Lyme Disease

Symptoms

The incubation period in various sources ranges from 1 to 50 days 
•    General infectious intoxication;
•    Erythema (reddening of the skin);
•    Arthritis;
•    Regional lymphadenopathy (enlarged lymph nodes);
•    Damage to the nervous system;
•    Damage to the cardiovascular system;
•    Hepatolienal (enlargement of the liver and spleen).
The periods of development of the disease are rather conditional, mainly limited only by the time frame:
1.    Early (localized and disseminated stages);
2.    Late;
3.    Residual.

Localized early stage
It begins acutely or subacutely with a low fever (subfebrile body temperature - 37.1-38 ° c), headache, weakness, discomfort in the muscles and joints. Rarely, nausea and vomiting occur. Catarrh (inflammation) of the upper respiratory tract occurs very rarely, sometimes there is regional lymphadenopathy, hepatolienal syndrome.
The most striking sign of this phase of the disease (but not always!) Is the emergence of migratory annular erythema on the skin surface (pathognomonic sign of the disease). Initially, at the site of the tick bite, a primary affect occurs (redness of 2-4 mm of reddish color), then a spot or papule of intense pink-red color appears, spreading in all directions many centimeters in diameter over the course of several days. The edges of the spot become clearly defined, bright red, slightly rising above the level of unchanged skin. More often in the center, the spot slowly turns pale, becomes cyanotic (turns blue), and the formation acquires the characteristic appearance of an annular erythema of an oval or rounded shape.
In the place of localization of erythema, itching, mild soreness are not excluded. In the absence of antibiotic therapy, erythema is visualized within a few days, in their absence it can last up to two months or more. In the outcome - a weak short-term pigmentation, peeling. In some patients, several erythemas of a smaller diameter appear (usually in a later period).
Disseminated early stage
This stage begins at 4-6 weeks of illness (in the absence of preventive and therapeutic therapy of the previous period). During this period, the previous symptoms disappear (syndrome of general infectious intoxication, fever and erythema). Neurological disorders are detected:
•    Mild encephalitis,
•    Mononeuropathy,
•    Serous meningitis ,
•    Encephalomyelitis with radiculoneuritic reactions,
•    Lymphocytic meningoradiculoneuritis, characterized by pain at the site of the bite, severe radicular pain with impaired sensitivity and motor function of the cervical and thoracic spinal cord - the so-called bannworth syndrome, which includes the triad: radicular pain, peripheral paresis (often the facial and abducens nerves) and lymphocytic cellular reaction with cell content from 10 to 1200 in mm3) when performing a lumbar puncture.
Possible damage to the cardiovascular system - cardialgia, palpitations, increased blood pressure, myocarditis, av blockade (impaired transmission of a nerve impulse in the conduction system of the heart).
Sometimes there are skin lesions (urticaria and other rashes). Borreliosis lymphocytoma (benign lymphadenosis of the skin) can be observed - a bluish-red skin infiltrate with lymphoreticular proliferation, mainly located on the earlobe or nipple. Rarely there are eye lesions in the form of conjunctivitis, choroiditis, iritis.
Mild hepatitis, impaired renal function are not excluded.
Joint damage in the form of reactive arthritis (mainly large joints) in the form of pain and limitation of mobility, without external changes, lasting from a week to three months. If left untreated, lyme disease becomes chronic.
Late stage of lyme disease
It starts 1-3 months after the early and more. It resembles asthenoneurotic syndrome: weakness, increased fatigue, decreased mnestic functions (memory and intelligence), cranialgia (headache), sleep disturbances, increased nervous irritability or depression, muscle pain. Inherent damage to the musculoskeletal system (initially migratory arthralgia without obvious inflammation), then benign recurrent arthritis with inflammation and a slow transition to a chronic progressive course (with an irreversible change in the structure of the joints - marginal and cortical usura (erosion), osteophytes, sclerosis). There may be dermatitis, scleroderma, paraparesis, neuritis, memory disorders. A characteristic lesion is atrophic acrodermatitis - the gradual appearance of cyanotic-red spots on the extensor surfaces of the limbs, nodules, 
Reinfection is described - "fresh" creeping erythema, congenital lyme borreliosis.
Borreliosis in pregnant women
Infection of a woman during pregnancy (and before it if untreated) increases the risk of fetal death and miscarriage. Possible intrauterine damage to the fetus with the development of encephalitis and carditis, but the magnitude of the risk of this remains unclear.
Differences of borreliosis in children
Lyme disease in children most often develops between the ages of 3 and 10 years. In this case, erythema migrans (reddening of the skin) often appears, located in the upper half of the body. Intoxication is usually stronger than in adults. Lymph nodes may swell near the site of a tick bite. Without treatment, up to 20% of cases of lyme disease become chronic.
Differential Diagnosis:
•    In the first phase - febrile conditions with exanthema, tick-borne encephalitis, erysipelas, erysipeloid, cellulitis;

