Lyme disease: symptoms, treatment, diagnosis, prevention

Lyme disease (synonyms: Lyme borreliosis, Lyme borreliosis, tick-borne ixodid borreliosis, Lyme disease) is an infectious pathology that occurs in acute or chronic form with damage to the skin, musculoskeletal system, nervous, cardiovascular system, etc. Natural focal infections are transmitted by ixodid ticks.
Lyme borreliosis is widespread in the habitat of ixodid ticks, namely in the northern hemisphere. In our country, about 8 thousand new cases of the disease are registered annually; all age categories are affected, but more than 10% of the sick are children. Ixodid ticks can be carriers of several infections at the same time, so when bitten by one tick, a person is at risk of contracting several infections.

The causative agent of infection

The causative agent of the infection is gram-negative bacteria Borrelia from the Spirochaetaceae family. In European countries and Russia, the predominant pathogens are Borrelia afzelii and Borrelia garinii; in the United States, the predominant amount of borreliosis is caused by Borrelia burgdorferi.

The carriers and distributors of the infectious agent are ticks of the genus Ixodes, the infestation of which varies from 10 to 70% in different areas. 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

The pathology is widespread in North America, as well as in Europe and Asia. In Russia, the disease is registered annually in 6-8 thousand residents of the country. The pathology has no age limits and can occur in any person who has been bitten by an infected tick. The risk group includes children and adolescents under fifteen years of age and adults 25-45 years old, as well as people professionally associated with working in the forest.

Natural reservoir and risk factors

The reservoir of infection (carriers of bacteria) are wild and domestic animals, mainly rodents, mammals - dogs, goats, sheep, which outwardly look healthy, and it is quite difficult to identify bacteria carriers in them. Ticks (carriers of bacteria) become infected from sick animals.

The peak of infection occurs in the spring and summer. Tick ​​activity is observed from April to October, but recently cases of early (March) and late (November-December) arthropod bites have become more frequent, which is associated with general climatic warming and the gradual adaptation of ticks to more severe living conditions.

Reminder for a patient with Lyme disease

Lyme disease is only transmitted through the bite of an infected tick. All people are susceptible to tick-borne borreliosis, regardless of age and gender. The incubation period is 10–14 days. The course of the disease is varied. At the first stage of the disease, which lasts up to one month, malaise, fever, and muscle pain are possible. The main symptom is redness of the skin at the site of the tick bite, gradually increasing in size and reaching 60 cm in diameter. The second stage (1–6 months) is characterized by the development of neurological and cardiovascular complications. At a late stage of the disease (more than 6 months), joint, skin and other inflammatory processes develop. The main treatment for the disease at all stages is antibiotics.

Risk factors for infection

• Frequent visits to forests and forested areas, wearing open clothes while walking, picnics, barbecues in unequipped “wild” places;
• Long-term presence of a tick on the body (more than 12 hours). It has been proven that earlier removal of an attached tick significantly reduces the risk of human infection. At the same time, even if a tick is filmed crawling on the body, the possibility of contracting Lyme infection cannot be ruled out.

Immunity

Passive (intrauterine) immunity against infection is not developed. Active immunity after illness is unstable and re-infection is possible even during this season or several years later.

Transmission routes

• Transmissible - the main route of transmission: - The Ixodid tick feeds on an animal with borreliosis and becomes infected itself. The second option is that the hatched larvae from an infected female tick may already be infected with the bacterium. — An infected tick attaches itself to a person, the bacterium enters the wound with the saliva and feces of the arthropod, and through it into the human blood.

• Foodborne - transmission of Borrelia through the raw milk of infected animals, most often goats.
• The transplacental route is the rarest option. Transmission of bacteria occurs from a sick mother to the fetus during the prenatal period.

Causes of Lyme disease

The causative agent of the disease is several species of Borrelia - B. garinii, B. burgdorferi and B. afzelii. These are gram-negative spirochetes that grow on media containing amino acids, animal serum, and vitamins.

1. The natural hosts of Borrelia are rodents, deer, and birds. When bloodsucking, borrelia end up in the tick's intestines (where they multiply) and are then excreted in the feces. The circulation of the pathogen in natural foci occurs according to the following scheme: ticks - wild birds and animals - ticks.
2. Infection with Lyme disease in humans occurs in natural foci of borreliosis through a tick bite. But there is a possibility of infection if tick feces come into contact with the skin during subsequent scratching. If the tick is removed incorrectly, if it ruptures, Borrelia can enter the wound. A nutritional route of transmission of the pathogen is also possible - through the consumption of raw cow's or goat's milk.

Infection with Lyme disease (borreliosis) occurs when visiting forests, forested areas inside cities, or when removing ticks from domestic animals.

The peak incidence of borreliosis occurs from May to June.

Classification

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

Stages of the disease

After a tick bite and Borrelia penetrates the human skin, they enter nearby lymph nodes, where they actively multiply. Within a few days, the bacteria pass into the blood and are carried by vessels throughout the body. At the same time, they continue to multiply, gradually affecting the nervous, cardiovascular systems, joints and muscles.

On a note!

The reaction of the victim's immune system is usually acute: antibodies are produced, but they are not able to completely destroy the infection. Most often, borreliosis disease becomes chronic, in which the patient's condition gradually worsens due to the increase in the autoimmune process and the constant release of toxic substances.

The incubation period, i.e. the time before the first negative symptoms appear, ranges from 3 to 32 days. Most often, the disease manifests itself 1-2 weeks after a tick bite.

Tick-borne borreliosis (ICD code 10-A69.20) occurs in 3 stages:

1. Borrelia multiply under the skin and in the lymph nodes, lasting up to 40 days.
2. The phase of active spread of pathogenic bacteria through the circulatory system throughout the human body, which lasts 5-6 months.
3. Chronic borreliosis, which affects the nervous, musculoskeletal or cardiovascular systems, lasts several years.

At each stage, certain symptoms appear, by which specialists can clearly diagnose the disease.

What happens in the human body

The causative agent of tick-borne borreliosis enters the body with the saliva of the tick. From the site of the bite, borrelia travel through the blood and lymph to internal organs, lymph nodes, and joints. The pathogen spreads along the nerve pathways, involving the membranes of the brain in the pathological process.

The death of bacteria is accompanied by the release of endotoxin, which triggers immunopathological reactions. Irritation of the immune system activates general and local humoral and cellular responses. The immediate production of IgM antibodies, and a little later IgG, occurs in response to the appearance of the flagellar flagellar antigen of bacteria.

As the disease progresses, the set of antibodies to Borrelia antigens expands, which leads to long-term production of IgM and IgG. The proportion of circulating immune complexes increases. These complexes are formed in the affected tissues and activate inflammatory factors. The disease is characterized by the formation of lymphoplasmatic infiltrates in the lymph nodes, skin, subcutaneous tissue, spleen, brain, and peripheral ganglia.

Drugs

The most effective drugs used against Lyme disease are penicillin antibiotics, cephalosporins and broad-spectrum antimicrobials .
They effectively destroy Borrelia, have a small list of contraindications and are well tolerated by the body.

The most common antibiotics prescribed for Lyme disease include:

• Doxycycline (Vibromycin, Medomycin, Unidox Solutab);
• Sumamed (Azithromycin, Azipol, Zomax);
• Amoxiclav (Amoxicillin);
• Ceftriaxone (Cefixime, Rotacef);
• Suprax (Zinnat);
• Rocephin (Loraxone, Rotacef).

In the absence of the required therapeutic effect, it is necessary to reconsider the treatment regimen and, if necessary, prescribe other drugs.

IMPORTANT! The chances of a complete recovery of the patient largely depend on compliance with the treatment regimen and medical recommendations - if live Borrelia remains in the body, a relapse of the disease with complications and serious health consequences is possible.

Immunoglobulin

Immunoglobulin is a special protein that is isolated from human blood and is used in the treatment of various diseases, including viral encephalitis, which is carried by ticks. In the treatment of tick-borne borreliosis, drugs containing it are ineffective , since borrelia differ significantly from the causative agents of encephalitis. Accordingly, the use of immunoglobulins for Lyme disease is inappropriate and can cause unpleasant consequences for the patient’s health.

Homeopathy

Homeopaths for borreliosis recommend taking medications that destroy the causative agents of the disease and have a detoxification effect, that is, they remove toxic substances formed after the death of borrelia from the body. The so-called nosodes are very popular - drugs that are made from living tissues and liquids containing the causative agent of the disease.

For the treatment of Lyme disease, the spirochete borrelia nosode was developed, which has proven itself well among homeopaths and their patients.

In addition, the following homeopathic medicines are often used in the fight against borreliosis:

• Ledum;
• Drosera;
• Lachesis;
• Vipera;
• Cantharis;
• Naya;
• Samento.

IMPORTANT! The most effective method of treating borreliosis is taking antimicrobial drugs, and herbal medicine and homeopathy are recommended to be used as adjuncts, since their effectiveness has not been fully proven and is disputed by many doctors.

Herbal remedies

One of the methods of treating Lyme disease is herbal medicine, which involves the use of herbs and medicinal plants with antimicrobial, anti-inflammatory and immunomodulatory effects in the fight against the pathological process.

1. Astragalus . A plant of the legume family, which is widely used in Chinese medicine to treat syphilis and other severe infectious diseases;
2. Echinacea . An effective remedy that activates the immune system and removes toxins from the body;
3. Ginkgo biloba . Used to prevent mental and neurological disorders that often accompany tick-borne borreliosis;
4. Colloidal silver . A substance with antibacterial, antiparasitic and immunomodulatory effects;
5. Stevia . According to research, stevia extract destroys Borrelia no less effectively than antimicrobial drugs, and also has an anti-inflammatory effect.

Other herbal remedies can be used to treat borreliosis, but the regimen for their use and dosage must be selected by a specialist.

Folk remedies

In folk medicine, borreliosis is treated with decoctions and infusions of medicinal plants, which include:

• drop cap;
• strawberry leaves;
• horsetail;
• hawthorn;
• oregano;
• calendula;
• comfrey;
• tansy;
• yarrow.

The infusion of the letter must be taken for at least a month, and in combination with it, drink tea from strawberry leaves, which has a general strengthening effect and contains a large amount of vitamins. Herbs containing silicon (nettle, comfrey, horsetail, borage), which have the ability to remove toxins from the body, are recommended to be drunk alternately over a long period of time. In addition, for borreliosis, infusions of bitter plants are recommended, including wormwood, tansy, elecampane and immortelle, which cleanse the blood and lymph, and also activate the liver and protect it from damage.

IMPORTANT! Self-medication for borreliosis can be extremely dangerous, so before using any medication you should consult a specialist.

