Tick-borne borreliosis — symptoms, stages, treatment and consequences of the disease
Tick-borne borreliosis – symptoms, stages, treatment and consequences of the disease
- 1 Tick-borne borreliosis – symptoms, stages, treatment and consequences of the disease
- 2 Characteristics of the concept
- 3 Mechanism of disease progression
- 4 Symptoms and stages of the disease
- 5 Diagnostics
- 6 Treatment methods
- 7 Preventive actions
- 8 Possible complications
- 9 Borrelioses are an important group of spirochetal infection.
- 10 Lyme disease or Lyme borreliosis , a tick-borne disease, is caused by Borrelia burgdorferi.
- 11 It comprises a wide spectrum of symptoms affecting skin, musculoskeletal system, heart, eyes, central and peripheral nervous system.
- 12 Infection was first described in patients from Lyme, Connecticut, but was later recognized along the northeastern coast of the United States.
- 13 Borrelioses are found in the temperate zones Europe, North America and Asia.
- 14 Ticks of the genus Ixodes are infected while biting deer and mice.
Borreliosis is an infectious disease that is common in certain geographic locations where the pathogen is the causative agent of pathology. In medical terminology, the disease is called systemic tick-borne borreliosis. Infections are also referred to as such: tick-borne borreliosis, erythemal spirochetosis, Lyme disease.
The disorder progresses gradually, affecting the tissues of the joints, heart muscle, and nerve plexuses. Pathology is easily treatable, subject to the timeliness of taking antibiotics. The peculiarity of the infection is the impossibility of transmitting the virus from person to person. Usually infection occurs due to tick bite.
Characteristics of the concept
Tick-borne borreliosis is an infection caused by borrelia spirochetes. The disease is named after these microorganisms. Spirochete vectors are ixodic ticks. The incubation period for tick-borne borreliosis is 7-14 days after the tick is sucked. In adults and in children, the pathology is accompanied by dangerous signs that can lead to disability.
A curious fact! The infection was first diagnosed in the city of Lima in Connecticut in 1975. Later pathology was given the name вЂњLyme diseaseвЂќ.
Pathology was registered after examination of adolescents who were diagnosed with arthritis. As a result of the collection of biological material from the articular tissue, spirochetes provoking the disease were detected.
Cases of borreliosis are detected only in countries where deciduous forests grow: America, Russia, the Baltic States. Vector and wild animals, including birds, dogs, rodents, are spirochete carriers. The tick infects from infected animals by biting them. Then the insect transmits the infection to a person by injecting saliva with borrelia into the bloodstream. It is also possible to become infected by drinking the milk of domestic animals. Some people become infected when tick feces fall on an open wound.
There are 2 forms of borreliosis: asymptomatic and manifest. In the first form, there are no manifestations of the disease, the diagnosis is made only after decoding the laboratory tests. The manifest form is characterized by a rapid progression of the clinical picture.
Mechanism of disease progression
Initially, a person feels weak, sore muscles, bouts of fever. A constantly growing erythema is formed. Spirochetes begin to spread through the articular and nervous tissue, lymph nodes. As a result of the spread of Borrelia along the nerve plexus, inflammation of the brain and spinal cord is progressing.
Note! Since the pathological process leads to the formation of an unstable protective reaction, the disease can recur after 5 years.
In the process of the spread of bacteria, many of them die. It starts the synthesis of endotoxin, which affects the tissues of the skin, joints, spleen, kidneys. Foci of inflammation are formed in the brain. Tissue infiltrates attract neutrophils from the bloodstream, destroying the structure of many organs.
Living spirochetes synthesize lipopolysaccharides that activate the development of inflammation in articular tissue вЂ“ arthritis, in which cartilage and bone are destroyed.. Because of the ability of Borrelia to exist inside the cell, the bacteria are found in the body after 10 years from the time of recovery.
Symptoms and stages of the disease
Borreliosis occurs in 3 stages. Each phase is characterized by the manifestation of specific pathological signs.
