How does infection with borreliosis during pregnancy affect the child?

Lyme disease, or tick-borne borreliosis, is one of the most dangerous diseases that is transmitted by ticks and can lead to serious consequences for the human body. Its danger lies in the fact that it is not always possible to detect an infection in the early stages, but when timely diagnosis and proper therapy the chances of complete recovery are significantly increased. Let us consider in detail when treatment begins, as well as how to cure borreliosis, and what to do when the first symptoms of the disease appear? Which doctor treats borreliosis in an adult or a child?

Lyme disease: the causative agent

Infection with Lyme disease occurs when black-legged ticks attach themselves to human skin and inject their saliva containing Borrelia into the wound. The peak activity of these insects is observed from April to May and from August to September, more often in cloudy and cool weather.

The incubation period after a tick bite and before the appearance of initial flu-like symptoms lasts from five to ten days.

Expert opinion

Author:

Andrey Igorevich Volkov

Neurologist, Candidate of Medical Sciences

Tick-borne borreliosis, or Lyme disease, is one of the most insidious diseases transmitted by insect bites, most often developing after tick bites. Children under the age of 14 are at risk, but adults are no exception. According to Rospotrebnadzor, Moscow and the Moscow region are among the top ten in terms of the number of people affected by tick bites.

Under no circumstances should you pull out a tick if it has already become embedded; it is recommended to immediately consult a doctor. In our clinic you will be provided with qualified assistance and, if necessary, the insect will be sent for analysis. After removing the tick, you will be sent to an infectious disease specialist or rheumatologist for consultation and further observation.

Borreliosis can occur in different clinical forms and with varying severity. Some patients do not complain of any symptoms at all, others may feel:

• severe joint pain;
• sore throat accompanied by a dry hacking cough;
• high body temperature, reaching 38.5 ºС;
• feverish state with chills;
• nausea and vomiting;
• feeling of weakness and drowsiness;
• lack of appetite;
• stiffness of the neck muscles;
• negative reaction to bright lights and sounds;
• rapid heartbeat, etc.

An indispensable symptom of Lyme disease is a rainbow-colored spot that appears on the skin. It is usually bright red in the center, at the site of the bite, with radiating circles of light and pinkish shades.

The basis of treatment is antimicrobial drugs. At each subsequent stage, groups of drugs prescribed by a doctor are used, differing only in dosage. Doctors conduct regular examinations and diagnoses, prescribing symptomatic treatment. Even if the disease has not reached the chronic stage, the prescribed course of therapy cannot be interrupted. Our clinic’s specialists practice a comprehensive approach to the treatment of Lyme disease.

How does the disease manifest in adults and children?

The difficulty in diagnosing Lyme disease lies in the fact that the intensity and characteristics of its manifestations can vary and be disguised as other pathologies, and in some cases they are completely absent, which reduces the chances of a successful outcome for the patient.

IMPORTANT! Most often, the symptoms of tick-borne borreliosis resemble manifestations of acute respiratory viral infections or dermatological diseases, and if there is at least a minimal possibility that a person has been bitten by a tick, you should immediately consult a doctor and undergo appropriate diagnostics.

The disease is accompanied by both specific and general symptoms - the first manifestations are noticeable about a week after the bite, and, as a rule, are limited to skin lesions and deterioration in general well-being. In the absence of medical intervention, the pathological process spreads to different organs, and new signs are added to the clinical picture.

The main signs of Lyme disease include:

• inflammation, swelling and rash in the bite area;
• fever, chills;
• headache and dizziness;
• pain in the joints, swelling, difficulty moving;
• severe fatigue and decreased performance;
• sleep disturbance, night sweats;
• deterioration in motor coordination, memory and concentration.

In rare cases (in 5-8% of patients), after the bite of an infected insect, signs of damage to the central nervous system are observed - nausea and vomiting, severe photophobia, stiff neck and increased sensitivity of the skin. Sometimes the signs of borreliosis appear so weakly that a person does not pay attention to them or writes off the malaise as ordinary fatigue.

Manifestations of tick-borne borreliosis in adults and children are similar, but in childhood they develop faster and are more pronounced, since the immature immune system cannot give an adequate response to the presence of foreign agents in the body.

REFERENCE! Lyme disease is not life-threatening and causes death in isolated cases (usually in people with severe immune disorders), but without treatment it becomes chronic and causes many complications.