Symptoms of tick-borne borreliosis

Incubation period

The disease begins with a latent or incubation period, which lasts 7-14 days, but can be either shortened or lengthened.

Local infection

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

• at the site of suction after a tick bite, on average, after 7 days, a painful and itchy red papule forms, with characteristic peripheral growth (erythema migrans). Expanding, the erythema forms a kind of ring 10-60 cm in diameter: the central part is pale in color and a bright red corolla along the edges. Erythema resolves within 1-2 months. Patients may complain of itching and burning in this area. At the site of erythema, peeling and pigmentation remain;

• general infectious syndrome is characterized by fever, headache, fever, chills, pain in muscles (especially cervical), joints and bones, weakness;

• other symptoms of Lyme disease are rhinitis, pharyngitis, urticaria, conjunctivitis, rash on the face, dry cough, pinpoint and small ring-shaped rashes, regional lymphadenitis. As a result of these symptoms, borreliosis is sometimes disguised as a cold, which is an unfavorable factor for further development (untimely, late treatment).

Disseminated stage

Develops over the next 3-5 months. Variants of the course of the disease are cardiac, febrile, mixed, meningeal, neuritic.

Persistence stage

Atrophic acrodermatitis, chronic Lyme arthritis and other complications develop.

Stages and symptoms of borreliosis

After the bite of an infected tick and the penetration of borrelia into the human skin, a disease develops, the course of which sequentially passes through three stages.

A patient with tick-borne borreliosis is not dangerous to others.

Signs and symptoms of borreliosis in the first stage of the disease

Tick-borne borreliosis in the first stage of disease development is characterized by local manifestations and symptoms of intoxication, which appear in the period from 1 to 20 days (according to some authors from 2 to 32 days) from the moment of the tick bite and lasts 4 - 6 weeks.

A third of patients often either do not remember or deny the fact of a tick bite. Fever, weakness, fatigue, drowsiness, migrating muscle and joint pain and redness at the site of the tick bite are the main symptoms of borreliosis during this period. Elevated body temperature lasts 2 - 7 days.

From the site of the bite, borrelia enter the lymphatic system and blood and spread throughout the body, affecting various internal organs, lymph nodes and joints. Moving along nerve fibers, bacteria penetrate the brain and spinal cord. With adequate and timely treatment, the acute phase of the disease ends in cure. Otherwise, the infection becomes chronic.

Borrelia strains found in Western Siberia often do not cause acute infection in humans. The disease immediately becomes chronic.

Erythema migrans

Erythema migrans is the main symptom of borreliosis. In the area of ​​the tick bite, 70% of patients develop redness (erythema), swelling (papule) and pain. Patients often note a loss of sensitivity in the bite area and a feeling of tightness. The erythema constantly increases in size, has a bright red rim and a light inner part. The appearance of the erythema resembles a ring. Sometimes several rings appear. The shape of migratory erythema is round and irregular. It can reach up to 60 cm in diameter or more. The light inner part of the erythema becomes bluish over time. The bite site becomes covered with a crust, and as it heals, a scar appears at the site of the crust.

In some patients, small ring-shaped rashes appear on the face and the mucous membrane of the eyes becomes inflamed. Sometimes erythema migrans resembles erysipelas.

After 2 - 4 weeks from the onset of the disease, either recovery occurs and the erythema disappears, or the disease becomes chronic.

At the site of the former erythema, increased pigmentation is noted, the skin is dry, and peeling is often noted.

In 2 - 20% of patients, tick-borne borreliosis occurs in a non-erythematous form.

Rice. 9. In the photo, erythema migrans is the main symptom of borreliosis in the initial stage of the disease.

Rice. 10. The appearance of the erythema resembles a ring. Sometimes several rings appear.

Rice. 11. The photo shows erythema migrans on the face and skin of the torso.

Signs and symptoms of borreliosis in the second stage of the disease

When Borrelia spread throughout the body through the bloodstream or lymphatic vessels, Borrelia primarily affects the heart, nervous system, or joints. Symptoms of damage to these organs develop 1.5 months after the tick bite. The duration of the 2nd phase is about six months.

In the absence of erythema migrans in patients after a bite of a Borrelia-infected tick, Lyme disease in phases 2 and 3 is severe.

Heart damage

Signs of heart damage develop several weeks after the bite of an infected tick. Pain in the heart area appears, the heart rhythm is disturbed, and atrioventricular blockades develop. The heart muscle and pericardium are affected. Dilated myocardiopathy develops. Compressive pain in the chest, palpitations, shortness of breath, dizziness are the main symptoms of borreliosis when the heart is affected.

Joint damage

Periodic (transient) osteoarticular pain is the main symptom of borreliosis when the musculoskeletal system is affected in the second phase of the disease.

Damage to the nervous system

When a person is infected, borrelia spread throughout the body, enter the nerve fibers, and then, moving along them, penetrate the brain and spinal cord. During this period, symptoms of damage to the meninges (meningitis), meningoencephalitis and damage to the peripheral nervous system are recorded.

In 5 - 15% of cases, signs of damage to the meninges are recorded during the development of erythema migrans. Severe headache, repeated vomiting, photophobia, and increased sensitivity to irritants are the main symptoms of Lyme disease, characteristic of damage to the nervous system in the initial period.

Some of the first to appear are pain along the nerves (neuralgia), pain in the area of ​​the nerve plexuses (plexalgia) and the roots of the spinal cord, meningitis, and isolated damage to the facial nerve.

Rice. 13. The photo shows an isolated lesion of the facial nerve.

Signs and symptoms of borreliosis in the third stage of the disease

Several months (or years) from the onset of the disease, late manifestations of tick-borne borreliosis develop. Chronic borreliosis develops in a tenth of patients. During this period, developed arthritis and heart damage are often combined with damage to the nervous system. Some patients develop atrophic dermatitis.

Arthritis

Lipoproteins, which are part of Borrelia, trigger a whole cascade of cellular reactions in the patient’s body, which leads to the development of inflammation in the joints, resorption of bone tissue and destruction of cartilage. There is marginal growth of bone tissue (osteophytes). Lyme disease typically affects large joints. In some patients, small joints are involved in the process. Joint damage due to borreliosis is recorded in 1/3 of patients.

Skin lesions due to Lyme disease

Common dermatitis, atrophic acrodermatitis (skin lesions of the extremities), scleroderma-like changes are skin lesions that are noted at the 3rd stage of the disease.

Rice. 14. The photo shows skin lesions of the lower limb in Lyme disease - chronic atrophic dermatitis (left) and scleroderma-like skin changes (right).

Acrodermatitis begins gradually. From the onset of the disease to the appearance of skin lesions, it takes from 1 to 8 - 10 years. Cyanotic-red spots or infiltrates appear on the skin (most often of the lower extremities), knees, elbows, and soles. There is an increase in regional lymph nodes. Sometimes the skin of the torso is involved in the process. Acrodermatitis develops slowly, gradually. The disease persists for many years, gradually turning into a sclerotic form. The skin becomes thinner and takes on the appearance of tissue paper.

Rice. 15. The photo shows skin lesions due to chronic borreliosis.

Lymphocytoma

Benign lymphocytoma is one of the manifestations of tick-borne borreliosis. It appears in response to a tick bite. It looks like a dense crimson nodule or a group of nodules. Most often, benign lymphocytomas are localized on the earlobe, areola of the mammary glands, nipples, face, genitals and groin areas. The course of the disease is wavy. The duration of the course ranges from several months to several years.

Rice. 16. The photo shows a benign lymphocytoma in the form of a single dense crimson infiltrate (left) and a group of nodules (right).

Other manifestations of borreliosis

Borrelia, spreading throughout the body from the primary focus through the bloodstream, can affect any organ. Diseases of the organs of vision, pharynx, lungs, liver, spleen, testicles and kidneys are described.

Damage to the nervous system

The frequency of damage to the nervous system (neuroborreliosis) ranges from 10 to 60% and depends on the distribution of certain Borrelia genotypes in the Russian Federation. The largest number of patients (43 - 64%) with neuroborreliosis is observed in the North-West region and the Center of Russia.

Borrelia burgdorferi can affect the nervous system at any stage of the disease

Chronic encephalomyelitis, spastic paraparesis, ataxia, memory disorders, dementia, radiculopathy, polyneuropathy, paresthesia are late manifestations of damage to the nervous system, which are recorded in 4 - 20% of cases.

With multiple tick bites, the absence of erythema migrans in patients at the sites of tick bites, early development of signs of dissemination, untimely or inadequate treatment, the likelihood of developing neuroborreliosis is especially high.

More often, Lyme disease occurs in waves, less often it is constantly relapsing.

Late neuroborreliosis manifests itself 1.5 to 17 years after the bite of an infected tick. During this period, Borrelia are in an inactive state. Activation of pathogens leads to the development of neuroborreliosis.

Non-erythema form

The non-erythematous form is most often manifested by systemic manifestations, namely damage to the CVS and NS:

Nervous system

The cardiovascular system

Pathological changes:

• Serous meningitis
• Meningoecephalitis
• Cerebral ataxia with movement disorders
• Myelitis
• Peripheral radiculoneuritis
• Facial neuritis

• Atrioventricular block of varying degrees
• Heart rhythm disturbance
• Myocarditis
• Pericarditis
• Dilated cardiomyopathy

Symptoms:

• Throbbing headache
• Myalgia, stiff neck
• Neuralgia
• Photophobia
• Tearing
• Loss of performance, sleep disorder
• Hearing impairment
• Changes in skin sensitivity
• Paresis (weakening of motor function)
• Peripheral paralysis (loss of reflexes, decreased muscle tone and muscle atrophy)

• Pain in the heart area of ​​a squeezing nature
• Tachycardia or bradycardia
• Atrial fibrillation
• Dyspnea
• Dizziness
• Attacks of suffocation
• Fainting
• Irregular pulse
• Dry cough
• General malaise

In addition to damage to the heart and nervous system, other organs and systems may be involved in the pathological process:

• Joints : bursitis, myalgia and arthralgia of a migrating nature, arthritis (more often than one large joint).
• Skin : lymphocytoma (benign dermatosis), erythema migrans.
• Genitourinary system : testicular orchitis, microhematuria (blood in the urine), proteinuria (protein in the urine).
• Eyes: chorioretinitis (inflammation of the choroid), conjunctivitis, iritis (inflammation of the iris).
• Respiratory organs: bronchitis, sore throat.
• Digestive organs: hepatolienal syndrome, hepatitis.

Chronitization of Lyme borreliosis occurs 6-24 months after infection. Borrelia persists in the body for more than 10 years, but the reasons for such long survival are unknown. Even with intensive antibacterial treatment, the infection is difficult to control; periodically, against the background of decreased immunity, relapses of the infection occur.

