Lyme's disease – an inoculable infection as which causative agent the spirokheta of Borrelia getting to an organism at a sting of an ixodic tick acts. The clinical course of disease of Lyme includes local skin (chronic migrating to erity) and system (fever, mialgiya, a limfadenopatiya, neuritis of peripheral and cranial nerves, meningitis, encephalitis, miyelit, myocarditis, perikardit, oligoartrit, etc.) manifestations. Confirmation of the diagnosis of a disease of Lyme is promoted by kliniko-epidemiological data, identification of antibodies to borreliya by the activator REEF and DNA method by PTsR method. Etiotropny therapy of a disease Laima is carried out by antibiotics of a tetracycline row.
Lyme's disease – (, tick-borne borreliosis) – a natural and focal infectious disease as which carrier serves the ixodic tick. Lyme's disease is characterized by a complex of skin and system manifestations, is inclined to a chronic current. Statistically, every third studied tick is infected. Lyme's disease is widespread in North America, Europe and Asia. The disease received the name on the town Lyme (the State of Connecticut, the USA) where in 1975 there was an outbreak of an infection including such manifestations as arthritis, a carditis, meningitis. In Russia 6-8 thousand new cases of tick-borne borreliosis annually are registered. Lyme's disease can arise at any age, however is more often diagnosed for children and teenagers up to 15 years, and also adults at the age of 25-44 years. Due to the wide range of clinical manifestations tick-borne borreliosis is of clinical interest not only to infectious diseases, but also dermatology, neurology, cardiology, rheumatology, etc.
Etiologies of Lyme
The disease Laima is caused by gramotritsatelny spirokheta of the sort Borrelia of three types: B. burgdorferi (dominates in the USA), Borrelia garinii and Borrelia afzelii (prevail in Europe and Russia). Borreliya get into a human body in mainly inoculable way, at stings of the infected ticks (pasturable, forest, taiga) belonging to the sort Ixodes. The activator gets into blood with saliva of a tick or his excrements (at raschesa of places of a sting). The alimentary way of infection (for example is less often possible, at the use of raw cow's and goat milk) or transplacentary transfer of borreliya.
Domestic and wild animals are the tank and a source of spread of a disease of Lyme. The risk of infection with Lyme's disease increases during the spring and summer period (the season of activity of pincers lasts from April to October). As risk factors visits of the woods and the green space, and also long (more than 12-24 hours) presence of the infected tick on skin act. After the postponed Lyme's disease unstable immunity is developed; in several years perhaps repeated infection with tick-borne borreliosis.
Soon after a sting of a tick in the place of its introduction the complex of inflammatory and allergic reactions in the form of the migrating ring-shaped eritema develops in epidermis. From primary center with current of a lymph and blood of a borreliya extend on an organism, calling the cascade of immunopathological reactions in various bodies, mainly TsNS, joints, heart.
Classification of a disease of Lyme
In a clinical course of disease of Lyme distinguish the early period (the I-II stage) and the late period (the III stage):
- I – stage of a local infection (eritemny and bezeritemny forms)
- II – a dissemination stage (current options – feverish, nevritichesky, meningealny, kardialny, mixed)
- III – a persistention stage (the chronic Lime arthritis, chronic atrophic akrodermatit, etc.).
On degree of expressiveness of pathological reactions Lyme's disease can proceed in easy, medium-weight, heavy and extremely severe form.
Symptoms of a disease of Lyme
After the end of the incubatory period (about 7-14 days) there comes the stage of a local infection which is characterized by skin manifestations and an intoksikatsionny syndrome. On the place of a sting of a tick there is an itching, slightly painful papule of red color inclined to peripheral growth (the migrating tick-borne eritema). In process of expansion of a zone of reddening the migrating eritema takes a form of the ring with a diameter of 10-20 cm having a bright red nimbus at the edges and more pale central part. In most cases the migrating eritema at Lyme's disease is spontaneously allowed within 1-2 months, and on its place there is a weak pigmentation and a peeling. Local displays of a disease of Lyme are followed by an all-infectious syndrome: fever with oznoba, the headache, artralgiya, bone and muscles pains expressed by weakness. Urticaria, conjunctivitis, regionarny lymphadenitis, cold, pharyngitis can occur among other symptoms in the I stage.
Within the next 3-5 months the disseminirovanny stage of a disease of Lyme develops. At a bezeritemny form of an infection tick-borne borreliosis can demonstrate from system manifestations at once. Most often in this stage defeat of nervous and cardiovascular system develops. Among neurologic syndromes serous meningitis, encephalitis are most typical for Lyme's disease, peripheral radikulonevrit, neuritis of a facial nerve, miyelit, a cerebral ataxy, etc. Can include in this period of display of a disease of Lyme the pulsing headache, a photophobia, mialgiya, neuralgia, considerable fatigue, frustration of a dream and memory, violation of skin sensitivity and hearing, dacryagogue, peripheral paralyzes and paresis etc.
The Kardialny syndrome at Lyme's disease is in most cases presented by atrioventricular blockade of various degree, violations of a rhythm, myocarditis, perikardity, a dilatatsionny cardiomyopathy. The migrating mialgiya and artralgiya, bursita, tendinita, arthritises are characteristic of damage of joints (usually in the form of monoarthritis of a large joint, is more rare - symmetric polyarthritis). Besides, the current of a disseminirovanny stage of a disease of Lyme can include damage of skin (the multiple migrating eritema, limfotsity), urinogenital system (a proteinuria, a mikrogematuriya, orkhit), eyes (conjunctivitis, Irit, horioretinit), a respiratory path (quinsy, bronchitis), digestive system (hepatitis, a gepatoliyenalny syndrome), etc.
