OPTIMIZATION OF TREATMENT OF PATIENTS WITH LYME BORRELIOSIS COMBINED WITH EPSTEIN-BARR VIRUS INFECTION AND VITAMIN D DEFICIENCY

Abstract

The aim of the research is to develop an optimal complex treatment for patients with Lyme borreliosis and Lyme borreliosis combined with chronic Epstein-Barr virus infection in the active phase and vitamin D deficiency.

Patients and methods. We observed 67 patients aged 28 to 65 years with LB: 22 men (32.8 %) and 45 women (67.2 %). In 31 (44.3 %) of 67 patients examined, in addition to Lyme borreliosis (LB), chronic Epstein-Barr virus infection (CEBV) was revealed. All patients were divided into two groups: group 1 involved 36 patients with LB without CEBV (LB only), group 2 – 31 patients with LB combined with CEBV (LB + CEBV). The EBV phase was established by real-time PCR, which determined the pathogen DNA simultaneously in the blood and/or saliva of patients. The presence of EBV nucleic acid at a concentration of 10³-10⁷ copies/ml evidenced the active phase of CEBV.

The vitamin D status of the examined patients was determined by the level of 25(OH) D in their blood sera. The study was performed using a chemiluminescent immunoassay (CMIA) with an Alinity I analyzer (Abbott, USA) and a Cobas 6000/Cobas 8000 test system, Abbott (USA).

For the treatment of LB, the antibacterial drug doxycycline hydrochloride 100 mg orally twice daily for 28 days was prescribed for the patients of both groups. In addition to etiotropic treatment, patients also received lyophilized Saccharomyces boulardii CNCM I-745, 250 mg, 1 sachet 2 times a day, and Silybi mariani fructus extractum siccum 2 tablets 3 times a day per os, for the same duration as the antibiotic.

The deficiency and insufficiency of 25(OH)D levels in the blood sera of patients in both groups prompted to prescribe cholecalciferol (vitamin D3) to all patients with LB in a dose of 5,600 IU, 1 tablet weekly per os for a course of 4 weeks (28 days), in accordance with the recommendations of the Consensus of Ukrainian experts “Diagnosis, Prevention and Treatment of Vitamin D Deficiency in Adults” (2023).

The efficacy of treatment of patients in both groups was assessed twice: on day 29 of the complex therapy with doxycycline and ergocalciferol and on day 57 after continuing treatment with diet (group 1) or ergocalciferol (group 2). The criteria were the dynamics of clinical manifestations of the disease, the activity of the pathological process in the affected joints (according to DAS28) and the levels of 25(OH)D in the patients’ sera.

Results and discussion. Comprehensive treatment of patients with only LB with the daily use of doxycycline hydrochloride tablets 0.1 g twice daily and ergocalciferol 5,600 IU per week for 4 weeks contributed to the development of arthritis remission (according to DAS28) in 63.9 % of patients and the elimination of vitamin D deficiency in the body. In patients with LB combined with HEBV, remission of arthritis was achieved in only 29.0 % of patients, and vitamin D deficiency was still present in 19.4 % of patients.

The treatment of patients with LB only continued with diet therapy with the foods containing vitamin D for 4 weeks that allowed achieving remission of arthritis in 88.9 % and sufficient vitamin D levels in 97.2 % of patients. Further treatment of patients with LB + HEBV with ergocalciferol at the same dose for another 4 weeks contributed to arthritis remission in 87.2 % of patients and sufficient vitamin D levels in 90.3 %.

The cholecalciferol tablets at a dose of 5,600 IU weekly to correct vitamin D deficiency in the blood sera of patients with LD combined with CEBV contributed to a 2.8-fold decrease in the percentage of patients with active viral phase on day 29 of the therapy, 5.5-fold on day 57 compared with day 29, and 15.5-fold compared with the beginning of treatment.

Conclusion. Patients with Lyme borreliosis combined with chronic Epstein-Barr virus infection and vitamin D deficiency should be prescribed a comprehensive treatment with the simultaneous use of doxycycline hydrochloride and ergocalciferol per os tablets that will not only lead to remission of arthritis and complete elimination of vitamin D deficiency, but also reduce the percentage of patients with active Epstein-Barr virus infection.