There are 3 options for the consequences of Lyme disease:

• Atrophic acrodermatitis: the appearance of swollen reddish lesions on the skin of the legs and arms. Subsequently, atrophic changes develop at this site. The skin becomes thinner, wrinkled, with telangiectasia and scleroderma-like changes.
• Benign lymphocytoma: the appearance of a red-blue node or plaque with rounded outlines on the skin of the face, ears, groin or armpit. Very rarely, malignancy into lymphoma is possible.
• Chronic Lyme arthritis is the most common variant. Recurrent joint damage is typical. There is damage to the synovial membrane and oculoarticular tissue, which leads to the development of tendinitis, bursitis, and enthesopathies. The clinical course is similar to rheumatoid arthritis. In the terminal stages, osteoporosis occurs, 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 become infected, intrauterine fetal death and miscarriage are possible. If the fetus survives, children are often born premature, with congenital heart defects, and delayed mental and motor development.

Sometimes the stage of the disease is not observed. In some cases, only a local reaction stage is present. Sometimes the disease manifests itself only at a late stage or even in a chronic form. Lyme disease in children occurs with the same symptoms, but the child cannot always correctly voice his complaints, so laboratory diagnosis plays a leading role.

Symptoms

The incubation period for Lyme disease from infection to symptoms is usually 1 to 2 weeks, but it can be much shorter (a few days) or longer (months to years).

Symptoms typically appear from May to September, as tick nymphs develop during this time, causing most infestations. Asymptomatic infections do occur, but statistically account for less than 7% of Lyme disease infections in the United States. The asymptomatic course of the disease is more typical for European countries.

The first symptoms of Lyme disease are nonspecific: fever, headache, chills, muscle aches, weakness. A characteristic symptom is stiffness of the neck muscles. A ring-shaped redness (erythema migrans) forms at the site of the tick bite. In the first 1–7 days, a macula or papule appears, then over the course of several days or weeks the erythema expands in all directions. The edge of the redness is intensely red, slightly raised above the skin in the form of a ring, in the center the redness is somewhat paler. Round erythema, 10–20 cm in diameter (up to 60 cm), is most often localized on the legs, less often on the lower back, abdomen, neck, axillary, and groin areas. In the acute period, symptoms of damage to the soft meninges may appear (nausea, headache, frequent vomiting, photophobia, hyperesthesia, meningeal symptoms). Pain in muscles and joints is often noted.

After 1–3 months, stage II may begin, which is characterized by neurological and cardiac symptoms. Systemic tick-borne borreliosis is characterized by a combination of meningitis with neuritis of the cranial nerves and radiculoneuritis.

The most common cardiac symptom is atrioventricular block; myocarditis and pericarditis may develop. Shortness of breath, palpitations, and compressive pain in the chest appear. Stage III develops rarely (after 0.5–2 years) and is characterized by damage to the joints (chronic Lyme arthritis), skin (atrophic acrodermatitis), and chronic neurological syndrome.

Diagnosis of tick-borne borreliosis

• Anamnesis. As a rule, a person points to a tick bite or a visit to forest and park areas.
• Early clinical manifestations (colds, skin erythema).
• Test for tick-borne borreliosis or Lyme disease: determination of antibody titer in blood serum (titer 1:64 and above).
• In later stages: EEG, ECG, joint radiography, skin biopsy.

It is imperative to exclude diseases with a similar clinical course: tick-borne encephalitis, serous meningitis, rheumatoid arthritis, etc.

Diagnosis of Lyme disease

A thorough history is critical to diagnosing Lyme disease. It is important not to miss the facts indicating the possibility of infection with tick-borne borreliosis (country walks, tourist trips, etc.). Experts also pay attention to the presence of primary signs of the disease: skin erythema and general intoxication.

Depending on the stage at which the disease develops, various serological and immunological laboratory tests are used (PCR, RIF, ELISA, microscopic studies, etc.). In order to identify structural disorders of various organs and tissues, additional research methods are used, prescribing fluoroscopy, puncture followed by laboratory examination of the material, electrocardiogram, biopsy of epidermal tissue, etc.

A differential diagnosis should be made with diseases such as: encephalitis, rheumatoid arthritis, dermatitis of various origins, neuritis, rheumatism, Reiter's disease and others with similar symptoms. In patients suffering from syphilis and various autoimmune diseases (infectious mononucleosis or rheumatism), serological reactions can be false positive, which requires additional confirmation of the diagnosis.

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Treatment

Etiological treatment of Lyme disease

With early diagnosis, antibiotics from the tetracycline group (tetracycline, doxycycline) are prescribed for a course of 14 days. If you are intolerant to the latter and in childhood, you can take amoxicillin.

Subsequent stages with the development of cardiac, articular and neurological lesions are treated with penicillins or cephalosporins in a course of 21-28 days.

In some cases, while taking antibiotics, the Jarisch-Herxheimer reaction occurs, which is characterized by an exacerbation of the symptoms of spirochetosis associated with massive death of bacteria and the release of endotoxins into the blood:

• temperature increase;
• chills;
• drop in blood pressure;
• nausea;
• headache;
• myaglia, etc.

If a reaction develops, antibiotic therapy is suspended for some time, then resumed at the previous dosage. In severe cases, hormonal treatment is used.

Pathogenetic treatment of tick-borne borreliosis

• For general infectious phenomena: intravenous and oral detoxification therapy - infusion of glucose, saline, vitamins, taking antipyretics.
• For joint damage: anti-inflammatory and analgesic therapy - Analgesics, NSAIDs.
• For meningitis: intravenous dehydration therapy - Trisol, Ringer's solution.
• In severe clinical course of the disease: hormonal therapy.

Lyme disease treatment

If characteristic symptoms of Lyme disease are detected, comprehensive treatment is carried out in an inpatient infectious diseases hospital.

In stage I, antibiotic therapy is indicated for 2-3 weeks:

• Doxycycline 100 mg 2 times a day
• Amoxicillin 500 mg 3 times a day (children 25-100 mg/kg/day) orally
• Reserve antibiotic - ceftriaxone 2.0 g IM 1 time per day

Against the background of antibacterial therapy, the development of the Jarisch-Herxheimer reaction (fever, intoxication against the background of mass death of Borrelia) is possible. In this case, antibiotics are stopped for a short time, and then taken again at a lower dose.

For stage II Lyme disease, antibacterial therapy is prescribed for 3-4 weeks:

• If there are no changes in the cerebrospinal fluid, doxycycline 100 mg 2 times a day or amoxicillin 500 mg 3 times a day orally is indicated
• If there are changes in the cerebrospinal fluid - ceftriaxone 2 g 1 time / day, cefotaxime 2 g every 8 hours or benzylpenicillin (sodium salt) 20-24 million units / day IV

At stage III the following is used:

• Doxycycline 100 mg 2 times a day or amoxicillin 500 mg 3 times a day orally for 4 weeks
• If there is no effect, ceftriaxone 2 g 1 time / day, cefotaxime 2 g every 8 hours or benzylpenicillin (sodium salt) 20-24 million units / day intravenously for 2-3 weeks.

Early treatment usually leads to a person’s complete recovery. Chronic stages can lead to disability and death (irreversible changes in the nervous and cardiovascular systems). After completion of treatment, regardless of its effectiveness, the person is registered with an infectious disease specialist and specialized specialists.

Prevention of Lyme borreliosis

Prevention measures are non-specific and generally recommended; they include preventing tick bites, as well as preventing the nutritional route of infection:

• When visiting forests and parks, wear thick clothing in light colors.
• Clothing should fit snugly to the body at the neck, wrists and ankles.
• Pants must be tucked into socks and boots.
• There must be a hat on the head.
• To repel arthropods, repellents should be applied to the skin or clothing: Off, Deta, etc.
• Avoid contact with tall grass, weeds, bushes, thickets - such places should be avoided.
• If you are forced to pass through dead wood, you should make your way using a branch or stick, tapping on the plants (there is a chance of knocking the tick to the ground).
• After every hour of travel, you should carefully examine each other, especially the area of ​​the neck, armpits, and chest: as a rule, the tick does not attach itself immediately, but chooses a favorable place for itself.
• Do not take plants, branches, or grass out of the forest - they may contain ticks.
• Be sure to boil milk from questionable and unknown sources.

Measures to prevent Lyme disease at the state level include mowing recreation areas and areas adjacent to forest and park paths, and anti-tick treatment of the area with special insecticides.

Etiology

The disease Berliosis (the colloquial name has become more common in everyday life than the medical name - borreliosis) is caused by a bacterium from the genus of spirochetes - Borrelia burgdorferi. It is a gram-negative microorganism with flagella. It grows well on liquid nutrient media with a complex protein composition. It is shaped like a twisted spiral that rotates slowly. On their surface, bacteria have antigens that determine their specificity among subpopulations and also ensure the narrow targeting of the immune response.

About a dozen variants of this microorganism have already been identified, which are found in all corners of the globe. It has been clinically proven that the clinical picture of the disease depends on the borrelia serotype. Therefore, Lyme disease does not mean one disease, but a whole group of nosologies that are homogeneous but different in etiology.

Algorithm of action when an attached tick is detected

• Remove the arthropod as soon as possible, ideally in a medical facility. For self-extraction, an anti-tick module or a loop of thread is used, which is placed over the front of the tick tightly to the human skin, tightened and carefully pulled out, and the wound is treated with an antiseptic. It is important not to damage the tick, but even if it does, collect everything in a jar with a lid.
• Visit a medical facility - health workers will check whether all parts of the tick have been removed from the wound, treat the skin and write out a referral for an arthropod examination to determine if it is infected.
• Take the tick for examination to any accredited laboratory. This should be done immediately, maximum within 24 hours. The tick should be stored in a tightly closed container in the refrigerator until transportation.
• Take prophylactic antibiotic therapy as prescribed by your doctor. As a rule, it is prescribed without waiting for the test result (Doxycycline or Amoxicillin for 5-10 days). You should not ignore taking the drug: the disease is not easy, and the results of the tick test may be false negative.

Author:

Sabuk Tatyana Leonidovna hygienist, epidemiologist

Treatment of borreliosis. Treatment at the Echinacea Clinic

The body's response to borreliosis largely depends on the genetic predisposition of the immune system to respond to borrelia. Some “forest” peoples are adapted to borreliosis and it does not cause illness in them. But people have long been “mixed” genetically, and each of us could get either good immune resistance to Borrelia or bad. Therefore, in some cases, borrelia cause borreliosis and autoimmune reactions, while in others, the body copes with the infection on its own, without medication. If there is no proper predetermined immune response to Borrelia, the disease develops in severe forms and requires treatment.

