DETECTION OF MARKERS OF SOME TICK-BORNE INFECTIONS IN PATIENTS WITH LOCALIZED SCLERODERMA IN THE PRACTICE OF A FAMILY PHYSICIAN
DOI:
https://doi.org/10.11603/1811-2471.2023.v.i4.14300Keywords:
localized scleroderma, Lyme borreliosis, bartonellosis, specific antibodies of classes M and G, ELISA, immunoblot, multiplex indirect immunofluorescence, BIOCHIP technologyAbstract
SUMMARY. The aim – to determine the frequency of detection of serological markers of Lyme borreliosis and bartonellosis in patients with localized scleroderma.
Material and Мethods. The study included 68 patients aged 19 to 60 years with localized scleroderma who were treated on an outpatient basis in 2019–2022 at the Ternopil Regional Clinical Dermatology and Venereological Dispensary of the Ternopil Regional Council and at the Ternopil District Primary Health Care Center of the Velyka Berezovytsia Rural Council. There were 12 men (17.6 %) and 56 women (82.4 %). The diagnosis of localized scleroderma was established on the basis of the clinical manifestations of the disease and was formulated according to the ICD-10 classification, code L94.0. To determine the possible infection of patients with localized scleroderma with Lyme borreliosis and bartonellosis pathogens, a unified questionnaire developed by scientists of I. Horbachevsky Ternopil National Medical University and the Pope John Paul II State Higher School (Biala Podlaska, Poland) was used. To detect specific IgM and/or IgG to B. burgdorferi s. l. (causative agents of Lyme borreliosis) in blood serum, a two-step method (ELISA and immunoblot) was used using test systems from Euroimmun AG (Germany). The results were analyzed according to the recommendations of the test system manufacturer. Specific class G antibodies to Bartonella henselae and B. quintana (causative agents of bartonellosis) were determined in patients' sera by multiplex indirect immunofluorescence using the test system "Mosaic for Bartonella henselae / Bartonella quintana (IgG)", Euroimmun AG (Germany), using BIOCHIP technology, which contained fluorescein-labeled antigens of these bartonella species. The results were evaluated in the field of view of a fluorescence microscope (Olympus IX70, ok ×10, ob ×20; 40) by the bright green glow of the fluorescein-labeled antigen-antibody immune complex to B. quintana – fluorescence was from fine to coarse-grained.
Results. The use of a two-stage serological study – ELISA and immunoblot - allowed to detect antibodies of classes M and/or G to B. burgdorferi s. l. in 24 (35.5 %) patients with localized scleroderma, which permit for 22 (32.4 %) patients to establish the final diagnosis of localized scleroderma combined with LB. By multiplexed indirect immunofluorescence using BIOCHIP technology, serum G class antibodies to B. henselae were found in 16.2 % of patients with localized scleroderma. In 13.2 % of the examined patients, localized scleroderma combined with LB and bartonellosis caused by B. henselae was diagnosed.
Conclusion. Family physicians should examine patients with localized scleroderma with the presence of prolonged fever, enlarged lymph nodes, myalgias, arthralgias, fatigue/general weakness, impaired concentration and anamnesis of tick bites or even stay in an area endemic for Lyme disease for the possibility of combined dermatosis with Lyme borreliosis and bartonellosis caused by B. henselae.
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