Lyme Disease: Symptoms and Treatment, photos

GENERAL

The first cases of systemic borreliosis were reported in 1975 in the US city of Lyme (CT). From several people received complaints of arthritis, which was combined with the annular erythema. The main carrier of infection was determined after 2 years, it has appeared iksoidny tick.

In 1981 he had a pathogen of the disease - previously unknown spirohetopodobnye bacteria of the genus Borrelia. They are also found in the blood and cerebrospinal fluid of victims, which helped to study in detail the origin and the epidemiology of Lyme disease.

10 facts about borreliosis:

• The name was given in honor of the city where the first cases of infection occurred. Later it turned out that in addition to North America, Lyme disease is prevalent in many countries in Asia and Europe.
• In Russia, Lyme disease is very common, it is able to identify as early as 1985.
• Natural carriers of the causative agent is the American white-tailed deer, dogs, Peromyscus, sheep, cattle and poultry, but reveal it in animal tissues proved difficult.
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• Based on the geographical spread of infection, infected ticks are transferred to the birds themselves during seasonal migration.
• Spirochetes-activators are mainly in the digestive organs, sometimes in the salivary glands of the tick, and transmitted to offspring.
• Iksoidnye mites prefer to live in mixed forests of the temperate climate zones. Their life expectancy is about two years. In the adult mites are found in large quantities at a height of not more than one meter from the ground. Here it is quite easy to move to the hair of mammals that pass by.
• In the human body pathogen enters transmisionno with saliva carrier at the time of suction. Rare cases of infection were recorded after receiving goats milk or unboiled on trituration arthropod precipitates on the surface of damaged skin.
• Infected with Lyme disease may be different people, regardless of age and gender. Most often infected children up to 15-16 years and adults aged 20-44 years.
• There is evidence of a possible transplacental transmission of the pathogen from mother to fetus.
• Borrelia are not transmitted between humans and from animals to humans.

Borreliosis characterized by distinct seasons, outbreaks of infections recorded in the spring and summer from May to September and correspond to the time iksoidnyh activity of ticks.

The area of ​​spread and tick-borne Lyme encephalitis It has common borders, so the co-infection of two types of agents of Lyme disease occurs with mixed symptoms.

After suffering an infectious disease resistant fail to develop immunity, after only 5-7 years may re-infestation.

CAUSES

Until recently, the causative agent of borreliosis used to be considered one type of spirochete - Borrelia burgdoiferi, but more detailed microbiological study provided information on the etiological heterogeneity of the disease Lyme. Now allocate ten species of the pathogenFor convenience combined in complex Borrelia burgdorferi sensu lata. Of the ten members of the group threatening the person are only three: B. garinii, B. burgdorferi sensu stricto, B. afzelii. These bacteria are gram-negative microaerophilic, in a laboratory culture they are quite demanding on the medium.

Bacteria complex spread across continents unevenly, their ability to cause certain symptoms varies depending on the type of pathogen bacteria. There are studies that confirm the relationship between the central nervous system and B. garinii. AT. burgdorferi sensu stricto is associated with arthritis, and V. afzelii cause atrophic dermatitis. For this reason, the signs observed in different habitats spirochetes will be different due to genetic heterogeneity of the complex.

The causative agent of Lyme disease, along with the secretions of the tick bite when gets under your skin. Together with blood and lymph infectious agent spreads in the body: First, the internal organs, lymph nodes and joints, and then affects the meninges. Death Borrelia provokes the release of endotoxins that is a signal for the development of immunopathological reactions.

CLASSIFICATION

Lyme disease forms:

• latent - confirmation of the diagnosis based on the results of laboratory analysis without showing symptoms of infection;
• manifest - confirmation of the diagnosis on clinical grounds, and data analysis.

Forms of the disease process and the nature of symptoms:

• Chronic - the defeat of the heart, nervous system, joints, duration of illness more than six months.
• Subacute - disease duration of 3-6 months, symptoms similar to acute.
• Acute - there is a defeat of the skin, joints, heart and central nervous system, disease duration less than three months, and erythema bezeritemnuyu isolated species.

