and renal, hepatic and ocular pathologies develop. Relapse of bronchitis may occur.
- The third stage of Lyme disease develops approximately 2-3 (or 5-6) months after the end of phases 1 and 2. At this time, the pathology goes into a phase of chronicity. The patient complains of constant fatigue and loss of strength, sleep disturbance and depressive states. At this stage, the process of destruction of various internal organs and systems continues.
Symptoms of Lyme Disease
The incubation period of the disease is 1-2 weeks. The first symptoms of Lyme disease do not have specific features, and they are expressed:
- aching joints;
- muscle weakness;
- general malaise and weakness.
Neck stiffness is one of the symptoms characteristic of Lyme disease. At the site of the bite ring-shaped redness is formed, which is the main manifestation of the migrating ring-shaped erythema. During the first days, a small macula or papule is formed, and then the erythema begins to spread, affecting large areas of skin. Along the edges, the redness has a bright tint, it rises a little above the epidermis. In the middle the ring is paler.
Round erythema can reach 10-2 cm in diameter. It is often localized on the legs, less often in the lumbar region, neck, abdomen, axilla, or inguinal region.
In the acute period of the disease may occur:
- nausea with vomiting;
- pain in muscles and joints;
- meningeal symptoms.
After 1-3 months, the disease can go to stage 2 of development. At this time, neuralgic and cardiac symptoms manifest.
Systemic tick-borne borreliosis is accompanied by the development of meningitis in combination with cranial nerve neuritis and radiculoneuritis. Atrioventricular block is noted among the most frequent cardiac symptoms. Myocarditis and pericarditis may develop.
Over time, the occurrence and increase of shortness of breath, increased heartbeat, chest pain. The last, 3, stage of development of Lyme disease is extremely rare. It comes approximately in 6 months, or 1-2 years. When it develops, damage to the joints (chronic Lyme arthritis), skin (atrophic acrodermatitis), and the nervous system (chronic neurological syndrome) occurs.
Symptoms of the chronic form
One of the most frequent symptoms of borreliosis is the development of arthritis, which may be accompanied by other chronic processes in the patient's body. In particular, it concerns the development of osteoporosis, the thinning of cartilage, and sometimes their complete loss, less often (in more severe cases) - degenerative changes.
Often there is a lesion of the skin, accompanied by the formation of a benign nodule - lymphocytoma, which has a crimson hue and a convex, rounded shape. When pressing on its surface, the tumor-like growth can become painful.
The most common location of such an infiltrate is the nipple of the breast and earlobe. Lymphocytoma can persist on the human body for several months, or even years.
Atrophic acrodermatitis is characterized by the appearance of cyanotic red spots in the extensor areas of the arms and legs. They are prone to peripheral enlargement and fusion. This, in turn, can lead to the development of systemic inflammation.
Over time, the skin in the area of spots atrophies and becomes similar to papyrus. The development of such a pathological process may continue for several months or years.
Lyme Disease - Photo
In the photo below you can see what Lyme disease looks like.
The diagnosis is made on the basis of a carefully collected history and analysis of the clinical picture observed in the patient. Since the peddler of pathology is a tick, the patient must remember whether there has been a visit to a forest, forest belt, or parks in the recent past. However, not all people notice the tick bite, so a timely visit to the doctor is a rare phenomenon.
To confirm or refute the diagnosis of Lyme disease, a specific diagnosis is carried out, consisting in the use of serological methods of blood analysis - ELISA and ELISA. Performing such diagnostic manipulations helps to identify in the patient's biomaterial immunoglobulins (antibodies) of the IgG and IgM classes.
However, in the first phase of the development of the disease, serological research methods are not informative in 50% of cases. For this reason, re-examination of blood serum is carried out after 20-30 days.
Through PCR, it is possible to accurately detect Borrelia DNA in a sample of skin tissue, cerebrospinal fluid, or blood.
It is very important to conduct a differential diagnosis of Lyme disease from diseases with similar symptoms. This list includes:
- tick-borne encephalitis;
- erysipelas of the skin;
- erisepeloid and others
From these diseases it is necessary to distinguish borreliosis at 1 stage of development. In the second phase, differential diagnosis should be carried out in order to exclude different forms of tick-borne encephalitis, rheumatic carditis or cardiopathy. At stage 3 of progression, pathology should be differentiated from rheumatoid arthritis, rheumatism, Reiter's disease, and reactive arthritis. For such a diagnosis, synovial fluid is used for further morphological studies.
Lyme Disease Treatment
Patients with this diagnosis are necessarily hospitalized in the hospital of the infectious disease ward. Pharmacological agents are prescribed taking into account the phase of the pathology.
Patients with mild borreliosis, as a rule, are prescribed tetracycline antibiotics (Tetracycline, Doxycilin). Medications are taken for 14 days. If necessary, may be prescribed the drug Amoxicillin.
The transition of Lyme disease to stage 2 and 3, accompanied by damage to the joints, nervous system and heart, requires the use of antibiotics of cephalosporin or penicillin. The course of therapy lasts from 3 to 4 weeks.
During the passage of antibiotic therapy, the patient may experience or aggravate the symptoms of spirochetosis. This is due to the process of death and elimination of Borrelia from the body, as a result of which endotoxins begin to actively flow into the blood. Under such circumstances, the antibiotics are temporarily stopped, after which it is resumed.
Treatment of Lyme disease largely depends on the associated symptoms. So, with the defeat of the joints are used NSAIDs, analgesics, and also conducted courses of physiotherapy. In the event of the occurrence of general infectious symptoms, detoxification therapy is carried out, and during meningitis, dehydration treatment is resorted to. If the development of severe systemic inflammation occurs, the patient is prescribed GCS for oral administration, or intra-articular injections are given (with the development of synovitis).
Lyme disease can lead to:
- Brain complications. The most severe course of pathological processes that hit the central nervous system. Inflammation of the meninges, peripheral or cranial nerve fibers may develop.
- Cardiac complications. Untreated borreliosis is fraught with the development of endocarditis or pericarditis.
- Joint complications, in particular, their inflammation.
To date, specific measures for the prevention of Lyme disease does not exist. Therefore, it is important to be careful in places where a person is most susceptible to tick bites.
When leaving the forest park zones, forest belts or forests, the body must be carefully protected. The easiest way is to wear a long-sleeved shirt with a high collar and long pants. If a tick has been detected on the body, it must be carefully removed. This should be done with gloves, using pre-disinfected tweezers. If the manipulation is successful, it is necessary to clamp the tick behind the head and remove it with twisting movements.
Do not push the tick - it can lead to the release of its pathological contents on healthy skin. After the procedure, the wound should be washed with antiseptic, and then - thoroughly wash your hands.
If there are pets in the house, they should be inspected after each walk, as ticks are often attached to animals.
Favorable prognosis is possible only with timely detection and treatment of the disease. There are cases when systemic tick-borne borreliosis stopped at an early stage of development, leaving behind the so-called "serological tail".
Unfavorable is the prognosis in patients who have long remained abnormally high levels of immunoglobulin IgG. In this case, repeated antibiotic therapy is indicated along with symptomatic treatment. Patients who have undergone pathology should be under observation in the conditions of CID during the year. During this time, clinical diagnostic tests are carried out every 14-21 days, 3, 6 and 12 months.
While preserving the skin, neurological or rheumatic symptoms, the patient is sent to specialized medical specialists. Further studies are conducted taking into account the patient's history.