CLINICAL AND IMMUNOLOGICAL FEATURES OF NON-ERYTHEMATOUS FORM OF LYME BORRELIOSIS AND HUMAN GRANULOCYTIC ANAPLASMOSIS

Abstract

The aim was to clarify the clinical and immunological features of non-erythematous form of LB (NEF LB) and human granulocytic anaplasmosis (HGA) in patients, separately and in combination.

Materials and Methods. Under supervision there were 97 patients with NEF LB and HGA, aged 19–77. The comparison group consisted of 30 blood donors, which by age and sex corresponded to the distribution of the examined patients. Two-stage diagnostics was used for serological confirmation of LB. Real-time PCR was used for laboratory diagnosis of HGA, A. phagocytophilum DNA was determined in the blood of the examined patients, and the method of indirect immunofluorescence analysis was determined, which fined specific IgM and IgG antibodies to A. phagocytophilum. The level of cytokines (IL-4, IL-6 and TNF-α) in the patients’ serum was determined by ELISA.

Results and discussion. Arthralgia, fever, and myalgia predominated in patients with NEF LB and HGA in all three groups, and fatigue, cognitive impairment, and cardialgia were less common, with no significant difference between the groups. However, swelling of the joints was more common in patients with LB and a combination of the two infections compared with patients with only HGA, p<0.01; lymphadenopathy prevailed in patients with HGA, both in monoinfection and in combination with LB, in patients with LB alone, p<0.05; patients with LB and HGA were more often concerned about decreased vision; nausea and vomiting occurred only in the persons with HGA.

IL-4 content was predominant in patients with two infections relative to the NEF LB group alone: 3.55 vs. 2.01 pg/ml, p<0.05, remaining within normal limits. There was a significant increase of the IL-6 in the serum of patients with only HGA and the combination of HGA + NEF LB compared with the comparison group: 38.70 vs. 0.43 pg/ml, p<0.001, and 12.93 vs. 12.93 pg/ml, p<0.001. At the same time, the concentration of IL-6 was significantly higher in those examined with HGA compared with patients with HGA and NEF LB: 38.70 against 12.93 pg/ml, p<0.001. The level of TNF-α was predominant in patients with HGA only, compared to the patients with NEF LB alone: ​7.43 vs. 4.81 pg/ml, p<0.05, remaining within the reference values. However, the concentration of TNF-α in the patients sera with HGA and NEF LB was higher than in the comparison group: 7.43 vs. 0.21 pg/ml, p<0.001 and 4.81 vs. 0.21 pg/ml, p<0.001, respectively.

Conclusions. Clinical and immunological features of NEF LB and HGA of the Ternopil hospitals patients, separately and in combination, were studied for the first time. It is established: the predominance of intoxication syndrome in all patients with tick infections, regardless of their combination; dominance of lymphadenopathy in patients with HGA, swelling of the joints in patients with NEF LB (p<0, 05). The concentration of anti-inflammatory IL-4 in the patients serum with NEF LB and HGA in combination and only with NEF LB was within normal limits, but higher in individuals with these infections (p<0.05).

The content of pro-inflammatory IL-6 was significantly increased in the patients’ serum of both groups, with a significant predominance in patients with HGA compared with the combination of NEF LB and HGA (p<0,001); TNF-α was increased in the patients’ serum with HGA only (p<0.05).