On the skin after infection

Dermatological manifestations of Lyme disease are a specific symptom that is observed in the early stages and allows one to suspect Borrelia infection.
Immediately after the bite, patients develop ring-shaped and migratory erythema , less often - a rash and spots , and after the disease passes into the third, chronic stage - atrophic acrodermatitis .

1. Ring-shaped erythema. The lesion occurs at the site of the tick bite and in appearance resembles a target - in the center the skin acquires a red tint, followed by a ring of a pale, almost natural shade, and behind it an inflamed rim that slightly rises above the skin. Its diameter varies from 10 to 60 cm, and if the spot is large enough, rings of smaller diameter may form in it. As a rule, erythema annulare does not cause discomfort, but can sometimes cause tingling and itching. A characteristic feature of such a spot is that it disappears after 2-4 weeks even in the absence of treatment.
2. Erythema migrans. Erythema migrans are practically no different from ring-shaped ones, but usually have a less intense shade and appear in places where there were no bites.
3. Atrophic acrodermatitis. It develops in the later stages of the disease and is characterized by the appearance of reddish inflamed spots on the skin of the extremities. With a long course of the pathological process, the skin in these places atrophies, wrinkles and becomes like tissue paper.

Of the other dermatological manifestations, Lyme disease is characterized by a small rash in the form of papules, bluish-purple spots of different sizes, areas of peeling, and less often, inflammation of the conjunctiva develops.

In addition to the erythema form of borreliosis, there is a non-erythema form, which begins not with damage to the skin, but with general symptoms - deterioration of health and signs of intoxication.

IMPORTANT! The erythema and non-erythema forms of Lyme disease are treated in the same way, but the second type of the disease is much more difficult to diagnose, so it more often leads to complications and unpleasant health consequences.

Lyme disease: what is it, photo of ixodid ticks

First, at the site of the ixodid tick bite (a photo of this insect can be found on the Internet), a strong swelling appears, then a red spot, and facial nerve paralysis may develop.

If you do not consult a doctor in a timely manner, the patient may develop serious chronic diseases, which may result in disability.

Antibacterial drugs are used to treat Lyme disease; at the initial stage of the disease, the therapeutic course lasts from two weeks to one month.

Lyme disease: causes

As mentioned above, tick-borne borreliosis (Lyme disease) develops after the bite of an ixodid tick, the saliva of which contains borrelia. Borrelia are very small microorganisms, from 11 to 25 microns in length, resembling a convoluted spiral in shape.

The natural reservoir of Borrelia in nature is animals: horses, goats, cows, deer and rodents. Ixodid ticks are vectors that become infected by sucking the blood of an infected animal. Subsequent generations of infected ticks also have Borrelia in their bodies.

Tick-borne borreliosis is most common in the northwestern and central regions of Russia, the Urals, Western Siberia, the Far East, the USA and some European countries.

Symptoms

Nonspecific signs sometimes become the culprits of insidious complications. The following are signals that may be manifestations not of Lyme disease, but also of other pathologies:

• heat;
• chills;
• headache;
• nausea;
• muscle pain;
• weakness.

Experts do not diagnose a patient with a symptom of chronic fatigue without checking for the presence of a spirochete in the blood. This is a classic manifestation of tick-borne borreliosis. The disease is also dangerous because it has long-term consequences. Signs may appear not only after a few months, but also after years.

Lyme disease: is it contagious?

After a tick bite, the pathogen penetrates the human skin and further multiplies there. The microorganisms then spread to the lymph nodes located near the bite site. After a few days, borrelia enter the bloodstream and spread throughout the body, hitting the heart, nervous system, joints, and muscles. The immune system begins to produce antibodies against Borrelia, but even with high titers, complete destruction of the pathogen is not achieved.

The immune complexes formed as a result of Lyme disease trigger an autoimmune process (antibodies begin to fight the body’s own tissues), which leads to a chronic course of the disease. When the pathogen dies, toxic substances are released into the body, as a result of which the patient’s condition worsens significantly.

Patients infected with tick-borne borreliosis are not dangerous to others and are not a source of infection.

Course of therapy

A pregnant woman is prescribed antibacterial therapy in a gentle dosage. It is important to start treatment as early as possible, before the virus has thoroughly penetrated the circulatory system and internal organs.

The earlier treatment is started, the easier and faster the recovery. If therapy is started in the first month after infection, the disease is cured, in most cases, completely without becoming chronic.

To treat borreliosis, antibiotics from the group of tetracyclines, penicillins and cephalosporins are prescribed.