First stage вЂ“ acute
Symptoms of Lyme disease are flu-like signs of intoxication вЂ“ an increase in temperature, weakness, pain in the head and muscles. Stage begins to appear after a week after infection, lasts about a month. If this stage does not end with recovery, then borreliosis becomes chronic.
The dominant sign of the disease is the formation of an erythema of a migrating nature вЂ“ a growing bright spot, bounded outside by a red rim. Erythema appears in the part of the skin that the tick bit. The size of the papules can reach 60 cm, which causes cyanotic swelling. The touch is hot, accompanied by soreness and burning.
Pathology is sometimes asymptomatic, only the presence of erythema indicates the disease.
Erythema can persist for several months, with etiotropic treatment, the spot regresses within 10 days. Traces of papules can be manifested by pigmentation, desquamation. Some patients have observed the formation of several erythema in other areas of the skin. This is due to the hematogenous nature of the infection. A possible option in which Lyme disease does not lead to the formation of erythema, there are only manifestations of intoxication, fever.
Second Stage вЂ“ Subacute
Areas of the nervous system and heart are affected. This leads to loss of sensitive susceptibility, numbness, meningitis, which is accompanied by paresis, stiff neck muscles, excruciating pain in the head, high fever. With the development of meningoencephalitis, when the brain and its membranes are inflamed, memory, sleep disorders, intellectual abilities occur.
In case of violation of cardiac activity, heartbeat increases, pain in the region of the heart increases. The duration of the stage reaches 6 months.
Disturbance of nerve functioning and cardiac activity are characteristic signs of stage 2 borreliosis. Concomitant symptoms may develop вЂ“ the appearance of rashes, spots, lymphocytomas.
Signs of borreliosis in humans at the 3rd stage are expressed in the appearance of arthritis, accompanied by damage to the heart muscle or parts of the nervous system. Atrophic dermatitis is formed.
Spirochetes can damage the lining of the brain, peripheral nerve plexuses. Borrelia can not provoke inflammation of the brain (encephalitis), but can lead to inflammation of the meninges (meningitis).
Ixodes can cause tick-borne encephalitis. After sticking such an insect, encephalitis and borreliosis are often diagnosed in parallel. It happens that doctors confuse the disease. But borreliosis and tick-borne encephalitis are 2 different pathologies that can develop as a result of the attack of the same tick.
The third stage inevitably leads to the development of a chronic form in which the disease progresses continuously. This is manifested by an increase in painful symptoms and a worsening of the general condition.
Signs of chronic pathology
The chronic form is manifested by relapses, replacing remission. The presence of Lyme disease leads to arthritis, osteoporosis, which is accompanied by a thinning of cartilage structures, degenerative phenomena.
Skin cells are affected, resulting in a benign lymphocytoma. Inclusion is a red dense infiltration, localized on the nipple or earlobe. The duration of the preservation of these formations reaches several years.
A characteristic manifestation of chronic borreliosis is acrodermatitis вЂ“ the formation of red rash on the folds of the arms and legs. Gradually, the parameters of the formations increase, merging into one focus of inflammation. The epidermis will atrophy at this point. Degenerative phenomena have progressed over several years. Tick-borne borreliosis, which occurs chronically, can cause disability.
Initially, the doctor interrogates the victim for epidemiological data, finds out whether the person was bitten by a tick. If the answer is positive, the specialist examines the patientвЂ™s body to identify the presence of erythema. Then it is required to determine the characteristic signs of Lyme disease: arthritis, meningitis, neuritis, the presence of lymphocytoma and acrodermatitis.
If pathological manifestations are detected in a patient, then blood is taken for borreliosis. A positive response is recorded in the presence of antibodies to spirochetes.
To identify borrelia in the blood, use such studies:
- RNIF вЂ“ the reaction of indirect immunofluorescence;
- ELISA вЂ“ enzyme immunoassay;
- PCR вЂ“ polymerase chain reaction.
When deciphering the analysis of REIT for borreliosis, the diagnosis is confirmed if the antibody titer exceeds the allowable values. If the ELISA test is positive, then antibodies to the spirochetes are detected вЂ“ the person is infected. When using immunoblotting and PCR, the amount of spirochetes in the blood is detected. The presence of Borrelia indicates pathology. The most informative studies are RNIF, ELISA. For their conduct produce venous blood sampling.
