CLINICAL AND LABORATORY FEATURES OF THE COURSE OF LYME BORRELIOSIS IN THE VORONEZH REGION
- Authors: Arustamyan A.A.1, Arinicheva S.A.1, Shukelait P.A.1
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Affiliations:
- Voronezh State Medical University named after N.N. Burdenko
- Issue: Vol 12 (2023): MATERIALS OF THE XIX INTERNATIONAL BURDENKOVO SCIENTIFIC CONFERENCE APRIL 20-22, 2023
- Pages: 176-177
- Section: Инфекционные болезни и иммунология
- URL: https://new.vestnik-surgery.com/index.php/2415-7805/article/view/8440
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Abstract
Lyme borreliosis (LB) is an infectious natural focal vector–borne disease. Currently, LB remains one of the most common diseases from the group of tick-borne infections. The disease is characterized by polymorphic clinical manifestations and a tendency to a prolonged recurrent course.
For the first time, data on the disease appeared in 1975 in the USA, in the state of Connecticut, the town of Lyme. The first cases of the disease were called juvenile rheumatoid arthritis. Subsequently, it was noted that the disease develops after a tick bite and proceeds in a combination of arthritis and migrating ring-shaped erythema. LB is a ubiquitous disease, found on all continents except Antarctica.
Considering the wide prevalence of LB in Voronezh and the Voronezh region, the polymorphism of clinical manifestations and the tendency to chronic course, knowledge of the features of the clinic and diagnosis of this disease is especially important. The article presents data on the features of the clinical course of LB in the Voronezh region for 2022. The analysis of laboratory data for this pathology is also carried out.
In the Voronezh region, persons 44 ± 13.5 years of age are most often ill with LB, all patients had only an acute manifest erythemic form of the disease with little intoxication. Epidemiological, clinical data and serological diagnostics play a crucial role in the diagnosis of LB.
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VI. Topicallim-borreliosis is a naturally focal, transmissible disease, which is characterized by damage to the joints, skin, heart, nervous system, and is also often prone to chronization, relapse. LB in terms of morbidity and severity of clinical course among natural focal zoonoses is one of the urgent problems of modern infectious pathology [1].Tick-borne infections remain an urgent problem for many regions of the Russian Federation, and their consequences are interdisciplinary, going beyond the infectious clinic. According to Rospotrebnadzor, LB accounts for up to 58% of all infections carried by ticks. Lyme disease is endemic to the Voronezh Region, so in 2022, 2,371 people sought help with tick bites. 89 patients were hospitalized in the Voronezh Regional Clinical Infectious Diseases Hospital with a diagnosis of LB in 2018, 109 in 2019, 120 in 2020, 95 in 2021 and 108 in 2022 [2]. The onset of the disease is usually due to the presence of erythema at the site of the tick bite. Locally there is itching, swelling and hyperemia of the skin, dilated for several days (erythema migrans), sometimes regional lymph nodes may increase. There is a "flu-like syndrome": moderate intoxication, headache, general weakness, malaise, short-term increase in body temperature to 38 ° C. The disease during this period of acute infection responds well to treatment with antibacterial drugs, but in its absence, the disease progresses after a few weeks or months with damage to the heart (arrhythmias, pericarditis, myocarditis), the nervous system (radiculoneuritis, neuritis, meningitis, etc.), respiratory organs, eyes are less often affected [3]. In the chronic course of LB, in addition to the skin and nervous system, joints are involved.Not only infectious disease specialists, but also doctors of other specialties can face the consequences of borreliosis: cardiologists, rheumatologists, neurologists, dermatologists. Lyme disease attracts attention due to the increasing incidence and diversity of clinical manifestations [4, 5].
VII. The aim is to identify the features of the clinical course, laboratory parameters in patients with Lyme borreliosis of the Voronezh region at the present stage.
