CLINICAL POLYMORPHISM AND DIFFERENTIAL DIAGNOSIS OF LYME DISEASE
DOI:
https://doi.org/10.11603/2415-8798.2018.1.8519Keywords:
Lyme borreliosis, Lyme disease, Borrelia burgdorferi sensu lato, erythema migrans, myocarditis, nervous system damage.Abstract
Lyme borreliosis is a chronic natural focal transmissive infectious zoonotic disease, which is caused by Borrelia burgdorferi sensu lato (Bbsl). The West of Ukraine, including Ternopil region, is the endemic area of Lyme disease. The study presents a review of the literature analysing the polymorphic character of Lyme borreliosis clinical manifestations, provides data about the differential diagnosis of Lyme dermatitis, Lyme arthritis, and neuroborreliosis.
The aim of the study – to learn Lyme borreliosis with the aim of improving the disease diagnosis and prevention among the population of Ukraine.
Materials and Methods. A questionnaire was answered by 326 people aged between 5 and 80. Statistical methods were used to establish the seasonality and localisation of tick bites in the survey participants, the number of patients, whose blood samples were examined for borrelia infection and who received preventive treatment. The patient complaints were analysed.
Results and Discussion. In Ukraine 5 strains of borellial complex Bbsl: Bbss, B.afzelii, B.garinii, B.valasiana, A14S circulate. The aforementioned borrelia genospecies are associated with the prevalence of corresponding clinical forms of Lyme borreliosis: arthritis is linked to Bbss, neurological manifestations are linked to B.garinii, skin manifestations to B.afzelii. Bbsl is the cause of etiologically undiagnosed 16.7 % neurological and 20.7 % pseudorheumatological pathologies. 326 survey participants aged between 5 and 80 included 229 tick-bitten individuals. The disease has a seasonal character which is connected to the tick activity periods. 59.2 % tick bites happened to the survey participants in summer, 25.7 % in spring, 15.1 % in autumn. 20 patients (8.73 % of the tick-bitten individuals) underwent laboratory blood tests for borrelia, the test result was positive in 6 cases. The most frequent complaints were erythema migrans (10 patients) and joint swelling (6 patients).
Conclusions. Lyme borreliosis is a chronic infectious transmissive zoonotic natural focal disease, which is characterized by cyclic course and multisystemic damages. In Ukraine five strains of borelia complex Bbsl are common. Differential diagnosis of Lyme borreliosis is developed with erysipelas, toxicodermia, erysipeloid, anthropod bites, reumatism, rheumatoid arthritis, infectious and invasive meningitis, tick-borne encephalitis, brain blood circulation disorders of different aetiology, multiple sclerosis, Guillain-Barré syndrome.
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