Lyme disease stage:

• I stage - local infection in bezeritemnoy and erythematous form;
• Stage II - dissemination (meningeal, neurotic, cardiac, fever and mixed flow);
• The III stage - persistence (acrodermatitis, arthritis).

SYMPTOMS

The latent period lasts about 1-2 weeks. Then, a period of local infection, during which develop skin lesions, and toxicity syndrome. On the site of the bite formed papule, it is red, itchy, in this area there is swelling and soreness.

Papule peripherally expands and increases in diameter, this phenomenon is called erythema migrans tick. It is characterized by the formation of a ring diameter of about 20 cm with a clear red border, and less pronounced in the center of pigmentation. Most often within one or two months of erythema migrans suddenly disappear, in its place is a pigmentation and signs of flaking. Against the background of erythema appear obscheinfektsionnye signs.

Obscheinfektsionnye symptoms of stage I Lyme disease:

• chills;
• weakness;
• fever;
• joint pain;
• headache;
• an increase of regional lymph nodes;
• conjunctivitis;
• hives;
• sore throat, runny nose.

The initial stage of Lyme disease can result in self-healingOtherwise begins the transition to the next stage.

Disseminated stage of developing long-term, over the next 3-5 months after infection throughout the body.

If Lyme disease is manifested in the form of bezeritemnoy (without skin redness), the Lyme disease makes itself known to the system of the body lesions.

Neurological syndrome of Lyme disease:

• Bell's palsy;
• encephalitis;
• cerebral ataxia;
• aseptic meningitis;
• throbbing headache;
• radiculoneuritis;
• Bannwart syndrome;
• myelitis;
• neuralgia;
• memory loss;
• fast fatigue;
• sleep disturbance;
• photophobia;
• myalgia;
• hearing loss;
• decrease in skin sensitivity;
• paresis and paralysis.

Cardiac syndrome of Lyme disease:

• atrioventrtikulyarnye blockade;
• myocarditis;
• Heart arythmy;
• pericarditis;
• dilated cardiomyopathy.

Signs of joint damage:

• migrating pain in muscles and joints;
• bursitis;
• tendonitis;
• arthritis of large joints.

Symptoms of skin lesions:

• lymphocytoma;
• erythema migrans.

Symptoms of organ damage:

• iritis;
• choroiditis;
• Panophthalmitis;
• conjunctivitis.

Symptoms of the excretory and reproductive system:

• red blood cells in the urine sample;
• orchitis;
• proteinuria.

Symptoms of upper respiratory tract:

• bronchitis;
• pharyngitis;
• tracheobronchitis;
• angina.

Symptoms of the digestive tract:

• hepatitis;
• Banti's syndrome.

Six months later (or in a period not exceeding two years), the acute phase of Lyme disease becomes chronic. At this stage usually reveal skin lesion akrodermatitom, benign limfoplaziey or chronic arthritis joints.

The characteristic features of the chronic stage of Lyme disease:

• In atrophic acrodermatitis the extremities appear inflamed areas of the skin at the site after which the inflammatory infiltration observed atrophic processes.
• Limfotsitomy benign on the surface of the ears, the face, in the inguinal folds and armpits appear reddish-blue round knotsWhich in rare cases can be transformed into malignant tumors.
• Furthermore skin lesions, for chronic phase is characterized as pathological changes in bone. At this stage, the symptoms are very similar to the symptoms of rheumatoid arthritis, Reiter's disease and ankylosing spondylitis.
• Among neurological manifestations borellioza last stage is isolated encephalopathy, ataxia, dementia, constant tiredness, polyneuropathy, chronic encephalomyelitis. they usually appear between one to ten years after infection. The chronic form of Lyme disease is characterized by undulating course with alternating periods of exacerbation and remission of symptoms.

Transplacental infection of the fetus may result in fetal death. Neonates marked prematurity, heart defects and neurodevelopmental delay.

DIAGNOSTICS

The initial phase of the diagnosis involves the collection of epidemiological history with the study of the early symptoms of the disease.