With a competent, comprehensive approach to the treatment of borreliosis, this is a feasible task. We treat borreliosis in several directions at once:

• Antispirochetal antibiotic therapy is carried out to reduce the amount of the pathogen in the body so that the immune system can more easily take control of Borrelia. In our clinic, it is customary to monitor the effectiveness of treatment and the body’s tolerance of medications during the course of antibiotic therapy. If necessary, we adjust the dosage of medications.
• Correction of immune status. We help weakened parts of the immune system and “cool down” hyperactive processes in the immune system that attack our own body. It is important to understand that some borrelia will remain in the body in a dormant state in any case, and our main task is to “turn” the situation towards adequate functioning of the immune system .
• Control and treatment of concomitant infections is carried out so that the immune system is not “distracted” to fight other infections and is less involved in autoimmune processes.
• Symptomatic treatment and restoration of those organs and systems that have damaged Borrelia.

Control after treatment. For two to three years after active treatment, we check the immunogram every six months or a year and, if necessary, preventively correct the functioning of the immune system and prevent it from weakening. As soon as the indicators cease to be outside the normal range, treatment can be stopped. Most serious researchers today believe that it is impossible to “sterilize” the body from Borrelia, but it is possible to bring the body into a state where it copes with Borrelia on its own.

Complex therapy (antibacterial + immunoregulatory + treatment of concomitant infections) gives the best result. The duration of active treatment usually takes from two months to a year, depending on the nuances and severity of the current situation. This approach to treatment allows us to give a good prognosis in most cases.

Disease prevention

Lyme disease and prevention are practically incompatible; we can only note that you should avoid places with a lot of trees and tall grass, such as forests, parks, lakes, and garden plots.

Use protective clothing , namely light-colored, high-collared, long-sleeved sweatshirts, shirts, long pants and trousers. Do not exclude the use of insect repellent chemicals.

While in these places, try to check the bare areas of the body as often as possible. Ticks can also enter the house on vegetation brought from the forest, park, or cottage. Outdoor pets are also carriers of ticks.

Pets should also be examined for the presence of ticks on their skin, especially during the spring-summer season.

Pictured is a tick trap

How to treat

If you become infected with tick-borne borreliosis, you should immediately contact a specialist. The effectiveness of treatment will be better the sooner the patient consults a doctor. The treatment process is especially effective at stage I of the disease.

Treatment of this disease can go in two directions:

1. The first direction of treatment is etiotropic. During this method, they act directly on the causative agent of the disease, using antibiotics.
2. The next direction of treatment is symptomatic and pathogenetic treatment. In this case, the affected organs and systems of the human body are treated (this is, as a rule, the patient’s nervous system, his heart, joints).

At the first stage of the disease, tetracycline, doxycyline, and amoxicillin are most often used for its treatment. The dosage and time of taking these drugs should be prescribed only by the attending physician.

At stage II, the patient is prescribed medications for parenteral administration. This is done in order to achieve the maximum concentration of the drug in the patient’s blood. During this period of treatment, the doctor prescribes to the patient: penicillin, ceftriaxone. As in the previous stage of treatment, the dosage and duration of medication is determined only by the attending physician.

When treating stage II, the same penicillin series of antibiotics is used. The patient must take medications under the strict supervision of the attending physician. Which, if necessary, can replace one drug with another. This occurs because the initially prescribed drug does not bring the desired result.

For symptomatic and pathogenetic treatment of the disease, antipyretics are mainly used.

In addition to them, the doctor prescribes detoxification and anti-inflammatory drugs to the patient. Perhaps the patient will be prescribed heart-strengthening medications. A vitamin complex may be prescribed.

It is unacceptable to self-medicate with such a serious illness. A patient can receive the most effective treatment only in an infectious diseases hospital. Only there will a person receive the entire range of treatment aimed at the complete destruction of barrels. If a sick person does not receive the necessary treatment, this can lead to disability, and in some difficult cases, death.

What diseases can it be associated with?

Lyme disease, especially in the case of successful treatment, has a favorable prognosis, but in rare cases a number of complications develop, namely residual damage to the nervous system and musculoskeletal system:

• ankylosis,
• joint stiffness,
• fibromyalgia,
• chronic fatigue syndrome.

There are cases when sluggish borreliosis became the cause of death.

What is special about the treatment of borreliosis in children?

Treatment of Lyme disease in children is probably the most difficult process.

Difficulties begin from the very beginning, in making a diagnosis.

Redness is often attributed to an allergy to a particular product, while missing the time during which the disease begins to progress.

If your child spent the summer in a vegetative area, do not rule out getting tested for Lyme disease in order to avoid the consequences of this disease. Courses of antibiotics are prescribed for a long period, and not every antibiotic may be suitable for a child’s body.

Ask your child about his condition as often as possible. Without waiting for a referral from your doctor, take general and chemical tests (urine, blood) and do an ultrasound of the abdominal cavity.

How does infection occur?

The bacteria that cause borreliosis are contained in a special secretion of the salivary glands of parasites. Bacteria enter the human body through a tick or lice bite. Almost immediately, characteristic redness appears at the site of the bite. Elements of a rash—erythema—appear along the periphery of the affected area.

From the site of the bite, bacteria enter the human lymphatic system and quickly spread to all organs and tissues of the human body. This process is accompanied by the emergence of various foci of inflammation. Most often, the structures of the skin, spleen, brain and musculoskeletal system are involved in the inflammatory process. Any inflammation automatically forces the immune system to work in emergency mode. This leads to the fact that the virus cells begin to die, and a huge amount of decay products enter the human body, which leads to general intoxication of the body. Moreover, some breakdown products can trigger a number of autoimmune reactions. The resulting antibodies begin to destroy not only the infectious agent, but also their own tissues. This applies to those areas where the largest number of bacterial cells have accumulated. Gradually, such autoimmune reactions disappear, and the processes of repairing damaged tissues or regeneration begin.

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...But suddenly the actors' round dance fell silent in fear. The crimson creature crawls towards them and devours them. It crawls, showing its power, without sparing its victims. The bloody gaping mouth is the Lord of human destinies. Edgar Allan Poe “The Worm is the Conqueror” I read these poems a long time ago, in my distant childhood. And even then I didn’t believe that we were talking only about a grave worm.

Well, why, in fact, is the most harmless larva of a gravedigger beetle terrible for the living? And dead, as you know. nothing at all... My imagination pictured something else. It’s different and scary. Something akin to the depictions of death with a scythe in medieval engravings: sudden, merciless, almost invincible... Only years later did I learn that the “crimson creature” really exists. Outwardly, it is similar to a corkscrew. Its length is from 11 to 25 micrometers. According to Gram, it is painted bright scarlet. It threatens to become for us what leprosy was in the old days. Her name is Borrelia Bulgorferi. Or - Lyme.

It all starts with a tick. The most common one, ixodid, which is found in abundance in any forest. However, why only in the forest? Recently, ticks have perfectly adapted to the urban environment; you can meet them in the park, on the lawn, or in a flower bed; they can arrive right into your home - on the fur of your beloved dog or on your clothes. And, sensing the warmth and smell of your body, he busily begins to suck. Unlike a mosquito, midge or horsefly, a tick is wingless and inactive, and therefore attaches itself firmly to you, “conscientiously”, with the help of a real harpoon - a hypostome. It is because of this “trunk” that we cannot easily brush off the bloodsucker. You have to unscrew it with tweezers, smear it with oil and get rid of it in every possible way. However, if you do not touch the eight-legged ghoul, he will not stay with you forever. A tick needs blood at least three times: to transform a larva into a nymph, a nymph into an adult, and for reproduction. Therefore, having sucked, the tick itself will leave you, fall into the grass and only after digesting the blood, will rush in search of the next “breadwinner”... If this were all, we would not need to worry. Well, we really don’t worry when we are bitten by mosquitoes while fishing... Oh, yes, ticks carry encephalitis. So - in Siberia! In addition, there are vaccinations against encephalitis, whoever needs them gets them, but why should we... This is how things stood, or almost this way, until recently. Recently, “recent time” ended... ...November 1, 1975, USA, Connecticut, the small town of Lyme halfway from Boston to New York. Researcher Allen Steere of the Centers for Disease Control describes a new disease - "childhood rheumatoid arthritis", naming it after the city - Lyme disease. He also noted the connection between the disease and a tick bite. It soon became clear that not only children suffer from Lyme disease, that arthritis (joint damage) is not the only and not the main manifestation of the disease, that the infection is spreading across the United States with extraordinary speed, and that similar cases are being found all over the world. In 1982, Willy Burgdorfer isolated the causative agent of the disease - a spirochete from the genus Borrelia, a close relative of canine borreliosis and a distant relative of the well-known syphilis. The microbe was named after its discoverer - Borrelia burgdorferi. And soon “sisters” were discovered in the evil infection - as many as eight: Borrelia garinii, Borrelia afielii, Borrelia valaisiana, Borrelia lusitaniae, Borrelia japonica, Borrelia tanukii, Borrelia turdae and Borrelia andersonii, and only the last “sister” lives in America, the other seven - inhabitants of Eurasia, and ancient inhabitants, it must be said: about 60% of the Borrelia genome was isolated from the mummy of “Ötzi the Man,” who died in the Alps 5300 years ago. How could it happen that medicine learned about Lyme disease only at the end of the 20th century? There is still no exact answer to this question, but some assumptions can be made. Borrelia burgdorferi and its “sisters” are an extremely “omnivorous” species. It affects about four hundred species of living creatures, including deer, sheep, goats, cows, dogs, rodents, birds and many others. Apparently, people have been infected from time to time with some “old-type Lyme” from time immemorial, suffering it in a mild form, as we now do - piroplasmosis. Few people think that this typically “canine” infection also affects people. True, it passes so quickly and asymptomatically that the “patient” does not have time to notice anything. That’s why the medicine was silent - there were no casualties. But recently Borrelia made an evolutionary leap, producing a highly virulent form capable of overcoming (more precisely, deceiving, more on this below) human immunity. And four hundred and one were added to the four hundred species... Cats, by the way, began to suffer from Lyme only in recent years, after the “bipedal erectus”. As for the rapid spread of the epidemic, there are two reasons for this: the transmission of ticks by migratory birds and the transportation by humans of sick dogs, cows and other domestic animals. To date, Lyme disease has spread to all continents, but has not reached Antarctica. I haven’t gotten there yet: penguins also suffer from ticks...

