Молодежный инновационный вестник

2415-7805

Федеральное государственное бюджетное образовательное учреждение высшего образования "Воронежский государственный медицинский университет имени Н.Н. Бурденко" Министерства здравоохранения Российской Федерации

8021

Unclassified

LYME DISEASE: REGULARITIES OF THE EPIDEMIOLOGICAL PROCESS IN THE TERRITORY OF THE VORONEZH REGION AND THE CITY OF VORONEZH, PRINCIPLES AND METHODS OF PREVENTION

Sergeeva

Evgeniya Vladislavovna

3rd year student of the Faculty of Medicine and Preventionsergeevaevgeniya5@gmail.comhttps://orcid.org/0000-0001-7643-0662

Voronezh State Medical University named N.N. Burdenko

20042023

12S2386390

24012023

05032023

2023

Lyme disease plays an important role in the structure of infectious morbidity in the territory of both the city of Voronezh and the Voronezh region, and in the whole of the Russian Federation.Particularly relevant is the problem of the spread of tick-borne borreliosis in rural areas, since there is a constant increase in the infection rate of ticks with the pathogen.The carriers of Lyme disease are ticks Ixodes ricinus, the causative agents are Borrelia afzelii and Borrelia garinii. The incidence is seasonal - the highest increase in cases is observed in the warm season, especially in the summer season, which indicates the need to strengthen preventive measures in the season of rising incidence and monitor the activity of natural foci. The article presents the results of the analysis of the incidence in the Voronezh region, a list of preventive measures against pathogens, as well as a brief description of the epidemiology, etiology, pathogenesis, clinical manifestations, diagnostic methods and principles for the prevention of tick-borne borreliosis Given the urgency of this problem, a thorough analysis of the conditions under which human infection occurred and the effectiveness of preventive measures that currently exist and are aimed at preventing tick bites and, as a result, reducing the incidence of Lyme disease is necessary.