Note! Since systemic borreliosis is similar in developmental mechanism to the manifestations of syphilis, it is important to immediately differentiate pathologies.
If you do a blood test after a tick attack, the results will be distorted. Class M borrelia antibodies are detected in the bloodstream several weeks after the tick attack and are present in the blood for 6 months. Antibodies of class G are detected a month after the formation of erythema, their presence is determined even after recovery. To monitor the dynamics of tick-borne borreliosis, it is required to re-detect the concentration of antibodies. If the titer decreases, the disease regresses.
Antibiotics that destroy spirochetes are used in the treatment of borreliosis. Duration and treatment regimen depends on the stage of the disease. At the first stage of development of the pathology prescribed tetracycline, Amoxicillin, Cefuroxime, Doxycycline, Azithromycin. The most effective antibacterial drug in the first stage is tetracycline, so the therapy begins with the admission of this drug.
Doxycycline is prescribed for neurological disorders. For intravenous administration, Ceftriaxone, Benzylpenicillin, Chloramphenicol are used. If signs of cardiac dysfunction are identified, Penicillin, Ceftriaxone, Amoxicillin, Doxycycline are used. Arthritis treatment requires Doxycycline, Amoxicillin or Ceftriaxone. With the development of acrodermatitis of chronic nature use Amoxicillin, Doxycycline.
The doctor prescribes a specific drug and determines its dosage in each case individually.
The minimum duration of antibiotic treatment should be at least 10 days. This period is sufficient for the treatment of erythema and intoxication manifestations. With damage to the heart muscle, nerve fibers and joints requires the maximum possible antibiotics.
With prolonged use of antibacterial agents, people notice an exacerbation of signs of the disease, which is expressed in the appearance of a rash or a number of erythema. A similar reaction is the physiological response of the body to treatment. This indicates the effectiveness of therapy.
When diagnosing borreliosis during pregnancy, a woman is prescribed Amoxicillin (500 mg three times a day for 3 weeks). This course is sufficient to prevent infection of the embryo.
Symptomatic treatment measures
In addition to antibacterial treatment designed to destroy spirochetes, it is necessary to eliminate the painful manifestations of Lyme disease. Symptomatic therapy is aimed at improving the condition of the patient and the removal of pathological signs.
Such treatment involves the use of the following medications:
- Nonsteroidal anti-inflammatory drugs that reduce pain and inflammation in articular tissue in arthritis вЂ” Nimesulide, Indomethacin;
- immunosuppressants, suppressing inflammation in arthritis, вЂ“ Plaquenil;
- diuretic drugs that reduce the swelling of the membranes of the brain during meningitis вЂ“ Furosemide;
- antihistamines, suppressing allergic reactions in the form of itching, rash, вЂ“ Cetrin, Suprastin, Erius;
- the introduction of detoxification solutions that reduce body temperature;
- medications that restore the work of the neuromuscular apparatus вЂ“ Galantamine, Oksazil, Prozerin.
During the rehabilitation period, vitamin B, C, A supplementation is prescribed, as well as the use of herbal remedies: eleutherococcus, ginseng.
If no more than 5 days have passed since the moment of the bite, and the person during this period goes to the doctor and brings a tick with him, then the doctors carry out preventive treatment. This requires a microscopic examination of the tick. When a Borrelia is found in an insect, the patient is prescribed Amoxiclav, Tetracycline or Doxycycline. Such preventive measures do not allow the development of borreliosis.
For arthritis, astralgia, neuritis, physiotherapy treatment methods are used. The purpose of this therapy is to eliminate inflammation in the articular tissue, normalize blood circulation and the nervous system. Electrophoresis, massage, magnetic therapy, physiotherapy exercises, acupuncture are prescribed.
Alternative medicine methods
Often, people resort to the treatment of chronic forms of borreliosis with folk remedies. This therapy has several advantages, because the recipes use natural ingredients that do not harm the body.