Data for anamnesis in the early stage of the disease:

• Active areas of epidemic spread iksoidnyh mites, forests and parks;
• fact of tick bite;
• spring and summer;
• erythema at the site of the bite;
• rashes on the body;
• fever;
• inflammation in the tissues of the joints;
• Voltage neck.

Laboratory diagnostic methods:

• Complete blood count - for the acute course characterized by rate increase of ESR and leukocytosis.
• Investigation of cerebrospinal fluid. When the tension of the neck muscles, nausea and vomiting performed a lumbar puncture for bacteriological examination of cerebrospinal fluid.
• PCR helps to identify bacterial DNA and antibodies to Borrelia of different body fluids. This method is mainly used for research purposes.
• Serological methods (RNIF, ELISA) are designed to detect antibodies to Borelli.

Typically, the diagnosis is enough presence of erythema migrans. At the initial stage of Lyme disease serological techniques can not detect the traces of the pathogen.

Difficulties arise in the diagnosis of the detection forms of the disease occurring without skin rash, and chronic borreliosis.

The differential diagnosis is carried out with a wide range of diseases that have similar symptoms. For an exception of certain pathologies carried serological analysis. However, false positive results are detected and associated with infectious diseases such as syphilis, mononucleosis, fever and rheumatic diseases.

TREATMENT

borreliosis treatment conducted a comprehensiveIts basis is causal therapy aimed at suppression of the pathogen. Timely antibacterial treatment is the prevention of Lyme disease severe complications and pathology of transition in the chronic stage.

The main stages of therapy:

• The patient is admitted to hospital infectious hospital departments. Exceptions are patients with erythema migrans without signs of toxicity, treatment may be carried out at home. In identifying late forms of the patient is directed for treatment in specialized cardiac, neurological and rheumatological hospitals depending on the clinical manifestations.
• drug therapy It depends on the stage of the disease. Antibiotics are often accompanied by a reaction due to the release of endotoxins and development against the backdrop of Borrelia spirochetosis death. In this case, antibiotic treatment is temporarily stopped and then resumed with lowering their dosage.
• In case of mixed infection (Lyme disease and encephalitis) in patients receiving antibiotics used immunoglobulin by tick encephalitis. Accelerate the elimination of toxins contribute to cardiovascular drugs and anti-oxidants.

The result of the treatment is assessed by the dynamics of clinical manifestations. For optimal rehabilitation recommended physical therapy course, Massage and oxygenation. During the chronic disease treatment shown in spas during remission. Persons who have had Lyme disease, subject to dispensary observation for two years.

COMPLICATIONS

Among the possible negative effects should be allocated borellioza irreversible changes in the nervous systemHeart and inflammatory joint disease, which in the absence of proper treatment lead to disability and, in severe cases, can become a cause of death.

PREVENTION

Specific prevention in the form of borreliosis vaccine does not existSo the only effective method of protection methods are non-specific. They is to use measures to prevent tick bites.

Prevention of infection borelliozom:

• limit walking in the forest areas of epidemic spread of ticks during the period of greatest activity;
• before taking a stroll in the woods to wear clothing that hides the exposed areas;
• individually apply repellents;
• after emerging from the forest to inspect the body, hair and clothes for ticks presence;
• removing the tick bite site to be treated or any antiseptic iodine;
• study the possibility of tick borreliosis infection in the laboratory;
• examine blood for the presence of specific antibodies one month after the bite;
• with an increase in body temperature, or the appearance of local redness at the bite area immediately seek medical attention;
• holding protivokleschevye forest treatments, belts and places of mass recreation.

FORECAST FOR RECOVERY

If early detection of Lyme disease and for preventive treatment with antibacterial drugs favorable prognosis. These measures prevent the transition to chronic course and prevent the development of serious complications. Sometimes, tick-borne Lyme ends of self-healing in the early stages, but in the blood remain high titers of antibodies to the pathogen. In this case, we recommend a second course of antibiotics and symptomatic treatment.

Late diagnosis with detection of lesions of the nervous system and internal organs often leads to low efficiency of medical actions. In most such cases, the outlook for the full treatment is unfavorable.

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