In the absence of neurological symptoms, the presence of erythema migrans and enlarged lymph nodes, medications in tablets or capsules are prescribed:

• Doxycycline - 100 mg 2 times a day;
• Amoxicillin - 1000 mg 3 times a day;
• Minocycline - 100 mg 2 times a day;
• Cefuroxime - 500 mg 2 times a day.

The course of treatment is 2-3 weeks (14-21 days).

In the acute course of the disease with signs of damage to the nervous and cardiovascular systems and joints, the following is prescribed:

• Doxycycline - 200 mg 2 times a day;
• Minocycline - 200 mg 2 times a day;
• Cefotaxime - 2000 mg 3 times a day intravenously;
• Ceftriaxone - 2000 mg 1 time / day IV or IM.

Duration of therapy is 21-28 days.

In the chronic form of Lyme disease with signs of damage to the joints, heart, nervous system and skin, the following are indicated:

• Ceftriaxone 2000 mg intravenously once a day for 21 days;
• Penicillin 4 million units intravenously 6 times a day for 14 or 21 days.

Local therapy is carried out at the site of the bite. For this, a special mash (mixstura agitanda) is prepared.

Compound:

• metronidazole - 5.0 g;
• sulfanilamide sulfacetamide 30% aqueous solution - 40 ml;
• dexpanthenol 75% 10 ml;
• prednisolone - 0.50 g;
• distilled water - 50 ml.

Before use, shake the liquid and make lotions in the form of applications for 10-15 minutes three times a day for a course of 5-7 days.

Treatment of borreliosis during pregnancy does not have a single scheme. The doctor takes into account the timing of pregnancy, the severity and form of the disease, the concentration of Borrelia in the body, and prescribes individual therapy.

Drugs are prescribed based on an objective assessment of the severity of the condition.

Most cases of borreliosis during pregnancy result in the birth of a healthy baby.

Lyme disease: symptoms

Lyme disease occurs in three stages, each with its own symptoms.

Lyme disease: symptoms and treatment in the first stage

The first stage of the disease, which lasts 3-30 days, is characterized by the appearance of the following symptoms:

• swelling and redness at the site of the bite;
• rashes on the skin;
• increased body temperature;
• headache;
• pain in muscles and joints;
• fatigue;
• body aches;
• chills.

In 5-10% of patients, Lyme disease in the first stage is accompanied by:

• nausea and vomiting;
• severe headache;
• increased skin sensitivity;
• photophobia;
• tension in the neck muscles.

Lyme disease: symptoms and treatment in the second stage

The second stage of the disease, which lasts one to three months, is manifested by the following symptoms:

• throbbing headache;
• photophobia;
• increased body temperature;
• decreased concentration;
• sleep disorder;
• sudden changes in mood;
• cranial nerve palsy;
• peripheral radiculopathy;
• impaired sensitivity of the limbs;
• dizziness;
• shortness of breath;
• tachycardia;
• chest pain;
• the appearance of lymphocytoma at the site of the bite.

Lyme disease: symptoms and treatment in the third stage

In the third stage, which begins one and a half to two years after infection, Lyme disease manifests itself with the following symptoms:

• epileptic seizures;
• disturbance of consciousness;
• dementia;
• painful muscle spasms;
• memory impairment;
• the appearance of bluish-red spots, infiltrates, nodules on the skin of the extremities;
• skin atrophy, which resembles crumpled paper.

Symptoms of tick-borne borreliosis

The disease occurs in several stages:

• incubation period (the period from the moment of infection until the appearance of the first symptoms) – lasts from 3 to 32 days;
• Stage I – coincides in time with the proliferation of borrelia at the site of penetration and in the lymph nodes;
• Stage II – corresponds to the phase of spread of the pathogen through the blood throughout the body;
• Stage III – chronic. During this period, one system of the body is predominantly affected (for example, nervous or musculoskeletal).

Stages I and II are called the early period of infection, and stage III is called the late stage. There is no clear transition between stages; the division is somewhat arbitrary.

Stage I

Characterized by general and local manifestations. General symptoms include: headache, pain and aches in muscles and joints, increased body temperature up to 38°C, chills, nausea, vomiting, and general malaise. Rarely, there may be catarrhal symptoms: pain and sore throat, slight runny nose, coughing.