White clay infusion
Raw materials assist in the evacuation of toxic compounds formed as a result of the vital activity of microorganisms. It is necessary to fill a glass of warm water with a teaspoon of white clay purchased at the pharmacy.
It is necessary to insist the solution within 12 hours. After the allotted time, you should mix the ingredients and drink the resulting solution. Therapeutic course is six months.
Medicinal drink cleans cells from the infectious agent and the waste products of microbes. It is necessary to purchase packaged dried algae at the pharmacy and make a drink out of them.
The tool is used for 10 days, then a break is taken for a week. This recipe is allowed to apply until the final recovery.
To clear the body of infection, eliminate burning and heal erythema, it is recommended to make lotions and infusions of such herbs: strawberries, nettle, hawthorn, horsetail, tansy, immortelle.
To prepare a healing infusion, you need to pour half a liter of boiling water with a tablespoon of dry raw materials, cover the container with a lid and leave for half an hour. It is necessary to drink a glass of drink 20 minutes before meals. To enhance the therapeutic effect of infusions is recommended to alternate.
In countries where natural locations of borreliosis are located, the majority of ticks act as carriers of pathology. Therefore, people living in these areas should observe non-specific preventive measures. When hiking in the forest, it is recommended to use protective repellents, thick clothes. Especially careful to be in the period of tick activity, which begins in May and ends in September.
If a person keeps a dog in the house, then after walking it is necessary to examine the animal for the presence of ticks, since insects can crawl from dog to owner. If the tick was able to cling to the person, you should pull it out with tweezers or thread. When twisting the tick, you need to be especially careful not to crush the insect, and its insides do not penetrate the skin. If the skin has an open wound surface, then the person will get Borreliosis.
After removing the tick, it is necessary to treat the affected area with a disinfectant. Doctors recommend taking doxycycline and ceftriaxone for several days. This preventive measure prevents the progression of borreliosis.
If tick-borne borreliosis is diagnosed at the first stage, the person fully recovers, subject to compliance with all medical prescriptions. The second stage of the pathology is cured in almost all patients, without causing any complications. With the late detection of the disease, incorrect therapy, or with a weak immune response, Lyme disease turns into a chronic form or a third stage.
The consequences that significantly reduce the quality of life of the patient:
- paresis of the legs and arms, unsteady gait;
- unilateral change in the shape of the face due to damage to the facial nerve;
- decreased susceptibility;
- decrease in acuity of hearing, sight;
- epileptic seizures;
- memory impairment, amnesia;
- dementia, delayed psychophysical development in children;
- thinning and destruction of articular tissue;
- heart failure
Such phenomena often cause disability.
Tick-borne borreliosis is an insidious infection that can develop asymptomatically. The most characteristic symptom of pathology is the appearance of erythema. To make a correct diagnosis, it is necessary to use laboratory diagnostic methods. When detected early, the disease is treated with antibiotics, leaving no serious consequences.
The following sources were used to prepare the article:
Bezborodov N. G., Polovinkina N. A., Popova S. P. Clinical features of the localized stage of tick-borne borreliosis (Lyme disease) // Zemsky Doctor Physician вЂ“ 2013.
Avdey G. M., Ignatenko A. L., Shchutskaya Z. P., Ovodinskaya T. G., Semenova S. G. Neurological aspects of Lyme borne tick borreliosis // Journal of Grodno State Medical University вЂ“ 2003.
Pomogaeva A. P., Obidina O. V., Karavaeva M. O. Impact of antibacterial therapy on the clinical and laboratory parameters of children with tick-borne borreliosis // Journal of Pediatric Pharmacology вЂ“ 2006.
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Borrelioses are an important group of spirochetal infection.
Lyme disease or Lyme borreliosis , a tick-borne disease, is caused by Borrelia burgdorferi.
It comprises a wide spectrum of symptoms affecting skin, musculoskeletal system, heart, eyes, central and peripheral nervous system.
Infection was first described in patients from Lyme, Connecticut, but was later recognized along the northeastern coast of the United States.
Borrelioses are found in the temperate zones Europe, North America and Asia.
