Causes of Lyme Disease
Lyme disease – natural focal infectious disease from the group of bacterial zoonoses caused by borrelia of the Borrelia burgdorferi sensu lato complex, which is transmitted by ticks and is characterized by the predominant skin lesion in the form of erythema migrans, as well as the nervous system, musculoskeletal system and heart.
For the first time, skin changes associated with Lyme disease were described in 1883 by a German doctor.
The first causative agent of this disease in 1982 opened
Since the 90s of the XX century, the incidence of Lyme disease has increased significantly, including in Ukraine. Indicator of the degree of epidemic disadvantage of individual territories is the level of infection of ticks with borrelia. In different regions of Ukraine tick infestation varies from 3 to 25%. The area of ticks is not continuous, but is divided into a significant number of large and small "islets", due to both natural processes and irrational human economic activity.
Now numerous pathogens of Lyme disease are part of the so-called species complex Borrelia burgdorferi sensu lato. It combines 12 different species and their genomic strains (the number of which is currently not fully known) belonging to the genus Borrelia, family Spirochaetaceae. These are mobile gram-negative spirilla. They differ in nucleotide DNA sequences (especially those found in different nosoareals), and the cases of Lyme disease caused by them have certain clinical features.
In the process of evolutionary development, they adapted to two different environments – tick and vertebrate organisms. Active stay and reproduction of borrelia inside warm-blooded animals or humans is a prerequisite for the survival and preservation of the virulence of the microorganism. In addition, there are other types of Borrelia that contribute to diseases such as recurrent epidemic typhus, recurrent endemic typhus, southern mite-associated fever and so on.
The source of infection are more than 130 species of mammals, mostly small, and about 100 species of birds, which are the breadwinners of ticks and the main reservoir of pathogens in nature. In small animals and birds, the infection often has an inapparent course. The disease is transmitted by transmission, through the suction of ixodic ticks, which circulate pathogens in natural foci. The possibility of infection by rubbing remnants of crushed mites into damaged skin and through raw milk of a sick animal (mainly goat) is discussed, when pathogens enter through microdamages of the mucous membrane of the mouth of the throat.
At all stages of development of ticks, blood is fed. Borrelia enter the body of the breadwinner with the saliva of an infected tick during blood sucking. More often, the disease is transmitted to a person by an adult mite – imago, less often by nymphs and larvae. Ticks are found in forest areas, urban forest plantations, plantations of ornamental shrubs; in the forest they accumulate mainly on the sidelines, along roads and paths. They more often attack animals, birds and people from branches that grow no higher than 1.5 m from the surface of the earth. The risk of disease increases in direct proportion to the duration of tick suction. It is greatest with the duration of the tick’s stay in the skin thickness within 2-3 days, the larvae 3-5 days. Sometimes mites are infected with other pathogens that can cause pathology associated with Lyme disease (babesiosis, human granulocyte anaplamoz, tick-borne encephalitis and
Lyme disease is a typical spirochetosis and is characterized by a number of clinically pathogenetic features of this group of infectious diseases, including the ability for long-term persistence of the pathogen in the body, systemic damage to various organs, a tendency to chronicity. During the borreliosis infection process, there are three stages:
- stage of local infection – the pathological process develops at the site of entry of the pathogen, begins in the period from 2 to 30 days after tacking of Ixodes ticks; inoculation of the pathogen occurs, its reproduction, which leads to the development of an inflammatory reaction, which is clinically manifested by erythema and intoxication syndrome;
- dissemination stage – the pathogen spreads from the place of primary penetration; develops on average 1-3 months after the onset of erythema migrans; hematogenous and lymphogenous dissemination occurs in the lymph nodes, parenchymal organs, joints, and nervous system, where borrelia are addicted to SMFs with the formation of metastatic foci of inflammation; generalization of the infectious process contributes to the mobilization of humoral and cellular immunity factors; IgM anti-borrelized antibodies can be detected with the help of modern sensitive tests from the 3rd week of illness, and they reach their maximum at 4-6th week.
- stage of persistent infection and autoimmune disorders – characterized by lesions mainly of the joints and nervous system, less skin, and may develop several months or even years after infection; induction of the humoral immune response leads to accumulation in tissues of various organs and systems of specific immune complexes, which include Borrelia antigens; pathological changes in erythema migrans are characterized by perivascular infiltration of the affected skin with neutrophils, macrophages, lymphocytes; hyperkeratosis, dystrophy of epithelial cells of the basal layer occur in the epidermis, in the dermis – marked edema, pericapillary and interstitial infiltrates.
By the nature of pathological changes are distinguished:
- the early period – covers the stage of local infection and dissemination;
- late period – the stage of persistent infection.
By the nature of the flow emit:
- acute borreliosis – up to 3 months,
- subacute borreliosis – up to 6 months,
- chronic (continuous or recurrent) borreliosis.