For Borrelia, a tick is a vehicle, like a bus.\ In its intestines, they can travel indefinitely and can even be inherited by ticks - children. But real life for an infection can only begin in the flesh of a creature with warm blood. You and I, for example... By sucking, the tick numbs the bite site like an experienced surgeon, injecting a highly effective anesthetic through the hypostome. And with it - Borrelia.

Once under the skin, the infection causes a violent immune response that is difficult to confuse with anything. We are talking about ring erythema - a very bright, unusual, memorable formation. Imagine a scarlet ring with a diameter of 2 to 15 centimeters that appears around the bite on the 2nd to 15th day. It’s not every day that we see such “decorations”, right? But, unfortunately, the majority of our fellow citizens “accurately” diagnose allergies for themselves and their neighbors and happily self-medicate, especially since after another three weeks the erythema goes away on its own. ... Meanwhile, the man has already been branded, the “crimson creature” has marked him with its seal, and although the denouement of the play is still far away, the first and most important act is shamefully lost due to human carelessness. But right now, at the first stage, the required dose of antibiotics is enough to defeat the creature: reliably and without consequences... In addition to erythema, the onset of Lyme disease is characterized by a flu-like malaise (or allergic, oh, the irony of fate!). There are exceptions: when Borrelia gets under the skin “accompanied” by other, non-human infections (babesia, ehrlichia and other “joys of our smaller brothers”), a more serious fever develops, similar to typhus. Then the patient runs (or, rather, is taken) to the doctor, but if the ring erythema has managed to smooth out, the chances of a correct diagnosis are low. More likely, typhus will be diagnosed... And although the “rash” is treated with the same antibiotics as Lyme, their doses are too small to overcome the “crimson creature”.

And the creature, meanwhile, does not waste time. Having overcome the primary immune reaction, rapidly spreading throughout the body with the flow of blood and lymph, it is looking for a place where it can apply two unique “know-how” - persistence and distortion of the immune response. We are accustomed to the fact that the main weapon of the immune system - antibodies - attack exactly what they are made against (which is why they compare favorably with “human” drugs). Lyme turns the immune system upside down, forcing the production of antibodies against the proteins of those tissues into which the infection has penetrated, destroying them and almost “serving them to the table” of a hungry creature. And immune complexes directed against Borrelia themselves do not achieve their goal due to persistence: unlike all other bacteria, Borrelia live not between cells, but inside them, which is excellent protection from both antibiotics and immunity. Moreover, thanks to this dislocation, Borrelia behaves like a suicide bomber: at the moment of death, the contents of the microbe spill out and kill the cell in which it lived. Scientifically, this is called the Jarisch-Herxheimer reaction: a sharp exacerbation of the symptoms of the disease due to the death of pathogens. Along with persistence, this is the main barrier to treating late-stage Lyme. However, this is still a long way off. At the second stage (lasting from three months to a year), the creature has not yet taken root in the flesh, “tasting” the tissues encountered along the way, and the symptoms of the disease grow and multiply by leaps and bounds. Meningitis and meningoencephalitis begin with persistent and violent headaches, photophobia, weakness, weakness, rapid mood swings and tension (stiffness) of the neck muscles. A little later, paralysis of the facial muscles occurs, the face becomes distorted or sags. At the same time, pain begins in various parts of the body caused by damage to the peripheral nervous system, attention disorder, and memory loss. Cardiac arrhythmia caused by atrioventricular block is characteristic, which can cost the lives of those who already had heart problems. Problems with the pelvic organs, damage to the kidneys and bladder, polyuria and urinary incontinence, the occurrence or exacerbation of cholecystitis and pancreatitis are common. If the pathogen is the American Borrelia burgdorferi, joint damage is possible already at this stage; if the European Borrelia garinii is the pathogen, the joints will not yet be affected, but psychoses such as panic attacks, sudden depression, or mania are possible.

At this stage, a person, willy-nilly, goes to the doctor. However, due to the variety of symptoms (and the fact that the fact of tick suction has long been forgotten), the correct diagnosis is not always made. However, the picture described above is often blurred, and the patient, having come up with a separate explanation for each of the ailments (fatigue, flu, sciatica from a cold, quarrel with mother-in-law, hangover ext.) again begins to self-medicate. Meanwhile, even with proper treatment, the prospects are no longer bright. The course of the disease in the second stage is persistent; repeated relapses are possible, including with the transition to the third, persistent stage, from which it is not easy to get out. However, even after successful healing, facial paralysis will not go away in a month or two; there may be a decrease in memory, attention, vision and hearing, which also does not go away in a day.

The third stage occurs after a year or two. The crimson creature achieved what it conquered the flesh for - intracellular persistence and distortion of the immune response. And now, waiting for the tick that will carry her to new victims, she will slowly, methodically devour the actor. The violent symptoms stop, everything becomes smaller and more indistinct. Facial paralysis can partially recover (leaving only some muscles without tone), headaches no longer force you to climb the wall, sometimes certain parts of the body hurt (or, on the contrary, lose sensitivity), only with arthritis (the very thing “why?” Lyme went"), the patient suffers physically. The real danger of stage three is brain damage. It occurs gradually, unnoticed by the patient. Memory suffers more and more: a person quickly forgets the recent and gets confused in the old. Somewhere the very ability to learn new things disappears, everything instantly “jumps out of your head”, the slightest mental stress causes irresistible fatigue. Attention and intelligence decrease, gait disturbances occur (unsteadiness, stomping), speech disorders (difficulty finding words, distorted sentences, “telegraphic style”), disorders of understanding someone else’s speech (sounds do not form words, as if the interlocutor is speaking a foreign language, or chirps like a bird), excessive or sudden drowsiness (even to the point of lethargy), depersonalization and derealization (this is when you confuse sleep and reality, and everything around you and you yourself seem unreal), depression of consciousness, impoverishment of emotions. The emotional background is initially depressive, later - frivolous and complacent. Sudden short-term deterioration is characteristic, both transient and leading to “stepwise” regression. It is often only after such a “sickness” that the patient consults a doctor for the first time (often a psychiatrist, alas... It’s good if he turns out to be competent). In addition to the brain, the skin suffers. In some places it takes on the appearance of tissue paper (atrophic acrodermatitis), and wounds, rashes, tiny erythemas, and growths (lymphocytomas) open on it by themselves. This happens because borrelia accumulate under the skin in anticipation of the tick. Often it is the combination of skin lesions and higher nervous activity that is the key to the diagnosis of Lyme in the later stages.

Joint lesions can either begin gradually or come suddenly. Crunching, pain, stiffness... Previously they thought it was the activity of Borrelia themselves, but it turned out that it was an autoimmune lesion due to a distortion of the response. Some experts identify the fourth stage of Lyme disease, others write about “late manifestations.” We are talking about the period when destructive processes exceed natural recovery, years and years after the onset of the disease, sometimes suddenly, more often gradually. On the part of the joints (if they are involved in the disease) - this is loss of cartilage and immobility, on the part of the brain - dementia. This is what acquired dementia is called and it’s scary. As well as the fact that in articles about late-onset Lyme they bashfully hide behind phrases like “a clinical picture similar to neurosyphilis.” For those who are not afraid, the link is here: https://tapemark.narod.ru/psycho/sifilis.html, but I will refrain from quoting. The purpose of this article is to fight the “crimson creature”, and not to cry for those whom we are unable to help. I can't yet. The invention of antibiotics (sulfonamides, antidepressants) led to the salvation of millions of sufferers, and the turn will come for those whose “house of the soul” has cracked. But it’s not worth joining their number for now - battles must be given to Lyme earlier.