VIII. Materials and methods 50 case histories of patients diagnosed with Lyme borreliosis who are being treated at the Voronezh Regional Clinical Infectious Diseases Hospital in 2022 were analyzed. All patients had only an acute manifest erythemic form of the disease. The average age of the patients was 44±13.5 years. Men made up 40% (20 people), women – 60% (30 people).All patients underwent clinical, laboratory and instrumental examination: general blood analysis, general urine analysis, biochemical blood analysis, indication of specific immunoglobulins of class M (IgM) and class G by enzyme immunoassay (ELISA) in the blood serum of all patients, as well as ECG and ultrasound of the abdominal cavity.Patients were treated at all stages of the study according to standard treatment regimens (based on the main provisions of the Federal Clinical Guidelines for the Diagnosis and Treatment of Lyme Borreliosis, 2019)., including standard therapy (antibacterial therapy with azithromycin and doxycycline, desensitizing and detoxification therapy).The software packages Office Std. 2010 (Excel 2010) and Statistica 13.3.
IX were used to process the data obtained. Results After analyzing the cases of LB disease in the Voronezh region, it was revealed that this pathology has gradually acquired an upward trend in recent years: if there were only 17 patients before 2005, then by 2022 there are already 108 cases of Lyme borreliosis.The analysis of epidemiological data made it possible to establish the fact of tick bite in the epidemic season (from April to October) in all patients of Voronezh and the region with a diagnosis of LB. Of the 50 patients with Lyme disease, 42 patients (84%) had a history of tick sucking, 8 patients (165) do not know tick bites. In 15 patients (30%), they were bitten in a forested area inside the city limits, namely when visiting city parks, in 35 patients (70%), they were bitten while living in dachas, in country houses, visiting forests and beaches.The main clinical manifestation of Lyme disease, according to the VOKIB Medical Center, was ring-shaped erythema (size from 5 to 30 cm). This sign was present in all 50 patients: 30 (60%) had erythema on the lower limb, 9 patients (18%) - on the back, 9 (18%) - on the abdomen, 1 – on the neck (2%) and 1 patient (2%) - on the upper extremity.Clinical signs of LB in the study group were as follows: 5 patients (10%) had fever up to 37.2°C-38 °C lasting from 2 to 4 days, moderate intoxication syndrome (headache, malaise, decreased appetite, myalgia, general weakness,); 45 people (90%) had fever within normal limits. 9 people (18%) had arthralgia; An increase in regional lymph nodes was detected in 12 patients (24%).There were no characteristic changes in peripheral blood and biochemical parameters in patients with Lyme borreliosis.
X. Discussion The features of the current clinical course of Lyme borreliosis in the Voronezh region are revealed: the previously described onset of the disease with a flu-like syndrome (severe intoxication, high fever), generalized lymphadenopathy in 90% of cases in our patients was absent. Also, we did not observe significant changes in the general and biochemical blood analysis, they remained close to normal values.
XI. Conclusion The study allows us to conclude that the course of Lyme borreliosis at the present stage proceeds in mild (90%) and moderate-severe (10%). The main clinical manifestation is the presence of ring-shaped erythema, which serves as a reason for patients to seek medical help. Epidemiological studies have shown that the incidence of tick-borne infections has increased in the Central Federal District. The main tick-borne infection in this region is Lyme borreliosis. LB is a dangerous infection, therefore, the main role in preventing morbidity is assigned to non–specific prevention. Namely, it is necessary to pay great attention to information and sanitary-educational work among the population with the involvement of the media and social networks.
About the authors
Anzhelika Arkadievna Arustamyan
Voronezh State Medical University named after N.N. Burdenko
Email: arustamyan_lika@mail.ru
ORCID iD: 0000-0002-6210-5444
SPIN-code: 3082-7559
6th Year Medical Student
Russian Federation, Student st., 10, Voronezh, Voronezh region, 394036Svetlana Alexandrovna Arinicheva
Voronezh State Medical University named after N.N. Burdenko
Email: svetaarinicheva99@mail.ru
ORCID iD: 0000-0002-1194-3499
6th Year Medical Student
Russian Federation, Student st., 10, Voronezh, Voronezh region, 394036Polina Aleksandrovna Shukelait
Voronezh State Medical University named after N.N. Burdenko
Author for correspondence.
Email: shukpol@yandex.ru
ORCID iD: 0000-0003-3105-0345
resident of the 1st training of the Department of Infectious Diseases
Russian Federation, Student st., 10, Voronezh, Voronezh region, 394036References
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