tick-borne borreliosisLyme diseaseincidencebitesinfection

клещевые боррелиозыболезнь Лаймазаболеваемостьукусызаражение

Introduction Tick-borne borreliosis, or Lyme disease, is a transmissible, natural focal disease prone to recurrence and chronicity, which is characterized by damage to various body systems, such as the cardiovascular, nervous, and musculoskeletal. The spread of Lyme disease over the past few decades is largely due to environmental changes caused by anthropogenic influences, which have led to an increase in the distribution and increase in the number of vector ticks and to the emergence of new foci.Lyme diseaseis dangerous because it is much more likely than tick-borne encephalitis to give chronic forms.Adults and the elderly are more severely ill, due to the presence of concomitant chronic pathology (atherosclerosis, hypertension).No deaths from Lyme disease have been reported to date. Etiopathogenesis Borrelia are Gram-negative bacteria.They are a corkscrew-shaped convoluted spiral, 11-25 microns long, have flagella.The antigenic structure is complex: they have protein antigens-flagellins and proteins of the cytoplasmic cylinder, proteins of the outer membrane-A, B, C, D, E, F. The antigenic composition is variable and can change during the life cycle.Several species of Borrelia are pathogenic for humans: Borrelia burgdorferi, Borrelia garinii, and Borrelia afzelii [2]. The etiological role of B. miyamotoi, which is genetically similar not only to the borrelia of the Borrelia burdorferi sl complex, but also to the borrelia of tick-borne relapsing fevers, has also been proven [4].Human infection occurs through the bite of a tick infected with Borrelia.The possibility of infection when rubbing a tick after it hits the skin, but without direct suction, has also been proven, but it is lower in comparison with a bite.With the saliva of the tick, the pathogen enters the human body.At the site of a tick bite, annular erythema develops - a local manifestation of tick-borne borreliosis, which in most cases is the first sign of a bite for a person, since the bite of the tick itself goes unnoticed. At the same time, immunopathological reactions are already developing in the human body, which are caused by endotoxin released after the death of the pathogen. Clinical manifestations The course of the disease is classified into acute, subacute and chronic.The frequent chronicization of Lyme disease confirms the relevance of the problem under consideration: almost 15% of those infected in the structure of the general morbidity have a chronic course. Classification by stages is conditional.The first signs can appear abruptly, bypassing the initial stages, or combined without the possibility of a clear definition.However, the following stages of the disease are distinguished: 1) early local manifestations (early localized): general infectious phenomena, migrating annular erythema, lymphadenopathy are observed at this stage;2) early disseminated manifestations (early disseminated): characterized by skin lesions, the appearance of secondary erythema, neurological disorders (meningitis, neuritis), cardiac disorders;3) late manifestations (late): expressed in the form of lesions of the musculoskeletal system (arthritis), serious neurological disorders (encephalomyelitis, polyneuropathy), chronic atrophic acrodermatitis.It is in the late stage that the chronicity of Lyme disease is observed. During the study of patients' medical records, it was noticed that the first signs with which people most often went to the hospital were redness at the site of the bite, itching, general weakness and malaise, subfebrile temperature, no atypical manifestations were identified.The very fact of a tick bite in most cases went unnoticed. Diagnostic methods For diagnosis, bacterioscopic, serological methods and the polymerase chain reaction method are used, depending on the stage.Materials for the study are skin biopsies, synovial fluid of the joints, cerebrospinal fluid, blood serum. At the first stage: bacteriological examination of skin biopsy specimens from erythema.At the second stage: a serological study with the determination ofIgM or an increase inIgGtiter, enzyme immunoassay or immunofluorescence reaction.At the third stage: the method of polymerase chain reaction for the determination of borreliae in the cerebrospinal fluid, joint fluid [3]. Epidemiology Tick-borne borreliosis is a natural focal disease.The carriers of Lyme disease are ticksIxodesricinus, the causative agents are Borrelia afzelii andBorreliagarinii.Natural foci areforest landscapes of the temperate climate zone.The natural hosts of Borrelia are wild animals, the most common of which are rodents.The circulation of the pathogen occurs as follows: when an infected wild animal sucks blood, the borrelia enters the tick's intestines - this is where the pathogen multiplies, then the tick bites a healthy wild animal, infecting it.However, infection does not always occur when an animal bites, because.the salivary glands may contain few or no borrelia.Thus, the circulation can be represented by the following scheme: ticks wild animals ticks.Human infection occurs in the same way as in the case of wild animals: when a person is bitten by an infected tick, as well as when it gets on the skin with subsequent rubbing (the chance of infection in this case is lower, unlike a bite) [1].The incubation periodis 332 days, with an average of about 7 days, and susceptibility to Lyme disease is high.Risk groups are persons who, by the nature of their activities, are associated with work in the forest.Most of the sick are adults, but children often get sick due to their low awareness of the danger of tick bites, negligence and inattention while outdoors in open clothing. Patterns of the epidemiological process on the territory of Russia and the Voronezh region The territory of Russia is the longest region in terms of the prevalence of tick-borne borreliosis in the world [5].The most favorable natural zones for the circulation of the pathogen are the forest and forest-steppe zones, which include the territory of the Voronezh region.The most epidemiologically significant are 2 species of ticks of the genus Ixodes:I. persulcatusandI.ricinus. On the territory of the region, ixodid ticks are distributed everywhere, especially in rural areas.Infection of ixodid ticks in the Voronezh region is approximately 24-25%.Most of the foci are concentrated in forests, however, in the past few years, an increase in infection and the spread of ticks has been recorded near forest areas, for example, in parks.In most cases, tick-borne borreliosis affects people working in open areas, especially in forests.In addition, infection is often observed outside the work activity of people, for example, during a normal