CLINICAL AND EPIDEMIOLOGICAL FEATURES AND IMMUNE CHANGES IN PATIENTS WITH URTICARIA

Abstract

Introduction. An actual problem of curent infectology and dermatology remains the study of clinical-epidemiological and immunological manifestations of urticaria with combined Lyme borreliosis and giardiasis.

The aim of the study – to investigate the clinical and epidemiological features and immunological changes in patients with urticaria.

Research Methods. 67 patients with urticaria, aged from 18 to 71 years, were under observation. The patients were divided into three groups, of whom 23 (group 1) – patients with urticaria and Lyme borreliosis, 20 (group 2) – patients with urticaria and giardiasis, 24 (group 3) – patients with urticaria without Lyme borreliosis and giardiasis. The control group consisted of 25 blood donors who did not differ significantly from the examined persons in terms of age and gender and whose history indicated the absence of tick bites. Antibodies to antigens of the B. burgdorferi s. complex were determined by ELISA in blood sera of patients with urticaria. l., using the test system of Euroimmun AG (Germany). To detect giardia cysts, a smear of native fecal material was prepared, which was examined under a light-optical microscope at low and high magnification (approx. ×8, ×40, approx. ×10). Antibodies of the IgM class to Giardia antigens in patients' blood sera were determined by enzyme immunoassay (ELISA) using the Giardia-IgM-ELISA-Best kits. The concentration of immunoglobulin class E was determined by ELISA using IFA-Best kits. The level of endogenous intoxication was estimated by the sorption capacity of erythrocytes (SZE), which was determined according to the method of A. A. Togaibaev (1981).

Results and Discussion. Epidemiological features of Lyme borreliosis in patients with urticaria were established: most people were bitten by ticks from April to October, with the peak occurring in July; patients were significantly more likely to experience a tick attack once; tick bites in the upper limbs prevailed (p<0.05); 43.8 % of respondents used the help of a doctor or nurse to remove the ticks. In patients with urticaria and giardiasis, the clinical picture of the disease differed significantly from urticaria without giardiasis: bitterness in the mouth, heaviness in the right hypochondrium, and nausea were significantly more common (p<0.05). A tendency to more frequent detection of stool instability (constipation, diarrhea) was also noted in such patients. Significantly higher levels of serum IgE were noted in patients with urticaria, compared to individuals with urticaria and Lyme borreliosis (p<0.05). An increase in the sorption capacity of erythrocytes was diagnosed in patients of all groups compared to those of the control group, and significantly more in patients with urticaria and giardiasis, compared to the group of patients with urticaria and Lyme borreliosis (p<0.05).

Conclusion. It is advisable to examine patients with urticarial, complaining in bitterness in the mouth, heaviness in the area of the right hypochondrium and nausea for the presence of possible Giardia infection.