Disease Лайма: симптомы, лечение, диагностика,prevention

Update: October 2018

Disease Лайма (другие названия Лайм-боррелиоз, клещевой
Borreliosis) refers to infectious, natural focal,
mainly transmissible diseases with a variety of
variants of clinical manifestations. Lyme Disease Symptom Complex
due to the immune response of the body to the introduction of bacteria (see
what tick bites look like).

The most common symptoms of ixodic tick-borne
borreliosis is a headache, fever and skin rash characteristic
a form called erythema migrans or erythema afcelius. AT ряде
cases, the infectious process encompasses heart tissue, joints and
nervous system.

The danger of the disease cannot be minimized, as well as
to exaggerate. With своевременном начале лечения болезнь может быть
completely cured without the risk of complications and chronitization. Later
Lyme borreliosis stages are difficult to cure, often ending
disability and even death of a person.

Story

The name of the infection is associated with the city of Lyme, Connecticut in
United States, where for the first time in 1975 an outbreak of
characteristic symptoms. Since 1991, borreliosis is included in
official list of nosologies available in Russia.

ATозбудитель инфекции

ATозбудителем инфекции являются грамотрицательные бактерии
Borrelia of the Spirochaetaceae family. AT Европейских странах и
Russia, the primary pathogens of pathology are Borrelia
afzelii and Borrelia garinii, prevailing in the United States
the amount of borreliosis is caused by borrelia burgdorferi.

The vectors and distributors of the infectious agent are
ticks of the genus Ixodes, whose infection in different areas
varies between 10-70%. Lyme borreliosis is one of
the most common diseases that are transmitted to humans
through the bite of infected ticks.

Prevalence of Lyme borreliosis and risk groups

Pathology is widespread in north america as well
Europe and Asia. In Russia, the disease annually
registered in 6-8 thousand inhabitants of the country. Pathology does not have
age limits and can occur with any person
bit infected tick. AT группу риска попадают дети и
adolescents up to the age of fifteen and adults 25-45 years, and
also people professionally associated with work in the forest.

Withродный резервуар и факторы риска

The reservoir of infection (carriers of bacteria) is wild and domestic
animals, mainly rodents, mammals – dogs, goats,
Sheep that look healthy and expose them
bacteria carrier is quite difficult. Ticks (bacteria carriers)
infected by sick animals.

The peak of infection falls in the spring and summer. Activity
ticks are observed from April to October, but lately
cases of early (March) and late (November-December) bites
arthropods, which is associated with general climatic warming and
gradual adaptation of ticks to more severe conditions
stay

Infection risk factors

  • Frequent visits to forests and forest park zones, wearing open
    clothes during walks, picnics, barbecues in unequipped
    �”Wild” places;
  • Prolonged presence of a tick on the body (more than 12 hours). Proven
    that previously removing a sucked tick reduces the risk of infection by several times
    person AT то же время, даже если клеща снимают ползающим по телу,
    the possibility of infection with Lyme infection is not excluded.

Immunity

Passive (intrauterine) immunity against infection is not
produced. Active immunity after the disease is unstable
and re-infection is possible even this season or through
some years.

Ways of transmission

  • Transmissible – main transmission path: – Ixodes tick
    eats on sick with borreliosis animal and becomes
    infected. ATторой вариант – вылупившиеся личинки от зараженной
    tick females may already be infected with a bacterium. – Infected tick
    sticks to the person, the bacterium enters the wound with saliva and
    фекалиями членистоногого, а через нее — в кровь person
  • Food – transmission of borrelia through raw milk infected
    animals, most often goats.
  • The transplacental route is the rarest variant. Broadcast
    bacteria occurs from a sick mother to the fetus in the intrauterine
    period.

Classification

According to the clinical course, there are 3 stages of the disease: According to the severity of pathological phenomena, 4 forms are distinguished.
course of the disease:
Signs of infection:
  • I – Local or local infection (non-erythema and erythema
    forms);
  • II – Dissemination or spread of the pathogen in the body
    (febrile, neuritic, meningeal, cardiac and
    mixed form);
  • III – Persistence or long-term survival of borrelia in
    human body (atrophic acrodermatitis, chronic
    borrelia arthritis, etc.).
  • Easy;
  • Moderate;
  • Heavy;
  • Extremely severe form.
  • Seronegative (antibodies to borrelia are present in the blood in
    diagnostic titer);
  • Seropositive (specific antibodies are not detected).

What happens in the body human

ATозбудитель клещевого боррелиоза попадет в организм со слюной
tick. From the site of the bite of borrelia by the flow of blood and lymph fall into
internal organs, lymph nodes, joints. Realizing the spread
возбудителя по нервным проводящим путям с вовлечением в
pathological process of the membranes of the brain.

The death of bacteria is accompanied by the release of endotoxin,
triggering immunopathological reactions. Immune irritation
system activates general and local humoral and cellular response.
Directly production of IgM antibodies, and a little later IgG occurs
in response to the appearance of flagellated flagellar antigen
bacteria.

