Lyme disease (Lyme borreliosis) - natural focal infectious vector-borne diseases, which is caused by spirochetes, and is transmitted by ticks and has a tendency to recurrent and chronic course and a primary lesion of the skin, nervous system, heart and musculoskeletal system.
This disease can occur at any age, but most often in children under fifteen years old, and adults between the ages of twenty to forty-four years. The agents of Lyme disease is Borrelia antibacterials drugstore. The reservoir and the source of the pathological process are the many species of domestic and wild birds and vertebrates (rodents, elk, white-tailed deer, and others.) Prikormitelyami ticks are more than two hundred species of wild animals.
The main mechanism of transmission of Lyme disease is the transmission (through blood). In rare cases, the pathogens enter the body when consuming raw milk (goat), with saliva through bites mite faeces (when rubbed with raschёsah in the site of the bite).
Immunity after the disease is unstable, a couple of years after recovery possible re-infection. Risk factors for infection can be called a stay in the mixed forests (tick habitat) in the period from May to late September.
The course of the disease is divided into early and late period. The first of these includes a first step of local infection. During this period, the pathogen enters the skin after a tick bite. Then Borrelia distributed in various organs, so at this stage is characterized by multi-organ injury symptoms. For the next stage is characterized by a stay (persistence) of the pathogen in a particular structure of the organism. Therefore, it is characterized by the appearance of signs of defeat certain organ or tissue. The division into these stages is conditional and is only acceptable to the whole disease. Sometimes staging is not observed, in some cases, it may be present only the first stage, and sometimes Lyme disease occurs only late symptoms.
In the early period of release bezeritemnuyu and erythema shape. It is important to diagnose this disease, in addition, the clinical picture has certain peculiarities depending on the presence or absence of erythema at the site of the bite Borrelia. At the stage of the spread of the pathogen, which is characterized by a multiplicity of clinical manifestations, can be identified dominant symptoms that define the current version of the disease:
The incubation period of the disease varies from one to twenty days. Its authenticity is determined by the accuracy of establishing the fact of sucking tick. Approximately thirty percent of patients do not remember it or deny bite. The disease has a subacute onset, with marked tenderness, itching, redness and swelling of the space sucking tick. Patients complain of general weakness, mild headache, nausea, malaise, disturbance of sensation in the affected area, and the feeling of constriction. At this time, there is a specific erythema of the skin (up to seventy percent of patients). The body temperature rises to subfebrile can sometimes appear chills. The duration of febrile period of up to one week.
The main clinical sign of Lyme disease is erythema migrans. It appears three to thirty-two days (on average seven days) as a red papules or place directly on the macula of a tick bite. redness around the area of the site gradually expanded, limited by healthy skin bright red border. In the center of the lesion is observed lower degree of modification. Erythema dimensions may vary from a few centimeters to seventy millimeters, but the severity of disease independent of their size.
The location of the initial lesion in some cases there may be intense erythema with vesicles, and there is necrosis. The color intensity propagating pathological focus is uniform on all its length within the outer boundaries can be observed several red rings. Over time, their central part pales. In place of the former location of erythema can often be kept pigmentation, and peeling of the skin. In some patients, symptoms of the disease may be limited to skin lesions in the immediate site of the tick bite, and the common symptoms are mild. Sometimes Borrelia spread to other skin areas, while there are secondary erythema. Among other skin symptoms observed urticaria, rash on the face, transient and small petechial rash annular shape, conjunctivitis.
Erythema with Lyme disease can sometimes bear a resemblance to erysipelas, the presence of regional lymphadenitis may masquerade as tularemia, and typhus. Skin symptoms in most cases supplemented by the rigidity of the neck muscles, headaches, chills, fever, migrating pains in bones and muscles, arthralgia, severe fatigue and weakness. In rare cases, there is a generalized lymphadenopathy, dry cough, sore throat, swelling of the testicles, conjunctivitis. The first symptoms subside or disappear completely within a few weeks even without treatments.
For the second stage of Lyme disease is characterized by the spread of Borrelia from the primary tumor in a variety of organs. For bezeritemnoy form of the disease characterized by high severity of clinical symptoms. Pretty soon may appear signs of a lesion of the meninges. At this time can still persist skin erythema. However, in this case, the inflammatory changes in the cerebrospinal fluid still lacking. Within a few weeks, or months from the onset of the disease, at fifteen percent of patients there are clear symptoms of the nervous system. During this period, isolated syndromes serous meningitis, meningo-encephalitis, as well as disorders of the peripheral nervous system: myalgia, pleksalgii, neuralgia, amyotrophic syndrome, isolated neuritis of the facial nerve. Signs of heart disease usually develop within a few weeks of onset. These include recurrent oligoarthritis of large joints. When biopsy of synovium exhibit fibrin deposition, villous hypertrophy, vascular proliferation.
Over time, the joint developed changes characteristic of chronic forms of inflammation: osteoporosis, marginal and cortical Uzury, loss and irreversible changes in the cartilage, subarticular sclerosis, osteophytosis.
Among the late lesions of the nervous system can be noted chronic encephalomyelitis, spastic paraparesis, ataxia, erased memory disorders, dementia, chronic axonal radiculopathy. Patients notice fatigue, headache, hearing impairment. Children celebrated delayed sexual development and growth. In the third step of the skin lesions appear as common form of dermatitis, and atrophic changes sklerodermopodobnyh akrodermatita.