An approximate strategy for defeating the “winner worm”: If you are healthy, do not fall into carelessness or pride. Ticks are not AIDS, they bite people regardless of income, lifestyle, skin color or moral character, anyone can be bitten, and common “anti-tick” advice (like repellents, closed clothing) is unreliable and difficult to implement. Therefore: ideally, it would be a good idea to take an IgM and IgG test (specific antibodies to Borrelia) twice a year. Most laboratories do this analysis, the price is 20 - 35 euros. In the event of a bite, do not panic, but take note of the case and, if you feel the slightest discomfort, go to the doctor. If ring erythema is detected, run to the laboratory at full speed, and then, with tests at the ready, go to the doctor (in exactly this order, so as not to run into the creeping diagnosis of “allergic reaction to an insect bite”). In the first stage, treatment for Lyme is not difficult - just injections of a bunch of units of penicillin. If you have recently gotten sick, hurry up quickly. The second stage is treated slightly worse (although much longer), problems begin when the lesions are restored (the fewer of them have time to arise, the better). Or - with inadequate, untimely and, worst of all, interrupted treatment. I won’t say anything about adherents of “alternative” and “folk” methods, so as not to swear. Nothing better than antibiotics against Lyme has been invented yet. There will be more of them here. Much. Perhaps through an IV. Be patient, hope, and after the hospital do not forget to go to the doctor to avoid relapse. Borrelia are capable of forming persistent spores, and if the infection resumes, the “signal” erythema will not appear again - remember this and get tested! If you don’t know when you got sick but, in all likelihood, it was a long time ago, hurry up slowly. Healing in the third stage is an extremely difficult task. The extermination of persistent Borrelia requires enormous doses of antibiotics, the Yarisch-Herxheimer reaction can cause destruction no less than Lyme itself, and neurological and mental disorders will not go away on their own. Therefore, it is important to conduct thoughtful research, carefully select drugs, and only then fight. You need a doctor and a smart doctor - you need to find him... And also, you shouldn’t fall into the common mistake of “they don’t skimp on health.” There are no miracle cures for Lyme yet, banal antibiotics like penicillin and ceftriaxone “go into battle” and there is no point in buying them in the most expensive version! Moreover, unauthorized replacement with “super-effective” carbapems like Tienam - they are neurotoxic, and in case of Lyme this is death. Expensive drugs for restoring intestinal microflora are only slightly better than conventional ones, and the effectiveness of fashionable pseudo-scientific methods (bioresonance therapy), to put it mildly, is questionable. Acupuncture is useful - but only after victory, to relieve paralysis. You will need sorbents - but also banal ones (reosorbilac, enterosgel, etc.), anyway, given the intracellular location of bacteria, the effectiveness of any sorbent is low. To reduce the Yarish reaction, pulse therapy is used (varying the dose of drugs according to a certain scheme), and sorbents are only a remedy for general intoxication. Money is also needed for other things - correction of the immune response, revitalization of nerves, treatment of the brain, and simply - life while you are disabled. Some little-known tips for those who “suffer from the head” in the third stage: Due to the clogging of the brain capillaries with autoimmune complexes, chronic hypoxia occurs (and the inability to fully wake up). From a lack of oxygen, nerve cells do not work well, or even die. Therefore, coffee is useful, and not only for vigor. Most of all, Borrelia like to settle in the cells of the white matter of the nerves and brain. They are the ones who damage them the most. Therefore, cheese is a useful product - it contains amino acids necessary for nervous tissue. A decoction of licorice root (or licorice candy) has a double benefit: the substances contained in licorice help restore nervous tissue and prevent the proliferation of the herpes virus (its role is discussed below). But do not overdo it - taking them daily leads to swelling. Hypoglycemia is a common and dangerous syndrome in the picture of Lyme infection. This is a sharp drop in blood sugar levels, well known to insulin-dependent diabetics. Symptoms: feeling of intoxication, numbness of the lips, slurred speech, and in severe cases, loss of consciousness. Lyme is characterized by small but frequent hypoglycemia, which is perhaps more dangerous than rare and severe ones. Brain cells cannot live without glucose and die. Therefore, stock up on candy. And you almost feel the fog in your head, the candy in your mouth. These tips are not treatment, but only self-help for the period while you are looking for a doctor, or after - while the symptoms continue. After all, unfortunately, even after dying, the “crimson creature” does not leave a person alone. Post-Lyme syndrome. This is the name of the complex of painful manifestations after the infection has been expelled. It comes after defeating the third (sometimes the second) stage of the disease and, like the Serpent-Gorynych, it has three “heads”. 1. Autoimmune lesion. As mentioned above, Borrelia distort the immune response to suit their needs. This effect does not go away on its own and causes more and more damage to its own tissues even after the destruction of all bacilli. It is an autoimmune lesion that is to blame for inflammation of the joints and it is because of it that it is so persistent that it can manifest itself and poison life even years later. From the nervous system - neuralgia, intermittent paralysis of individual muscles, but a picture reminiscent of multiple sclerosis may develop. Fortunately, all this is curable (it is precisely thanks to the fight against multiple sclerosis that medicine has accumulated considerable experience, but here everything is easier if you tackle it in time). 2. Outbreak of concomitant infection. Borrelias do not walk alone. Quite often, when a tick bites, other microbes enter the bloodstream. For the most part, Babesia and Ehrlichia do not lead to chronic disease, but there are exceptions. However, it is much more important that the borreliosis distortion of the immune response is extremely beneficial to those infections that already exist in the body. First of all, these are herpes: simplex, Epstein-Barr virus and herpes-6. Being relatively harmless to a healthy person, in the presence of Lyme it is capable of causing immeasurable troubles, for example, the following: https://www.eurolab.ua/diseases/200/ After the death of Borrelia, the “accompanying virus” can multiply rapidly, and you need to be prepared. First of all, you need to find out which of the viruses became concomitant - there are tests for this. Then, during treatment, antiviral (or other, if it’s not a matter of viruses) drugs, preferably against this infection. Broad-spectrum - only as a last resort (ineffective, and, moreover, expensive). If everything is done correctly, there will be no outbreak of the accompanying virus at all. 3. Continuation of neurological syndromes and their social consequences. A sagging face, unable to smile due to paralysis of the facial muscles, is a bad decoration. A leaky memory, from which both the old and the new spills out, is a bad help. When a person loses his job as a result of this, it’s bad for him and his neighbors. And often those around them are the first to break down, leaving the sufferer to the mercy of fate (and depriving him of hope for healing: these phenomena take a long time to heal, and a person with damaged memory (speech, balance) is often helpless). Therefore, be merciful. And - patient. And also, be understanding of the hardships that the patient is going through. Persistent neuralgia can cause suffering such as pain in all teeth at once - think about it! Arthritis can make every step almost a feat - help the patient walk! Due to brain damage, he cannot relate to what is happening the way you do - do not give in to the temptation to lecture the poor fellow. Yes, basic things have become incomprehensible to him and he confuses right and left. Don't scold him for this! Yes, he finds it funny. when you're scared. And thank God! Would it really be a joy for you if the poor fellow also suffers? Yes. after recovery, he remembers the past, like a book he read, something that happened to someone else. Is this really a problem? Or maybe it’s nonsense? After all, how many of us have fresh childhood memories? That's the same! It remains to add a little: The test for Lyme reads like this: IgM - fast antibodies, IgG - slow. Therefore, if a person has IgM, but no IgG, he has fallen ill recently; if, on the contrary, he has been sick for a long time; if both, the disease is at its peak. A questionable reaction is also a reason to visit a doctor, and in the presence of erythema - one hundred percent Lyme (antibodies are often delayed for several days, and sometimes even a week). Lyme is almost impossible to spread from person to person. “Almost” refers to those rare cases when a tick dropped from a sick person bites a healthy one. Due to the fact that ticks attach quickly and firmly, this is difficult to achieve. The same can be said about blood-to-blood transmission of infection. Cases of infection with a non-sterile syringe can be counted on one hand; Borrelia does not survive in canned blood and serum preparations, and cases of sexual infection have not been described at all. What remains is direct blood transfusion and blood fraternization... Conclusion: before fraternizing, get tested. Unfortunately, there is another route of infection and it is much more likely. Lyme can be contracted by drinking fresh milk from a sick cow or goat. Moreover, in this case, ring erythema will appear in the stomach and the patient will remain in the dark for a long time... It seems that lovers of fresh milk will have to reconsider their habits. Moreover, the most alarming news has leaked onto the Internet that Lyme can be carried by deer fleas, bloodsuckers, jet flies, horseflies and even mosquitoes. If this is not an “instant transfer” in the manner of a fresh blood transfusion, but a full-fledged carriage with a long stay of the infection in the insect’s body, we will have a hard time... It seems that Lyme can be transmitted from mother to child - both in utero and during breastfeeding. For the first couple of years this is not noticeable, then there is a full-blown third stage with dire consequences. During the infection and immediately after it (when there is a possibility of relapse), you should not get pregnant! Immunity does not develop with Lyme; a person can become infected again even immediately after recovery. But a “serological tail” is formed - a positive IgG reaction for a year - a year after treatment. It is this that prevents the occurrence of erythema during re-infection. And it is because of her that cases of self-healing of Lyme at the first stage are not happiness, but grief. Within a year, a person can become infected and not know about it. Like all new phenomena, Lyme disease has caused a lot of discussion on the Internet and beyond, which has almost given rise to a subculture. And increasingly, the patient goes to the Internet before going to the laboratory. In principle, this is good: knowledge is power. But sometimes on the forums they write things that come either way or fall: all sorts of “treatments” with the help of diets, propolis, bioresonance therapy ext. In principle, a person has the right to pin his hopes even on the ear of a yellow bull - a miraculous remedy of the ancient Sumerians - as long as he does not forget about antibiotics. Unfortunately, not all “forum wisdom” is harmless. Not so long ago, one of my friends, who was treating Lyme in the first stage, happened to read that, supposedly, with Lyme you should give up sweets, even if you really want to, because eating sugar feeds borrelia. Fortunately, it didn’t come to that... After all, such “advice” is like death! At least for the brain. As I wrote above, Lyme is characterized by hypoglycemia - a drop in sugar levels. And if you don’t “feed the borrelia,” they will deplete the brain of glucose and the person will plunge into a mori-like syndrome - a kind of cheerful dementia with increased sociability and a tendency to philosophize. Does this remind you of anything? As for me, the author has already angered his Borrelia “I just can’t do it.” There is no vaccine against Lyme and it is unlikely that one will be created in the foreseeable future (well, we have not had vaccinations against syphilis for a century now...). For now, all hope lies in antibiotics and all sorts of clever ways to use them. For example, after hyperthermia. Once upon a time, syphilis was treated this way - they inoculated with malaria, which caused the body temperature to rise sharply. The delicate spirochetes died immediately from this. Borrelia do not die, but leave their places of persistence, and that is what we need: outside the cells they are vulnerable and their death does not threaten the Yarish reaction. True, this method is not easy for the patient, although now hyperthermia can be achieved with chemicals alone, without malaria and quinine: lying around for days and nights with a temperature of 42 degrees is not something that many people like... But, perhaps, the “crimson creature” will be deceived. Like many bacteria, Borrelia are capable of chemical communication—communication, if you will. This is where high technology can step in. It may be possible to send false “antipersistent” signals to Borrelia, and, after leaving the cells, the “crimson thing” will begin to wander around the bloodstream, becoming an easy target for antibiotics and antibodies. A kind of chemical pipe for the rat-catcher of Hamel... But these are things to come - and we must survive and live now, so that this future comes. So let's win! Unfortunately, due to the reluctance of domestic medicine to admit its unpreparedness, and even incompetence, the scale of the Lyme epidemic is downplayed, or even hushed up altogether. But Borrelias do not know political ambitions, they don’t care whether you are a deputy, a janitor or a tourist. And therefore, everyone should know about the impending disaster: if you read it yourself, pass it on to someone else!

How to identify Lyme disease in humans

Laboratory tests are the most informative way to identify the causative agents of Lyme disease in the body before the development of severe symptoms and complications.
Most often, so-called serological diagnostic methods are used for diagnosis, which make it possible to determine antibodies (immunoglobulin) in the body that are produced by the immune system after the pathogen enters the bloodstream.

There are several types of antibodies to borreliosis, each of which is produced at a certain stage of the disease:

• an increased concentration (titer) of IgM immunoglobulins indicates an acute course of the infectious process, since they are produced 2-4 weeks after infection;
• IgG immunoglobulins are observed at the second or third stages of the disease, and the long-term presence of antibodies to Borrelia of this class in the blood indicates the transition of the pathological process to a chronic course.

The test is taken 2 weeks after contact with the parasite, and then repeated 20-30 days later, since not all patients develop antibodies to Borrelia in the early stages.

If it is impossible to conduct a serological test for any reason, microbiological diagnostic methods, most often PCR, are used for diagnosis. They give a less accurate picture, since it is more difficult to isolate the pathogen from blood and other samples using such a study.

How and where to take tests

If venous blood is used for the study, it is taken on an outpatient basis, after which the patient can go about his business. Collecting cerebrospinal fluid and joint fluid is a complex and sometimes painful procedure, so hospitalization is required for the study.

In order for the analysis result to be as accurate as possible , before the procedure you need to prepare to adhere to the following rules:

• avoid stressful situations and excessive physical activity;
• do not consume fatty and spicy foods, as well as alcoholic beverages 72 hours before blood sampling;
• do not smoke several hours before the test;
• The last meal should be no earlier than 8-10 hours before the delivery of the biomaterial.

In addition, the doctor must be informed about all medications that the patient is taking, as well as about existing diseases.

IMPORTANT! To identify tick-borne borreliosis, not one, but several diagnostic methods are used, which complement each other, making it possible to make the most accurate diagnosis and determine the stage of the disease.