As the disease progresses, the range of antibodies to
antigens of Borrelia, which leads to long-term production of IgM and IgG.
The proportion of circulating immune complexes is increasing.  Data
complexes form in the affected tissues and activate factors
inflammation. For the disease is characterized by the formation
lymphoplasmic infiltrates in the lymph nodes, skin,
subcutaneous tissue, spleen, brain, peripheral
ganglia

Symptoms of tick-borne borreliosis

Incubation period

The disease begins with a latent or incubation period,
which lasts for 7-14 days, but can be shortened as well as
lengthen.

Local infection

After incubation, a stage of local infection begins, including
intoxication and skin manifestations with a duration of about 30
days:

  • in the place of suction after a tick bite on average after 7 days
    a painful and itchy red papule is formed, with
    характерным периферическим ростом (мигрирующая erythema).
    Expanding, erythema forms a kind of ring 10-60 cm
    to diameter: the central part of pale color and bright red nimbus on
    the edges. Resolution of erythema occurs within 1-2 months. Patients
    may complain of itching and burning in this area. In place of erythema
    remains peeling and pigmentation;
  • obesity is characterized by an increase in
    fever, headache, fever, chills, muscle aches
    (especially cervical), joints and bones, weakness;
  • other symptoms of Lyme disease – rhinitis, pharyngitis, urticaria,
    conjunctivitis, rash on face, dry cough, punctate and small
    ring-shaped rash, regional lymphadenitis. ATследствие
    of these symptoms borreliosis is sometimes masked as catarrhal
    diseases, which is an unfavorable factor for further
    development (late, late treatment).

Disseminated stage

Develops in the next 3-5 months. ATарианты протекания
diseases – cardiac, febrile, mixed, meningeal,
neuritic

Stage persistence

Atrophic acrodermatitis, chronic Lyme arthritis and
pr. complications.

Non-edematous form

Non-edematous form чаще всего манифестируется системными
manifestations, namely the lesion of the cardiovascular system and NS:

Nervous system

The cardiovascular system

Pathological changes:

  • Serous meningitis
  • Meningocephalitis
  • Cerebral ataxia with movement disorders
  • Myelitis
  • Peripheral radiculoneuritis
  • Neuritis of the facial nerve
  • Atrioventricular block of varying degrees
  • Heart rhythm disorder
  • Myocarditis
  • Pericarditis
  • Dilated cardiomyopathy

Symptoms:

  • Throbbing headache
  • Myalgia, stiff neck
  • Neuralgia
  • Photophobia
  • Tearing
  • Loss of performance, sleep disorder
  • Hearing loss
  • Change in skin sensitivity
  • Paresis (weakening of motor function)
  • Peripheral paralysis (loss of reflexes, decreased muscular
    muscle tone and atrophy)
  • Pain in heart
  • Tachycardia or bradycardia
  • Atrial fibrillation
  • Dyspnea
  • Dizziness
  • Withступы удушья
  • Fainting
  • Irregular pulse
  • Dry cough
  • General malaise

In addition to damage to the heart and nervous system, the pathological
The process may involve other organs and systems:

  • Суставы: бурсит, миалгии и артралгии
    arthritis (more often than one large
    joint).
  • Кожа: лимфоцитома (доброкачественный
    dermatosis), migrating erythema.
  • Мочеполовая система: орхит яичка,
    microhematuria (blood in the urine), proteinuria (protein in the urine).
  • Eyes: chorioretinitis (inflammation of the choroid),
    conjunctivitis, iritis (inflammation of the iris).
  • Органы дыхания: бронхит, ангина.
  • Органы пищеварения: гепатолиенальный
    syndrome, hepatitis.

Chronitization of Lyme borreliosis occurs 6-24 months after
infection. Borrelia remain in the body for more than 10 years, but
The reasons for such long-term survival are unknown. Even with
Intensive antibacterial treatment of infection is difficult to take
control, periodically, against the background of reduced immunity, arise
recurrence of infection.

ATыделяют 3 варианта последствий болезни Лайма:

  • Atrophic acrodermatitis: the appearance of edematous reddish lesions
    on the skin of the legs and arms. AT дальнейшем на этом месте развиваются
    atrophic changes. The skin becomes thinner, wrinkled, with
    telangiectasias and scleroderm-like changes.
  • Benign lymphocytoma: the appearance of a red-blue node
    or plaques with rounded outlines on the skin of the face, ears,
    inguinal or axillary region. Very rarely malignancy is possible
    to lymphoma.
  • Chronic Lime Arthritis is the most common option.
    The lesion is characterized by recurrent joints. Celebrated
    defeat of the synovial membrane and oculo-articular tissue that
    leads to the development of tendinitis, bursitis, enthesopathy. Clinical
    the course is similar to rheumatoid arthritis. In terminal stages
    osteoporosis occurs, the thinning and destruction of cartilage tissue with
    loss of function of the affected joint.