•    In the second stage - serous meningitis of another etiology, tick-borne encephalitis, rheumatic heart disease;

•    In the third stage - rheumatism and similar diseases, rheumatoid arthritis, Reiter's disease. 
Differences from tick-borne encephalitis
With tick-borne encephalitis, there is a pronounced fever, cerebral and neurological symptoms, with borreliosis - lesions of the skin, joints and heart.

Causes

Kingdom - Bacteria
Genus - Borrelia (type Spirochete)
Species - more than 10, of which the most etiologically significant Borrelia burgdorferi (the most common), Borrelia azelii , Borrelia garinii .
For the first time, this group of diseases was officially registered in the United States in the area of the city of Lyme (Connecticut) - hence the name - in 1975 by researcher Allen Steer. The carrier was identified in 1977, and in 1982 the pathogen was isolated by biologist Willy Burgdorfer.
Gram-negative. Cultivated in modified Kelly medium (selective medium BSK-KS). Likes liquid multi-component media. Flagellates. Small diameter, which allows them to bypass most household bacterial filters. Borrelia burgdorferi consists of a plasma cylinder covered with a cell membrane containing a thermostable LPS. The temperature optimum is 33-37 ° ?. Similar to a corkscrew twisted spiral. The type of curls is uneven, rotational movements are slow.
 

Treatment

Antibiotic therapy is prescribed to eliminate the pathogen from the body. Preparations from the group of penicillins, tetracyclines, macrolides and cephalosporins of 3-4 generations are highly effective against Borrelia. The choice of antibiotic and its dosage is determined by the severity of tick-borne borreliosis, the age of the patient, the presence and nature of complications. The drugs are used in oral form, with neuroborreliosis - parenterally.

The intracellular localization of Borrelia and their unequal sensitivity to antibiotics, depending on the genotype, creates difficulties in treatment. To enhance the effectiveness of antimicrobial agents, interferon inducers are used. They reduce the duration of the disease, reduce the severity of symptoms of intoxication. The drugs contribute to the formation of a strong immune response, which reduces the risk of chronic borreliosis.

In addition to etiotropic therapy, symptomatic treatment is carried out. In febrile fever, antipyretics from the NSAID group are prescribed, intoxication syndrome requires the administration of glucose solutions and electrolytes. If the central nervous system is affected, concomitant metabolic therapy is necessary: neuroprotectors, B vitamins, antihypoxants and angioprotectors.

Tests Required for Diagnosis

According to indications, erythema migrans, a pathognomonic sign of Lyme disease, is of the greatest importance. To confirm the diagnosis, a complete laboratory and instrumental examination is prescribed, within the framework of which the following are carried out:

•    Laboratory confirmation of infection. The detection of at least 2 out of 3 types of class M antibodies and 5 out of 10 IgG antibodies has diagnostic value. In the erythemal form of borreliosis, the cultural method using skin biopsy specimens shows high accuracy. Additionally, PCR diagnostics of the skin, synovial fluid is carried out.

•    Liquor research. Spinal puncture is prescribed for neurological manifestations of borreliosis. A laboratory study allows you to determine a low lymphocytic pleocytosis, a moderate increase in protein, and an increase in glucose concentration. Such values reflect the picture of serous meningitis.

•    Blood tests. Hematological studies are less informative in children than in adults. At the height of Lyme disease, moderate leukocytosis is observed with an increase in the number of lymphocytes, an increase in ESR . In the biochemical analysis, the growth of ALT, AST and LDH enzymes is determined, however, an increase in acute phase indicators is not typical.

•    Instrumental Visualization. Symptoms of neuroborreliosis require CT or MRI of the brain , with convulsive paroxysms, an additional EEG is performed. The defeat of the musculoskeletal system is diagnosed by the results of ultrasound of the joints , x-ray methods. Disorders of the heart - an indication for echocardiography and ECG .