Tests to detect Lyme disease can be taken at any private clinic; the approximate cost is 600-1000 rubles, depending on the diagnostic method. In public hospitals, the study is carried out free of charge, but not all medical institutions have the necessary equipment and chemicals for this.

Serological research methods

For serological diagnosis by ELISA, venous blood is used, which is taken 2-4 weeks after the bite, and then repeated 20-30 days later. The study provides a fairly informative picture of the disease , but sometimes requires additional tests to clarify the diagnosis.

Interpretation of a blood test using ELISA for borreliosis

Antibodies to Borrelia	Negative result, OU/ml	Doubtful result, OU/ml	Positive result, OU/ml
Anti-Borrelia IgM	less than 0.8	0,8-1,1	more than 1.1
Anti-Borrelia IgG	less than 16	16-22	more than 22

Indicators, or reference values, in deciphering the results of a blood test for Lyme disease may differ depending on the laboratory, so you should consult a doctor to make an accurate diagnosis .

Immunochip

The immunochip technology is similar to the ELISA method, and is based on identifying antibodies in the patient’s blood that are produced when Borrelia enters the body. The advantages of the technique are that it allows you to get results much faster , and also has not two, but much more markers, therefore it determines the presence or absence of the disease with greater accuracy .

IMPORTANT! A single test for tick-borne borreliosis is not able to give an accurate result, even when using innovative techniques - to assess the patient’s condition, doctors conduct several tests at certain intervals to see the indicators over time.

Other blood tests

In addition to serological studies, if borreliosis is suspected, bacteriological (cultural) methods are used, which involve isolating the pathogen on nutrient media.
Their value in making a diagnosis is quite low, since Borrelia are very demanding on the conditions of the analysis, and the likelihood of obtaining a false result increases .

Decoding the results of such studies is simple - depending on the presence or absence of pathogens in the biomaterial, the analysis can be positive or negative.

At the second and third stages of the disease, patients are prescribed a general blood test, which allows identifying inflammatory and infectious processes in the body - characteristic markers for borreliosis are an increase in ESR and an increase in the concentration of leukocytes .

Blood tests are of particular importance in the diagnosis of Miyamoto borreliosis , which occurs without annular erythrema, a specific symptom of Lyme disease, which makes it much more difficult to identify. In this case, patients require a comprehensive diagnosis, which includes various research methods and careful monitoring of their health status.

PCR (polymerase chain reaction)

The PCR technique is based on the detection of Borrelia DNA fragments in the patient’s biological fluids (blood, cerebrospinal fluid) and tissues from the affected area. The analysis has a number of advantages, including accessibility, high accuracy of results and speed of obtaining them - the maximum period is 72 hours.

In addition, using PCR analysis, it is possible to identify not only Borrelia, but also other pathogenic microorganisms dangerous to health. The transcript of the study after a tick bite is as follows: a positive or negative result, depending on the presence of Borrelia DNA in the samples.

IMPORTANT! A positive PCR result in almost 100% of cases indicates the presence of the disease and is a sufficient basis for prescribing immediate treatment.

Immunoblot and Western blot (if false negative)

Immunoblot and Western blot are among the most informative and modern research methods , which involve the identification of specific protein compounds in the patient’s biomaterial.
They make it possible to identify antibodies to 10 antigens of pathogenic microorganisms during diagnosis, determine its stage and chronic course. The analysis is done 2-4 weeks after the bite, after which it is repeated a month later to clarify the diagnosis and assess the dynamics of indicators.

Most often, Western blot and immunoblot are used for the diagnosis of tick-borne borreliosis in combination with serological research methods.

The disadvantage of these methods is that they often give a false negative result , that is, they show the absence of the disease in infected people, which can lead to incorrect diagnosis and lack of adequate treatment. Most often, this phenomenon is observed in people with immunodeficiency states - their body is unable to give an adequate response to the presence of the pathogen, which is why specific immune complexes are absent in the blood.

Checking a tick for borreliosis

If the entire tick was removed from the body of the injured person, it is taken to the laboratory for examination for the presence of borreliosis pathogens. For this, the PCR method is used, which makes it possible to identify the genetic material of Borrelia in the DNA of the parasite. Infection of a tick does not 100% indicate that the bitten person was infected with the disease, but to prevent unpleasant consequences, he is placed under strict medical control and preventively treated with antibacterial drugs.

What medications are used to treat Lyme disease?

• Azithromycin - 0.5 g on the first day, 0.25 g on days 2-5,
• Amoxicillin - 0.5 g 3 times a day,
• Bicillin - 300,000 units and 600,000 units once a week or 1.2 million units 2 times a month,
• Hydroxychloroquine - 0.4 g once a 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.

Forecast

The nature of the prognosis depends on how quickly a person realizes the problem and seeks medical help. The disease borreliosis can be cured at an early stage and prevent it from becoming chronic, but the pathogen in small quantities will still circulate in the body, as well as the formed immune complexes.

Dispensary observation is indicated in the conditions of the CIZ (infectious diseases office) for a year after clinical recovery. Patients are tested for the pathogen three weeks after discharge, then three months, six months and finally a year later.

The causative agent of the disease

The etiological heterogeneity of Lyme borreliosis has been proven quite recently. For a long time it was believed that the disease was caused by one species of Borrelia - B. burgdoiferi. The evidence obtained for the heterogeneity of the protein composition of isolates obtained from different natural foci identified more than a dozen groups of the B. burgdorferi genome sensu lato.

As a result, the patient had different types of damage to internal organs with different manifestations of the disease. There is a dependence of the development of the clinical picture on the patient’s place of residence. The development of the chronic form of atrophic dermatitis is associated with damage to Borrelia of the genus B. afielii, Lyme arthritis - with spirochetes of the B. burgdorferi ss species, neurological manifestations - with damage to the body by spirochetes of the species B. garinii.

Based on the data obtained, Lyme disease can be considered as a result of damage by a large group of Borrelia, with each type of spirochete developing independently.

Diagnostics

As usual, the doctor first conducts a survey of the patient, compares the data received from him with the time of year and the diseases characteristic of him. Examines the patient for insect bite marks, erythema annulare, or urticaria. Checks neurological status and also orders an ECG. If there is a suspicion that it may be tick-borne borreliosis (Lyme disease), the description is recorded in the medical history, and the patient is asked to take a blood test and perform a puncture of fluid from the edge of the erythema to identify the pathogen.

A serological test is required to determine the type and type of borrelia, as well as to determine the stage of the disease in a particular patient. The diagnostic titer for verifying the diagnosis is considered to be 1 in 64. Since in the early stages the test can give a false negative result, it is recommended to repeat it after twenty days or a month, when the amount of immunoglobulins is greater and there will be enough of them to stage a reaction. False-positive reactions are also possible. They occur in patients with syphilis, infectious mononucleosis, relapsing fever, and rheumatic diseases.

Diagnosis of borreliosis

With regard to the division we have given into stages as a whole, it should be noted that it is conditional in nature, and the clinical manifestations for each period are not obligatory for each patient.

Early diagnosis of the disease is carried out, however, on the basis of the obtained clinical and epidemiological indicators. The presence of a typical manifestation of borreliosis in the patient in the form of erythema ensures registration of the disease without the need for clarification in the form of laboratory confirmation, and also without the need for specific data regarding the tick bite. Laboratory diagnosis, in particular, is made on the basis of a serological blood test.

What other drugs are used

Doxycycline

Doxycycline is an antibiotic of the tetracycline group, which is often prescribed to patients with tick-borne borreliosis in the absence of contraindications and allergic reactions. It has a wide spectrum of action and a bacteriostatic effect - it does not destroy pathogenic microorganisms, but prevents their reproduction, due to which they die and are eliminated from the body naturally. The active substance of the drug destroys not only Borrelia, but also other bacteria - chlamydia, mycoplasma, Klebsiella, rickettsia, etc.

Compared to other antibiotics, Doxycycline is well tolerated by the body and rarely causes side effects , but still requires caution when used, following the instructions and medical recommendations.

Azithromycin

The drug belongs to the category of broad-spectrum macrolides and is used for a number of different diseases, including Lyme disease.
For tick-borne borreliosis, it is prescribed more often than other antibiotics of the group , as it has a number of advantages:

• well tolerated by the body and rarely causes side effects;
• actively penetrates the cell membrane of microorganisms and begins to fight them immediately after administration;
• quickly accumulates in tissues, providing the necessary therapeutic effect.

Azithromycin is available in tablet form; in childhood, an oral suspension is used.

Recommended doses are 500 mg for adults and 30 mg per kilogram of body weight for children, tablets are taken twice a day for 10-21 days. Azithromycin is contraindicated in case of hypersensitivity to the active substance, severe kidney and liver dysfunction, under the age of 12 years, and used with caution in disorders of the urinary system, heart and digestive tract. The most common side effects include stool disorders, nausea and vomiting, headaches, allergic reactions, dysbiosis and candidiasis.

REFERENCE! Antibiotics are also used to treat tick-borne borreliosis in pregnant women, but before taking it, you should choose the right drug, and also balance the benefits for the mother with the possible risk for the child.

Amoxiclav

Amoxiclav is a combination of the active component amoxicillin with clavulanic acid, which improves its effects - it destroys bacteria that are resistant to the effects of the drug. This broad-spectrum remedy, which is recommended for the treatment of various diseases, effectively and quickly combats the manifestations of tick-borne borreliosis. Available in the form of tablets that contain 250 or 500 mg of active ingredient.

The average dose of the drug for the treatment of tick-borne borreliosis is 500 mg for adults (Amoxiclav in tablet form is not prescribed for children under 12 years of age), administration is carried out at intervals of 8-12 hours, the therapeutic course is 14 days, but if necessary it can be extended.

Contraindications to the use of the drug include hypersensitivity and allergic reactions, infectious mononucleosis, severe blood diseases, and should be used with caution in severe kidney and liver diseases.

Amoxiclav is well tolerated by the body , but can sometimes cause disorders of the digestive, nervous and urinary systems, allergic reactions and changes in blood composition.

Sumamed

Sumamed is an analogue of azithromycin - it contains the same active ingredient. It has a wide spectrum of antimicrobial effects, quickly penetrates the cell membrane of pathogenic microorganisms and destroys them. Available in the form of capsules, tablets and powder, which is used to prepare an oral suspension.

If there are signs of borreliosis, the drug is prescribed according to the following scheme: on the first day, 1000 mg, after which the dosage is reduced to 500 mg, tablets or capsules are taken once a day, the course of treatment is 5-7 days. In childhood, the dose is calculated based on body weight - 20 mg/kg on the first day and 10 mg/kg on the following days.