Lyme's disease passes into a chronic form (a persistention stage) in 6 months - 2 years after a sharp stage. In the late period of a disease of Lyme most often there are damages of skin in the form of an atrophic akrodermatit or a good-quality limfoplaziya or damage of joints (chronic arthritis). Atrophic akrodermatit it is characterized by emergence of the edematous eritematozny centers on skin of extremities on which place develops atrophic changes over time. Skin becomes thin, wrinkled, on it teleangiektaziya and sklerodermopodobny changes appear. The good-quality limfotsitoma has an appearance reddish knot or a plaque with roundish outlines. It is usually localized on face skin, auricles, axillary or inguinal area; in rare instances it can be transformed to a malignant lymphoma.
For chronic the Lime arthritis not only defeat of a sinovialny cover of joints, but also the periartikulyarny fabrics leading to development of bursit, tendinit, ligamentit, entezopatiya is characteristic. On the clinical current arthritis in a late stage of a disease Laima reminds rheumatoid arthritis, a disease of Reuters, Bekhterev's disease, etc. In late stages of chronic arthritis thinning of a cartilage, osteoporosis, regional uzura radiological comes to light.
Except skin and articulate syndromes, at a chronic stage of a disease of Lyme neurologic syndromes can develop: encephalopathy, chronic encephalomyelitis, polyneuropathy, ataxy, syndrome of chronic fatigue, dementia. At transplacentary infection pregnancy can end with pre-natal death of a fruit and an abortion. At live-born children the pre-natal infection results in prematurity, causes formation of congenital heart diseases (an aortal stenosis, a koarktation of an aorta, an endokardialny fibroelastoz), a delay of psychomotor development.
Diagnosis of a disease of Lyme
When performing diagnosis of a disease of Lyme it is impossible to underestimate the epidemiological anamnesis (visit of forests, park zones, the fact of a sting of pincers) and early clinical manifestations (migrating erity, a grippopodobny syndrome).
Depending on a stage of tick-borne borreliosis for identification of the activator in biological environments (serum of blood, a sinovialny zhidyokost, a likvor, skin bioptata) the microscopy, serological reactions (IFA or REEF) and the PTsR-research are used. For the purpose of assessment of weight of organospetsifichesky defeats the X-ray analysis of joints, the ECG, EEG, a diagnostic puncture of joints, a lyumbalny puncture, a skin biopsy, etc. can be carried out.
Differential diagnosis of a disease Laima is carried out with a wide range of diseases: serous meningitis, tick-borne encephalitis, rheumatoid and jet arthritises, disease of Reuters, neuritis, rheumatism, dermatitis, ugly face. It must be kept in mind that false positive serological reactions can be observed at patients with syphilis, an infectious mononukleoz, returnable typhus, rheumatic diseases.
Treatment of a disease of Lyme
Patients with Lyme's disease are subject to hospitalization in an infectious hospital. Medicamentous therapy is carried out taking into account a disease stage. At an early stage antibiotics of a tetracycline row are usually appointed (, doxycycline) within 14 days, amoxicillin reception is possible. Upon transition of a disease of Lyme to II or III stage and development of articulate, neurologic and kardialny defeats use of penicillin or tsefalosporin a course of 21-28 days is expedient. Against the background of antibiotic treatment Yarisha-Gerksgeymer's reaction which is characterized by an aggravation of symptoms of a spirokhetoz in connection with death of borreliya and an exit in blood of endotoxins can be noted. In this case antibiotic treatment for a short time stops, and then is resumed in a smaller dosage.
Pathogenetic treatment at Lyme's disease depends on clinical manifestations and their weight. So, at all-infectious symptoms dezintoksikatsionny therapy is shown; at arthritises – NPVS, analgetics, physical therapy; at meningitis – dehydrational therapy. At a heavy system course of disease of Lyme glucocorticoids in or in the form of vntrisustavny injections (are appointed at a sinovita).
Forecast and prevention of a disease of Lyme
Early or preventive antibiotic treatment allows to prevent transition of a disease of Lyme to a disseminirovanny or chronic stage. At overdue diagnostics or development of severe defeats of TsNS there are resistant residual phenomena leading to an invalidization; the lethal outcome is possible. Within a year after the end of treatment had Lyme's disease have to be on the account at the infectiologist, the neurologist, the cardiologist, an artrolog for an exception of synchronization of an infection.
For the purpose of the prevention of infection with tick-borne borreliosis at visit of the woods it is necessary to put on protective clothes; to use the repellents which are frightening off ticks; after walk in the woods it is attentive to examine integuments regarding possible introduction of a blood-sicking insect. At detection of a tick it needs to be removed independently by means of tweezers or to address to the nearest emergency station for carrying out the corresponding manipulation with the surgeon. The taken tick has to be brought to sanitary and epidemiologic laboratory for carrying out a rapid test for borreliya by method of temnopolny microscopy. Preventive antitick-borne processing of the woods and the green space did not lose the relevance.