Lyme disease

Posted onApril 9, 2020 in Pain

Lyme disease , or systemic tick-borne borreliosis, is an infectious disease that affects mainly the skin, nervous system, heart and joints. It is known relatively recently, it was isolated in an independent nosological form only in 1977. The name of the disease comes from the name of the village of Lyme in Connecticut (USA), where the epidemic of this infection was first recorded. It has now been proven that the disease is spread not only in the United States, but everywhere. Epidemics in Europe, Australia; Asia, China, Japan. The disease is caused by one of the varieties of spirochetes – Borrelia burgdorferi, ixodid ticks are the carrier. The peak incidence occurs in the summer months, mainly children and young people are sick.

The main clinical sign is erythema migrans, usually on the hips, in the inguinal and axillary regions. Fever, chills, headache, myalgia, lymphadenopathy, splenomegaly are observed. Sometimes neurological disorders are detected – neuritis, especially with damage to the cranial nerves, paresis of the facial nerves is often observed. In severe cases, the clinical picture of serous meningitis, encephalitis is noted. Damage to the heart develops in 4-8% of patients, the most common is atrial ventricular conduction, up to the development of complete transverse blockade. Myocarditis with left ventricular failure, pancreatitis can be observed. Joint damage develops in 60% of patients within a few months to 2 years from the onset of the disease. Usually, one or several large joints (knee, elbow, shoulder, etc.) are affected, and symmetric polyarthritis is often found. Arthritis resolves on its own within 1-2 weeks, but can recur for a number of years. Some patients develop chronic arthritis with erosion of cartilage and bones, joint ankylosis is extremely rare. The diagnosis is made in the presence of a characteristic skin lesion – tick-borne erythema. It is necessary to take into account the epidemiological factor: the disease occurs in areas where there are carriers – ixodid ticks. The presence of typical clinical manifestations of the disease – neurological, cardiac and articular lesions – allows you to confirm the diagnosis. If cutaneous erythema is absent, the diagnosis should be based on the results of a serological examination. Abroad, a sensitive and highly specific enzyme immunosorbent method (ELISA) is used to confirm the diagnosis. Differential diagnosis at the first stage of the disease during erythema is carried out with skin lesions of a different nature, with complications from the nervous system – primarily tick-borne encephalitis, which is also transmitted by ticks and is found in central Russia. In the early stages of the disease, tetracycline 250 mg 4 times a day, penicillin, erythromycin are effective. Arthritis is treated with vibramitia (doxycycline hydrochloride) 100 mg 2 times a day, penicillin 20 million units (fractionally) per day for 14 days.

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