In addition to the joints, neurological symptoms develop:
chronic encephalomyelitis, encephalopathy, polyneuropathy,
dementia, chronic fatigue.

When pregnant women are infected, the intrauterine is possible.
fetal death and miscarriage. If the fetus survives, children often
are born prematurely, with CDF of the heart, mental and
motor development.

Sometimes staging of the disease is not observed. In some cases
there is only a local reaction stage. Sometimes the disease manifests
only at a late stage or even in a chronic form. Disease
Lime in children proceeds with the same symptoms, but the child does not
can always correctly voice their complaints, so the leading role
playing laboratory diagnostics.

Diagnosis of tick-borne borreliosis

  • Anamnesis. As a rule, a person points to a tick bite or
    visiting forest and park areas.
  • Early clinical manifestations (colds, skin
    erythema).
  • Tick-borne borreliosis or Lyme disease: definition
    antibody titer in serum (titer 1:64 and above).
  • In the later stages: EEG, ECG, X-ray of the joints, biopsy
    skin.

It is mandatory to exclude diseases with similar
clinical course: tick-borne encephalitis, serous meningitis,
rheumatoid arthritis and others.

Treatment

Etiological treatment of Lyme disease

If diagnosed early, antibiotics from the group are prescribed.
tetracyclines (tetracycline, doxycycline) course for 14 days. With
intolerance to the latter and in childhood is possible
amoxicillin.

The subsequent stages with the development of cardiac, articular and
neurological lesions are treated with penicillins or cephalosporins
course acceptance 21-28 days.

In some cases, against the background of antibiotics occurs
Yarish-Herksheimer’s reaction, which is characterized by aggravation
symptoms of spirochetosis associated with the massive death of bacteria and
endotoxins in the blood:

  • temperature rise;
  • chills;
  • drop in blood pressure;
  • nausea;
  • headache;
  • Miaglia and so on.

With развитии реакции антибиотикотерапия приостанавливается на
some time, then resumes at the same dosage. AT
severe cases apply hormonal treatment.

Pathogenetic treatment of tick-borne borreliosis

  • With общеинфекционных явлениях: внутривенная и пероральная
    detoxification therapy – infusion of glucose, physiological
    solution, vitamins, antipyretic intake.
  • With поражении суставов: противовоспалительная и обезболивающая
    терапия – Анальгетики, НПATС.
  • With менингите: внутривенная дегидратационная терапия – трисоль,
    ringer’s solution.
  • With тяжелом клиническом течении болезни: гормональная
    therapy.

Forecast

Early treatment usually results in complete
man’s recovery. Chronic stages can lead to
disability and death (irreversible changes in the nervous and
cardiovascular systems). After the end of treatment out
Depending on its effectiveness, a person is registered with
infectious diseases and narrow specialists.

Prevention of Lyme borreliosis

Prevention measures are non-specific and common.
recommended, are to prevent the tick bite, as well as
Prevention of the alimentary route of infection:

  • With посещении лесов и парков одевать плотную одежду светлых
    tones.
  • Clothing should be tight to the body in the neck, wrists and
    ankles.
  • Pants should be tucked into socks and boots.
  • The head should be a headdress.
  • To repel arthropods on the skin or clothing should
    put repellents: Off, Det and others.
  • Avoid contact with tall grass, weeds, shrubs,
    thickets – such places should be avoided.
  • With вынужденном прохождении через валежник следует прокладывать
    yourself a way with a twig or stick, tapping on plants
    (there is a chance to shake the tick on the ground).
  • Every hour of the journey you should carefully inspect each
    other, especially the neck, underarms, chest: usually a tick
    sticks out not immediately, but chooses a favorable place.
  • Do not carry plants, branches, grass out of the forest – they can
    be tick.
  • Be sure to boil milk from dubious and unknown
    sources.

Lyme disease prevention measures at the state level
is mowing down recreation areas and areas adjacent to forest and
park paths, tick-borne treatment area
special insecticides.Как правильно снять клеща

Algorithm of action when a sucked tick is detected

  • Remove arthropod as early as possible, ideally in
    medical institution. With самостоятельном извлечении
    An anti-tick or loop of thread module is used, which
    throws on the front of the tick tight to the human skin,
    tighten and gently pull, and the wound process
    antiseptic. ATажно не повредить клеща, но даже если и так –
    collect all in a jar with a lid.
  • Visit the hospital – health workers will check whether all
    mite parts are removed from the wound, skin is treated and discharged
    arthropod research subject for
    contamination.
  • Take the tick to study in any accredited
    the lab. This should be done immediately, maximum – within 24 hours.
    Ticks should be stored in tightly closed containers before transport.
    in a refrigerator.
  • Withнимать профилактическую антибиотикотерапию, назначенную
    a doctor. As a rule, it is prescribed, without waiting for the result.
    studies (doxycycline or amoxicillin for 5-10 days).
    Ignoring the drug is not worth it: the disease is not easy, but
    tick results may be false negative.

Автор: врач-гигиенист, эпидемиолог

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