CLINICAL AND LABORATORY FEATURES OF ERYTHEMATOUS FORMS OF LYME BORRELIOSIS IN CHILDREN OF THE LVIV REGION

Abstract

The aim of the study was is to determine and analyze the clinical and laboratory characteristics of the course of early localized and early disseminated stages of Lyme disease in children of the Lviv Region.

Patients and methods. Under observation were 44 children aged from 1 year 4 months to 17 years (204 months) diagnosed with Lyme borreliosis: solitary erythema migrans (EM) and multiple erythema migrans (MEM). Verification of the diagnosis was based on typical clinical signs and positive results of IgM and IgG to B. burgdorferi sensu lato in blood serum. A two-tiered method (enzyme immunoassay and immunoblot) was used using test systems from Euroimmun AG (Germany). The level of creatine kinase-MB was determined by the kinetic method using the Roche Diagnostics (Switzerland) test system. Peripheral blood tests, biochemical parameters: ASLO, C-reactive protein and rheumatoid factor were performed on the patients. The evaluation of the research results was carried out using descriptive and analytical statistics methods. Erythematous forms of Lyme borreliosis in children most often appeared on the lower limbs on the 13th day; the occurrence of EM in the head area was inversely related to the child’s age.

Results. As a result of the study, it was found that multiple erythema migrans developed in every fifth patient (22.7 % [11.71–36.11]), and 77.3 % [63.89–88.29] of children had isolated erythema. Among the studied patients with manifestations of multiple erythema migrans, no gender dependence was found.

When collecting the epidemiological anamnesis, it was established that most often tick bites occurred in the summer season – half of all 44 cases (50.0 % [39.85–68.85]). At the same time, in a quarter of patients (25.0 % [13.47–38.69], n=11) the parents did not remember the tick bite. Among them, four – with multiple erythema. Erythema migrans in 44 children of the research group most often appeared on average on the 13th day [9.00; 15.50], 3-4 days at the earliest, 30 days at the latest. The predominant localization of EM on the body in the studied group of children was the lower extremities (47.7 % [33.28–62.37]). EM was also quite often found on the head (27.3 % [15.29-41.23]) and on the upper limbs (27.3 % [15.29–41.23]). The presence of EM on the head was inversely related to the age of the child (R=-0.55, p<0.05). Among the investigated blood parameters, the direct interdependence of the presence of multiple erythema migrans with the level of leukocytes (R=+0.31, p<0.05) and creatine phosphokinase of the MB fraction (CK-MB) (R=+0.35, p<0.05).

Conclusions. The use of a two-tiered method of serological diagnosis of Lyme borreliosis revealed that in all children with erythematous forms of Lyme disease, which developed more often in boys (65.9 %), MEM was observed in every fifth patient (22.7 %). It was established that the mean value of immunoglobulin G and CK-MB was higher in patients with MEM than in patients with single EM. In children with MEM, VLsE protein and higher concentrations of IgG were detected more often, which indicates the duration of the untreated infectious process.