The incubation period lasts on average 7-14 days, but can reach 45 days. The stage of local infection is clinically characterized by the development of erythema migrans at the site of tick suction, which is a pathognomic symptom of Lyme disease and occurs in 70-80% of patients. At first, erythema may appear uniformly saturated with a bright red spot, often with a cyanotic hue. In the future, the size of the erythema increases, the central part gradually brightens and takes on the appearance of healthy skin, while the edges remain bright red. This erythema develops in 2/3 of patients and is called ring-shaped.
In other patients, there is a continuous erythema of a homogeneous nature with a cyanotic hue without enlightenment of the central part. In a quarter of patients, several rings can be observed concentrically in each other and form "Bulls-eye" (more often registered in Europe). The size of the erythema averages 15-20 cm, although they can vary from 5 to 60 cm or more. The rate of increase in the size of erythema – 1-2 cm per day. If the rate of spread of erythema is lower and its size is less than 5 cm, the diagnosis of Lyme disease is questionable.
In the case of localization on the limb, erythema can cover it and merge with its subsequent distribution in the proximal and distal directions with the formation of the so-called "cuffs". When the ring-shaped erythema reaches a very large size and covers the surface of the body, the ring configuration is lost and the skin can see peripheral areas of the erythema in the form of strips, so-called "whip blows".
Migrating erythema can be localized on any parts of the body, but more often on the lower extremities and the body, where the tick is sucked in, and predominantly affected areas with thin skin that are less in contact with clothing (often the popliteal fossa area).
Non-erythematous forms of the disease occur in 20-30% of patients with a manifest course; they are usually not diagnosed in time, which can lead to further progression and chronicity.
Migrating erythema in 60-70% of patients is accompanied by intoxication syndrome of varying severity. It is characterized by general weakness, malaise, fever, headache, mild chills, arthralgia, myalgia. Although in most patients the symptoms of intoxication are minimal or moderate, in some individuals the temperature of the body may rise to 38-40 ° C. More often, high fever and severe intoxication develop in cases of Lyme disease in the United States.
Progression of the disease in the dissemination stage is observed in 1/4 of patients with erythema migrans, who, as a rule, did not receive adequate antibiotic therapy. After 3-5 weeks from the onset of the disease, they may have foci of secondary erythema, which are a clinical marker of the dissemination stage. The number of elements of the secondary erythema can be from 2 to 40, their size is smaller compared to the primary erythema. A typical, though not frequent, sign of the dissemination stage is a benign lymphocytoma of the skin, which most often occurs 3-5 weeks after the appearance of erythema and is localized on the ear lobe or around the nipple. Manifested in the form of slightly painful multiple nodules with a diameter of up to 0.5-1 cm, the skin over which is swollen, with a cyanotic-brown tinge.
Quite often, manifestations of the same Lyme disease are cranial and spinal polyradiculoneuropathy with motor or sensory disorders, multiple mononeuritis, serous meningitis with lymphocytic pleocytosis, and encephalitis. A typical manifestation of neuroborreliosis is Bannwart’s syndrome, which is characterized by a combination of lymphocytic meningitis, facial nerve neuropathy and spinal polyradiculoneuropathy. Patients most often complain of headache, radicular pain in the lower back and neck, which is sometimes very intense and increases at night.
Neurological disorders last up to several weeks or months. In the dissemination stage, cardiac lesions can be observed in the form of myocarditis, which is characterized by conduction disturbances by transient atrioventricular blockade. In most patients, especially with timely started treatment, myocarditis has a favorable course.
Liver damage is not uncommon with a slight increase in the level of bilirubin and an increase in the activity of aminotransferases; however, clinically significant hepatitis develops only in a small number of patients and has a benign course. The stage of persistent infection is clinically manifested by various organ lesions of autoimmune etiology. Patients complain of decreased performance, fatigue, sleep disorders, joint pain. Typical for this stage are arthritis that occurs in a third of patients. They can occur as arthralgia (quite often when infected with Lyme disease in Europe), as well as in the form of recurrent arthritis with signs of inflammation of the joints (often in the United States). Mainly large joints (knee, hip) are affected. In some patients with arthritis, the disease is resistant to treatment, is progressive and leads to disability.
How to treat Lyme disease?
Lyme disease treatment in patients with mild erythema is performed on an outpatient basis. Moderate and severe course of the disease requires hospitalization. In any case, antibiotic therapy is necessary. For erythema migrans, oral antibiotics are prescribed for 14 days – doxycycline, amoxicillin, cefuroxime. Patients with signs of the dissemination stage need an extended course of antibiotic therapy for up to 21 days.
If the first course did not give the desired result, it is recommended to repeat the course with another antibacterial agent for another 30 days. In case of neuroborreliosis, intravenous administration of ceftriaxone is used within 14-28 days.
In mild cases of Lyme disease, admit the possibility of prescribing azithromycin.