Contraindications include allergic reactions, severe kidney and liver dysfunction, and the list of side effects includes disorders of the nervous system and digestive tract (headaches, dizziness, vomiting, nausea, diarrhea), less commonly, disorders of the cardiovascular and circulatory system, allergic reactions.

IMPORTANT! If severe side effects develop or there is no improvement in the patient’s condition, you should consult a doctor as soon as possible to change the drug - using analogues on your own is strictly not recommended.

Unidox Solutab

An antibiotic from the tetracycline group, which includes the active substance doxycycline.
It has similar effects and indications, but does not irritate the mucous membrane of the gastrointestinal tract, which means it can be used in people with diseases of the digestive system .

Available in the form of tablets for oral administration, each of them contains 100 mg of active substance.

Unidox Solutab is taken at a dosage of 200 mg per day on the first day, after which it is switched to a dose of 100 mg, the therapeutic course lasts at least 10 days. Children over 12 years old with a body weight of less than 50 kg are prescribed 4 mg/kg of body weight on the first day, and in subsequent days they switch to 2 mg/kg.

The antibiotic is contraindicated for people with individual hypersensitivity, serious kidney and liver diseases, during pregnancy and lactation. Sometimes it causes allergic reactions, gastrointestinal disorders, disorders of the hematopoietic system, candidiasis.

IMPORTANT! When treating tick-borne borreliosis with antibiotics, it is important to complete the full course - if you do not complete the treatment, live borrelia may remain in the body, which will provoke a relapse of the disease.

Amoxicillin

Amoxicillin belongs to the penicillin group of antimicrobial agents, has a wide spectrum of effects and is effective against a large number of pathogenic microorganisms. In the treatment of tick-borne borreliosis, the drug is more active than doxycycline and some other antibiotics, reduces the risk of relapse of the disease and the development of complications . Sold in pharmacies in the form of tablets containing 500 mg of active substance.

The dosage of Amoxicillin for Lyme disease is 0.5-1 g three times a day; in childhood, 20 mg per kilogram of body weight per day is prescribed. Therapy lasts 10-14 days, and can be continued if necessary.

Amoxicillin is not used for severe kidney and liver disorders, allergic reactions to penicillins, pregnancy, infectious mononucleosis and lymphocytic leukemia. The most common side effects are nausea, vomiting and diarrhea, allergic manifestations, disorders of the nervous, genitourinary and biliary systems.

Suprax

A third-generation antimicrobial agent of the cephalosporin group, based on the active substance cefixime.
Refers to antibiotics with a broad spectrum of action and bactericidal effect, used in the treatment of infections caused by microorganisms sensitive to the effects of the drug, including in the treatment of tick-borne borreliosis.

In pharmacies it is sold in the form of tablets and granules for the preparation of a suspension.

The average daily dose of Suprax is 400 g of active substance, divided into 1-2 doses. For children, the drug is prescribed in the form of a suspension, the dosage depends on age and body weight - from 2.5 to 10 ml per day.

A contraindication to the use of the antibiotic is hypersensitivity to its components; the drug is used with caution in old age and in case of kidney disease. In rare cases, when taken, gastrointestinal disturbances, allergic manifestations, headaches and dizziness, and changes in blood test values ​​are possible.

Rocephin

Rocephin is an antibiotic from the group of third generation cephalosporins made in Switzerland with a high degree of purification . It has a powerful, prolonged effect, quickly reaches the required concentration when it enters the body and effectively fights pathogens. Available in powder form, which is diluted to obtain a solution, complete with lidocaine.

For adults and children over 12 years of age, Rocephin injections are given once a day, 1-2 g; in severe cases, the dosage can be increased to 4 g; for patients under 12 years of age, the daily dose is calculated depending on body weight - 20-80 mg/kg .

The only contraindication to the use of antibiotics is intolerance to drugs of the cephalosporin group, possible side effects - allergic manifestations, stool disorders, headaches and dizziness, changes in laboratory test results.

REFERENCE! In modern medicine, Rocephin is considered the optimal drug for the treatment of Lyme disease, but the main disadvantage is its high cost.

Ceftriaxone

The medicine belongs to the third generation of the cephalosporin group and is considered one of the most powerful and effective antimicrobial agents used in the fight against Lyme borreliosis .
It is available in the form of a powder, which is diluted with sterile water and administered intramuscularly (sometimes intravenously), but since Ceftriaxone injections are quite painful, it is recommended to dilute it with lidocaine.

For children over 12 years of age and adults, the average daily dose is 1-2 g; younger patients are prescribed 20-50 mg per kilogram of body weight per day; the therapeutic course lasts 10-14 days. Intravenous administration of the drug is indicated in severe cases and is carried out only in a medical facility.

Ceftriaxone is contraindicated in case of individual hypersensitivity to cephalosporins and penicillins; it is used with caution in renal and liver failure, inflammatory diseases of the gastrointestinal tract, pregnancy and lactation. Side effects occur in the digestive, nervous, urinary and hematopoietic systems, and sometimes allergic reactions are possible.

Cefixime

Cefixime belongs to the same group of antibacterial drugs as Ceftriaxone (third generation cephalosporins), but unlike it, it is not destroyed when it enters the gastrointestinal tract, so it is taken orally. Compared to analogues, it has a rather narrow spectrum of action, and the therapeutic effect in the treatment of tick-borne borreliosis is less pronounced, so it is used for preventive purposes or for mild forms of the disease .

The daily dose of Cefixime for adults and adolescents is 400 mg of the active substance per day, divided into two doses, for children weighing 25-50 kg - 200 mg in one dose. The average course of treatment is 10-14 days.

Cefixime is not prescribed for individual intolerance, pregnancy and lactation, as well as for children weighing less than 25 kg. The most common side effects are abdominal pain, nausea, loss of appetite, diarrhea; disorders of the nervous, genitourinary and hematopoietic systems, and allergic manifestations occur less frequently.

Yodantipyrine

Yodantipyrine is not an antibiotic, but an antiviral agent , and, in addition to the ability to fight pathogenic microorganisms, it has anti-inflammatory and immunostimulating properties.
It is produced in the form of tablets and is used as part of complex therapy in the treatment of diseases that are transmitted by the bite of ixodid ticks.

The dosage and regimen of Yodantipirin depends on the clinical course of the disease and the characteristics of the patient’s body - the average daily dose is 1-3 tablets three times a day for 7-10 days.

The drug is contraindicated in case of individual intolerance to iodine and iodine-containing drugs, as well as in case of hyperfunction of the thyroid gland. Side effects during treatment are rare - allergic reactions and gastrointestinal disorders are possible.

Lyme borreliosis: symptoms of chronic form

The course of the chronic form of borreliosis is characterized by alternating remissions and relapses. In some cases, the disease also acquires a recurrent nature in its continuous manifestation. Most often, chronic borreliosis is characterized by the presence of arthritis, in addition to which typical changes characteristic of chronic inflammation also develop. This includes osteoporosis, cartilage thinning and loss, and in rare cases, degenerative changes.

A fairly common symptom is skin lesions, manifested in the form of benign lymphocytoma, which is an edematous and dense infiltrate (i.e., a nodule) of bright crimson color. It is characterized by mild pain, determined by palpation. It can be located in the area of ​​the nipple of the mammary gland or on the earlobe, and the duration of its preservation in these areas can range from several months to several years.

Another typical lesion for the chronic form of the disease is atrophic chronic acrodermatitis. It consists of cyanotic-red spots formed in the area of ​​the extensor surfaces of the extremities, and they tend to peripherally increase in size, as well as to merge and become systematically inflamed. Over time, the skin at the site of the spots atrophies, becoming similar in appearance to papyrus. The development of this process can be relevant for several months, and sometimes even years.

It should be noted that tick-borne borreliosis, the symptoms of which last a long time in the chronic form of the disease, in some cases becomes the cause of partial or complete loss of ability to work.

Clinical manifestations

Before systematization, Lyme disease was described by a list of individual diseases, the etiology of which was unclear:

• chronic atrophic dermatitis;
• Bannwart's syndrome;
• tick-borne erythema annulare;
• migrating chronic erythema;
• radiculoneuritis;
• serous meningitis;
• acrodermatitis;
• chronic arthritis.

After the establishment of spirochetal etiology, Borreliosis was classified as a nosological disease acquired through transmissible infection.

The human body responds with high, almost absolute susceptibility to damage by spirochetes of the genus Borrelia.

Inoculation of the pathogen into the human body occurs with the saliva of the ixodid tick, but the development of the alimentary route of infection is not excluded. In some cases, transplacental transmission of spirochetes to the fetus from an infected mother has been observed.

The disease progresses in the case of a combination of hematogenous and lymphogenous spread of infection. Spirochetes are localized in joints and lymph nodes, causing internal inflammatory processes in organs, including the meninges.

As a result of active damage to internal organs, ixodid tick-borne borreliosis irritates the immune system and leads to the generation of a hyperimmune response in the human body.

Symptoms

a) place of the tick bite; b) border of annular erythema

The duration of the incubation period depends on the type of parasitic microorganism. Its length ranges from one to twenty days. The average period for the development of the disease is a week when a bite is detected by a tick vector.

The disease manifests itself subacutely, with the formation of edematous redness at the site of infection by the parasite. Patients complain of signs of nausea, general weakness, moderate headaches, and loss of sensation at the site of the bite.

Conditional differentiation of the disease includes early and late periods, and the first is characterized by two stages of infection localization:

1. The erythemal stage includes the initial entry of the pathogen into the upper layers of the dermis after a parasite bite.
2. The non-erythema form is accompanied by the dissemination of spirochetes and their localization in the internal organs of the human body.

At the second stage of development of the disease, various manifestations of the clinical picture are noted. The course of the disease depends on the types of borrelia and their dislocation in internal systems and organs.

Manifestations of the late period, or third stage, are characterized by damage to both one organoid and the entire system of internal organs. There may be no transition from stage to stage, but at the last stage, it is possible that only one symptom may appear, indicating the presence of infection.

Read more about symptoms.

Symptoms of the disease

Symptoms of borreliosis begin to appear several days after the insect bite. At this time, bacteria actively spread throughout the body of a sick person. Symptoms at this stage of the disease:

• weakness;
• chills;
• temperature increase;
• weakness;
• headache.

Only 15% of patients experience similar symptoms.

Symptoms that manifest themselves as disturbances in the patient’s cardiac activity are observed in only 8% of patients.

If borreliosis is not treated, arthritis can be observed in 60% of patients. This symptom may appear in the patient for several years. And only 10% of patients can develop chronic arthritis of the knee joint.