stay in an open area and in open clothes during the period of tick activity (spring-autumn period). Infection occurs due to non-compliance with preventive requirements: violation of the rules for the use of special protective clothing or ordinary closed clothing - you can not leave parts of the body open when in a natural focus, where contact with ticks is likely.It is especially dangerous to leave open areas of the legs, as the movement of ticks is usually upward. More than 50 medical records were analyzed for the study.The analysis revealed that about 90% of patients did not notice the tick bite and applied to a medical facility after the first symptoms appeared - redness at the site of the bite, there was also a slight deterioration in the general condition - weakness, malaise. Some patients, however, reported the patient's bite themselves and went either to the hospital or to the laboratory for bacteriological examination from skin biopsies.Some patients also removed the tick from the suction site themselves and handed it in for bacteriological examination at the Center for Hygiene and Epidemiology in the Voronezh Region.More than half of all cases were bitten by a tick between June and August. We also analyzed data from tick studies for the presence of a pathogen in the period from 2018 to 2022, which were conducted at the Center for Hygiene and Epidemiology in the Voronezh Region.Thus, in 2022, the Laboratory of Especially Dangerous Infections tested 1,229 ticks using the polymerase chain reaction method, incl.1099 ticks taken from humans and 130 from natural biotopes.In ticks taken from humans, RNA of the causative agent of ixodid tick-borne borreliosis was found in 297 (27%) samples in the following areas: Anninsky (1), Borisoglebsky (22), Ternovsky (2), Novokhopyorsky (1), Povorinsky (4), Kalacheevsky (2), Vorobyovsky (6), Petropavlovsky (1), Liskinsky (35), Bobrovsky (5), Kamensky (1), Ostrogozhsky (40), Novousmansky (11), Bogucharsky (7), Rossoshansky (3), Olkhovatsky (4), Kantemirovsky (1), Semiluksky (33), Nizhnedevitsky (1), Repevsky (1), Khokholsky (2) and in Voronezh (3), self-conversion -111.Material was also taken from the external environment - RNA of the causative agent of ixodid tick-borne borreliosis was found in 26 samples (20.0%) obtained in Petropavlovsk (3), Bogucharsky (3), Verkhnemamonsky (3), Rossoshansky (1), Olkhovatsky (1) , Kantemirovsky (1), Semiluksky (3), Anninsky (1), Vorobyovsky (1) districts and the vicinity of the city of Voronezh (8).In general, the indicator for the past year is significantly lower than for previous years since 2018. Prevention At the moment, in accordance with the Decree of the Main State Sanitary Doctor of the Russian Federation dated January 28, 2021 N 4 "On approval of sanitary rules and norms SanPiN 3.3686-21 "Sanitary and epidemiological requirements for the prevention of infectious diseases" the following measures fornon-specific prevention are carried out: 1) anti-tick measures include: sanitary and ecological transformation of the environment, deratization measures, treatment of natural and anthropogenic foci with acaricidal agents, measures to exterminate ticks and rodents. 2) measures of individual anti-tick protection (the need for closed clothing when staying in the territories of natural and anthropogenic foci). 3) information and explanatory work with the population. Specific preventive measures includeemergency antibiotic prophylaxis.Emergency antibiotic prophylaxis of ixodid tick-borne borreliosis is carried out for medical reasons by medical organizations when a person seeks medical help in connection with tick bite, including taking into account the results of laboratory tests. Results As a result of the analysis ofthe data of registration forms No. 2 "Information on infectious andparasitic diseases" for 2007, 2008, 2009, 2010, 2012, 2013, 2014, 2015, 2018, 2020 and 2021, a trend towards an increase in the incidence of ixodid tick-borne borreliosis in the population was noted.This may be due both to the spread of tick-carriers in anthropogenic foci, such as gardens, parks, and to an increase in infection of the ticks themselves. It should be noted that in the period for 2020, the incidence rate was lower compared to 2019, which may be the result of restrictive measures introduced in connection with the spread ofCOVID-19 and, as a result, a decrease in human contact with foci.An important role is played by hygienic education of the population.To reduce the incidence of Lyme disease, it is necessary to strengthen non-specific prevention: carry out anti-tick measures in natural and anthropogenic foci, apply individual protective measures and conduct awareness-raising activities about the importance of preventing tick bites in all age groups of the population.It is also necessary to strengthen individual protection measures for persons whose occupation is related to being in nature. Discussion Natural foci are located in the steppe and forest-steppe natural zones.On the territory of the Voronezh region and the city of Voronezh, the carriers of Lyme disease are ticksIxodesricinus, pathogens - Borrelia afzelii andBorreliagarini.The season of tick activity is observed in the spring-autumn period, especially in summer, which is associated with an increase in the incidence at this time of the year.To reduce the incidence of ixodid tick-borne borreliosis in the population, a set of measures is needed to prevent bites by vector ticks, which include both measures against the pathogen and vector, and measures against the susceptible organism.Over the past decade, there has been a trend towards an increase in the incidence, so it is necessary to strengthen the complex of preventive measures. Conclusion In connection with the increase in the incidence of Lyme disease, especially in rural areas, it can be concluded that there is a lack of public awareness of the dangers of tick bites.At the moment, no deaths have been registered, however, there is a fairly large number of cases of chronic disease that carries health-threatening conditions.Also, the increase in the incidence is due to the fact that the etiology of some tick-borne borreliosis is still unknown and is being studied.Despite this, hygienic education and training of the population is necessary in order to control the spread of the disease, regardless of the measures aimed at the pathogen and vector.In addition, people staying in nature need to be more careful and wary about the choice of clothing,examine exposed areas of the body, since during the analysis of medical records it was noted that the fact of a bite in most cases went unnoticed.Only all preventive measures in the aggregate can give a stable result and lead to a decrease in morbidity.

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