What is Lyme Disease?
Lyme disease – a combination of recurrent mono or oligoarthritis with erythema migrans. The name is given in connection with the locality where the first cases of the disease were discovered. The disease is described by A. Steere in the beginning as arthritis, occurring in geographically well-defined areas, among members of the same families or communities. Lyme arthritis is currently registered in Europe. The etiological factor is Vogrelia burgdorferi spirochete, as a result of which the Lyme disease is considered as borreliosis. The carriers of infection are ticks: in the USA – Ixodes dammini and I. pocificus, and in Europe – I. ricinus. Ticks I. ricinus are found on the territory of the Baltic republics and Siberia.
Lyme disease – a systemic disease, probably associated with immune disorders, as evidenced by the detection of cryoglobulins and IR in the blood and synovial fluid. Mostly children and young men are ill. The peak incidence occurs in the summer months.
Symptoms of Lyme Disease
The main clinical marker of Lyme disease is erythema migrans. At the site of the tick bite, a red macula or papule usually appears, which further increases to 16 cm or more, and the center of the spot fades, but sometimes there is intense erythema, induration, vesicles, necrosis. Skin rashes occur anywhere, usually on the hips, in the groin and axillary areas. Of the common symptoms, chills, malaise, fever, headache, stiffness in the neck and back, myalgia, lymphadenopathy, splenomegaly are observed. Within a few weeks or months, 15% of patients develop neurological disorders (meningitis, mild symptoms of encephalitis, neuritis of the cranial nerves, motor or sensory radiculoneuritis, mononeuritis, or myelitis).
Within a few weeks of the onset of the disease, 8% of patients develop symptoms of heart disease, atrioventricular block, in some cases myopericarditis, cardiomegaly, pancarditis. In terms from several months to 2 years after the onset of the disease, 60% of patients develop arthritis. It usually begins suddenly with moderate pain and swelling of the knee and, less commonly, other large joints, in some cases there is symmetrical polyarthritis. Articular syndrome lasts no more than a week, does not cause persistent defigrations, but may recur for a number of years. In 10% of patients, the defeat of large joints becomes chronic with signs of destruction of cartilage and bone. Biopsy of the synovial membrane reveals fibrin deposits, villous hypertrophy, vascular proliferation, and severe plasma cell and lymphocytic infiltration. In some cases, when dyeing with silver, spirochetes are detected. The number of leukocytes in synovial fluid is 5 · 102-11 · 104 / ml, most of which are segmented neutrophils. An elevated protein content, normal or reduced glucose levels are noted, tests for rheumatoid and antinuclear factors are usually negative.
Spirochet culture can reliably establish the diagnosis, but this is rarely possible. A few weeks from the beginning of the infection, the detection of IgG antibodies to the spirochete can almost always serve as a diagnostic criterion, which makes it possible to differentiate Lyme arthritis from other inflammatory lesions of the joints. Although antibodies to B. burgdorferi crosshair react with other spirochaetes, including the pale spirochete, Wasserman’s reaction in patients with Lyme arthritis is always negative.
Treatment of Lyme Disease
In the early stages, the drug of choice for adults is tetracycline at a dose of 250 mg 4 times a day. Instead, it can be applied phenoxymethylpenicillin at a dose of 500 mg 4 times a day or erythromycin at a dose of 250 mg 4 times a day. Therapy should last 10-20 days. Salicylates “break off” articular syndrome. In case of persistent arthritis, penicillin prolonged preparations of 2,400,000 units per week for 3 weeks or intravenous administration of penicillin 20,000,000 units a day fractionally for 10-20 days are recommended, which is effective in 50% of cases. In the absence of the effect of antimicrobial therapy produce synovectomy.