Ticks of the genus Ixodes are infected while biting deer and mice.
Three species of Borrelia burgdorferi have been identified as human pathogens :
Borrelia burgdorferi sensu stricto, Borrelia garinii and Borrelia afzelii .
» New bacteria has been discovered that causes Lyme disease. It is known as Borrelia mayonii, named after Mayo Clinic, where it has been identified.»
Three days to four weeks after inoculation, a papule develops.
A ring-like rash expands outward from the site of the bite and lasts from a month to a year.
The majority of patients suffer from migratory polyarthritis, which may develop into chronic arthritis.
Myocarditis and neurologic symptoms are seen in a minority of patients.
Manifestations of Lyme carditis include atrioventricular block, myopericarditis, intraventricular conduction disturbances, bundle branch block and congestive heart failure .
Diagnosis is made by associating the clinical and historical features of borreliosis, such as previous tick bite, electromyography , or neurologic involvement, with electrocardiographic abnormalities and symptoms such as chest pain, palpitations, syncope, and dyspnea.
Serologic studies and endomyocardial biopsy can support the diagnosis in the correct clinical setting.
About 80% of all Lyme borreliosis cases represent skin manifestations (dermatoborrelioses).
The three characteristic dermatoborrelioses are erythema chronicum migrans , borrelia associated B-cell Lymphoma, and acrodermatitis chronica atrophicans , which occur in different stages of the disease.
Erythema migrans is the hallmark of early Lyme borreliosis, whereas acrodermatitis chronica atrophicans is the characteristic manifestation of late Lyme borreliosis.
Several spirochetal factors (Example: infection with different genospecies, co-infection with other tick-transmitted pathogens) as well as host factors (Example: cytokine patterns at the site of infection) influence the course of the disease.
The papule shows acanthosis and necrosis of keratocytes in the epidermis. In the dermis and synovium, lymphocytes and histiocytes infiltrate neurovascular spaces. Spirochetes are found in vessel walls.
Association of infection with Borrelia burgdorferi and primary cutaneous B-cell Lymphoma (PCBCL):
Borrelia burgdorferi has been identified within lesional skin of patients with p rimary cutaneous B-cell Lymphoma either by culture or PCR.
It has been suggested that Borrelia burgdorferi — associated PCBCL arises from chronically stimulated lymphoid tissue acquired in response to Borrelia burgdorferi infection in a manner similar to gastric Marginal zone lymphoma and Helicobacter pylori infection.
PCR analysis of Borrelia burgdorferi DNA is a fast test that should be performed in all patients with PCBCL to identify those who more likely could benefit from an early antibiotic treatment.
The organisms are grown from blood, cerebrospinal fluid, and skin specimens.
Diagnosis in the early stage of Lyme borreliosis relies on the clinical picture, whereas serological, molecular, microbiological, and histopathological findings are important adjuncts in the diagnosis of later stages of the infection.
Penicillin V and tetracycline shorten the duration of the illness.
Antibiotic treatment is necessary for all stages and manifestations of Lyme borreliosis.
Doxycycline is the antibiotic of choice for most patients with dermatoborrelioses.
Adequate antibiotic therapy cures more than 90% of the patients.
However, in some patients repeated therapy is necessary and a small number of patients develop chronic arthritis or other features.
While there is currently no vaccine available, prevention of tick bite is the most effective prophylaxis.
Pathology of Neuroborreliosis:
Human infection by Borrelia burgdorferi, the etiological agent for Lyme disease, can result in serious acute and late-term disorders including neuroborreliosis, a degenerative condition of the peripheral and central nervous systems.
Usually patients develop a lymphocytic meningitis, radiculoneuritis or cranial neuropathy, occurring singly or in combination.
Patients with radicular involvement often have a myelopathic component as well.
Rarely patients develop focal inflammation of the central nervous system, an encephalomyelitis, that appears to involve white matter more often than grey.
Often patients may develop cognitive and memory impairment-a mild encephalopathy.
In some patients this may represent a subtle form of encephalomyelitis, while in others it is probably a «toxic-metabolic» effect of systemic infection.