Pathogenetic therapy is the use of intravenous detoxification. Prescribe drugs that improve microcirculation in the skin and internal organs, which contributes to a better penetration of the antibiotic into the focus of inflammation (xantinol nicotinate, vitamin PP), as well as antihistamines.
In cases of severe arthritis and autoimmune disorders, a 1-2-month course of hydroxychloroquine is recommended, depending on its immunosuppressive and anti-inflammatory activity. It is especially indicated with the ineffectiveness of previous courses of antibacterial therapy.
The use of glucocorticosteroids in this case is considered inexpedient.
What diseases can be associated with
Lyme disease, especially in case of successful treatment, is evaluated by a favorable prognosis, but in rare cases a number of complications develop, namely residual lesions of the nervous system and musculoskeletal system:
There are cases when sluggish borreliosis became the cause of death.
Lyme disease treatment at home
Lyme disease treatment in home conditions, if diagnosed with its mild form. Patients with moderate or severe course are hospitalized. Home treatment should be carried out in accordance with all medical prescriptions, the patient is recommended to periodically visit specialized specialists.
The diet of the patient with borreliosis requires some adjustments:
- easily digestible protein – meat of fish, chicken, turkey, soy protein;
- vitamin C – sauerkraut, freshly squeezed vegetable and fruit juices, possibly diluted with water in equal proportions;
- frozen and fresh berries – cherry, blackberry, cranberry, lingonberry, currant in combination with 1
When the body temperature, and possibly the general condition is normal, there is no reason to stop treatment. The course can be long, sometimes measured in months, and supportive and immunostimulating therapy should be carried out for years. Failure to follow this course is fraught with relapses of Lyme disease.
What drugs to treat Lyme disease?
- Azithromycin – 0.5 g on the first day, 0.25 g in 2-5 days,
- Amoxicillin – 0.5 g 3 times a day,
- Bitsillin – 300000 IU and 600,000 IU once a week or 1.2 million IU 2 times a month,
- Hydroxychloroquine – 0.4 g 1 time per day for 1-2 months,
- Doxycycline – 0.1 g 2 times a day,
- Ceftriaxone – 1 g 2 times a day for 14-28 days,
- Cefuroxime – 0.5 g 2 times a day.
Lyme Disease Treatment
Lyme disease treatment folk remedies does not produce sufficient effect, and therefore is not recommended for widespread use. Individually, you can discuss with your doctor the effectiveness of the following formulations:
- combine in equal quantities the grass and oregano horsetail, the roots of valerian and motherwort, calendula flowers, lime and hawthorn, leaves of St. John’s wort and blackberry, black elderberry, add half the amount of thyme; 50 grams of the resulting collection pour 250 ml of boiling water, insist for 20-30 minutes, strain; take 50 grams three times a day before meals for a month;
Lyme disease treatment during pregnancy
Information about the combination of Lyme disease with pregnancy can not be called exhaustive, such cases are rare, but can easily happen – after being bitten by the same infected tick. Transmission of the pathogen through the placenta is recorded in isolated cases, and the teratogenic effect of Borrelia is a theoretical assumption, based on the similarity of this pathogen with the causative agent of syphilis, pale treponema.
Lyme disease is not associated with miscarriages or premature births; There is no evidence of transmission of the pathogen through breast milk.
Diagnosis of borreliosis in pregnant women is no different from that of other people – antibodies of IgG and IgM for borreliosis are determined, their levels are monitored weekly for a month.
Prophylactic antibiotic treatment after a tick bite is not performed, especially in pregnant women. If the diagnosis is established, then treatment will not be avoided – from antibiotics, amoxicillin in tablet form is preferred over 2 weeks after the bite.
Which doctors to contact if you have Lyme disease
Diagnosis of Lyme disease is primarily based on clinical and diagnostic criteria, which become the basis for laboratory research. The pathognomonic sign of Lyme borreliosis is a typical migrating erythema at the site of tick suction. Important data of epidemiological history:
- stay in an endemic area
- visiting the forest
- identify stuck ticks.
After that, it is advisable to confirm the diagnosis to carry out specific diagnostics. It consists in performing a serological study — identifying anti-borrelio antibodies using an enzyme immunoassay and an indirect immunofluorescence reaction. A fourfold increase in the level of antibodies in the dynamics of the disease is taken into account. Positive and doubtful results of studies need to be confirmed by immunoblotting, a highly sensitive method for the detection of proteins, based on a combination of electrophoresis with ELISA or RIA.
In order to confirm neuroborreliosis, an indication of anti-borrelia antibodies is carried out using ELISA separately in serum and cerebrospinal fluid with the determination of the liquor-serum index (LSI).
The bacteriological method (detection of the pathogen in the cerebrospinal fluid, skin biopsy specimens), as well as PCR, are informative for verifying the diagnosis in the case of non-erythematous forms of the disease. With late dermatological manifestations in the skin biopsies of the affected areas, it is often possible to isolate borrelia.