Local symptoms are as follows: pain, swelling, itching, and redness appear at the site of the tick bite. The so-called ring-shaped erythema is formed - a specific symptom of tick-borne borreliosis. Is detected in 70% of patients. At the site of the bite, a red, dense formation appears - a papule, which gradually expands to the sides over several days, taking on the shape of a ring. In the center, the bite remains a slightly paler color, and the rim has a richer red color and rises above the unaffected skin. In general, the redness zone has an oval or round shape with a diameter of 10-60 cm. Sometimes smaller rings can form inside the ring, especially if the size of the erythema is large. Quite often, erythema does not cause the patient any discomfort, but it happens that this place itches and burns. It happens that ring-shaped erythema becomes the first manifestation of the disease and is not accompanied by general reactions. Additional annular erythema may appear, secondary, i.e. in places where there were no bites.

Erythema lasts for several days, sometimes months, on average 30 days. Then it disappears on its own, leaving peeling and pigmentation in place of the erythema.

Other skin manifestations may include a rash like urticaria and the development of conjunctivitis.

Local symptoms are accompanied by enlargement and tenderness of regional lymph nodes, stiffness of the neck muscles, increased temperature, and migrating joint-muscular pain.

Stage I is characterized by the disappearance of symptoms even without drug intervention.

Stage II

One of the manifestations of borreliosis is damage to the nervous system in the form of meningitis.
Characterized by damage to the nervous system, joints, heart, and skin. May last from several days to several months. By this point, all local and general manifestations of stage I disappear. There are situations when tick-borne borreliosis begins immediately from stage II, bypassing ring erythema and general infectious syndrome.

Damage to the nervous system is manifested by three typical syndromes:

• serous meningitis;
• damage to the cranial nerves;
• damage to the spinal nerve roots (radiculopathy).

Serous meningitis (inflammation of the meninges) is manifested by moderate headache, photophobia, increased sensitivity to irritants, moderate tension in the neck muscles, and significant fatigue. Typical symptoms of Kernig and Brudzinski meningitis may be absent altogether. Possible emotional disorders, insomnia, impaired memory and attention. In the cerebrospinal fluid (cerebrospinal fluid), the content of lymphocytes and protein increases.

Of the cranial nerves, the facial nerve is most often affected. This is manifested by paralysis of the facial muscles: the face looks distorted, the eyes do not close completely, food pours out of the mouth. Quite often the lesion is bilateral, sometimes one side is affected first, and after a few days or even weeks the other. With tick-borne borreliosis, damage to the facial nerve has a good prognosis for recovery. Of the other cranial nerves, the visual, auditory, and oculomotor nerves are involved in the process, which is expressed, respectively, in deterioration of vision, hearing, development of strabismus, and impaired eye movements.

Damage to the roots of the spinal nerves makes itself felt clinically by severe shooting pains. In the torso area, the pain is girdling in nature, and in the extremity area, it is directed from top to bottom along the length. After a few days or weeks, the pain is accompanied by muscle damage (weakness develops - paresis), sensory disorders (increased or decreased general sensitivity), and tendon reflexes are lost.

Sometimes damage to the nervous system due to tick-borne borreliosis can be accompanied by speech impairment, unsteadiness and instability, the appearance of involuntary movements, trembling in the limbs, impaired swallowing, and epileptic seizures. Similar symptoms are observed in 10% of patients with tick-borne borreliosis.

Joint damage at this stage manifests itself as recurrent monoarthritis (one joint) or oligoarthritis (two or three joints). More often this concerns the knee, hip, elbow or ankle joints. They experience pain and limited mobility.

Heart damage also presents several clinical forms. This may be a disturbance in cardiac conduction (the most common are atrioventricular blockades), myocarditis and pericarditis are possible, manifested by palpitations, shortness of breath, chest pain, and heart failure.

Skin disorders in stage II are quite varied: urticaria-type rash, secondary small ring erythema, lymphocytomas. Lymphocytoma is a rather specific sign of tick-borne borreliosis. This is a bright red nodule from a few millimeters to several centimeters, protruding above the skin level. Most often it forms on the earlobe, in the nipple area, and in the groin area. Lymphocytoma is a collection of lymph cells deep in the skin.

Stage II of tick-borne borreliosis can manifest itself by affecting other organs and systems, but much less frequently. Since borrelia are carried throughout the body in the blood, they can “settle” anywhere. Cases of damage to the eyes, bronchi, liver, kidneys, and testicles have been described.

Stage III

Such patients experience paresthesia and sensory disturbances.
It develops several months and sometimes years after the onset of the disease. It has several typical and known medical manifestations:

• chronic arthritis;
• atrophic acrodermatitis (skin lesions);
• damage to the nervous system (encephalomyelitis, encephalopathy, polyneuropathy).

More often, the disease selects one of the body systems, i.e., damage develops to either the joints, or the skin, or the nervous system. But over time, a combined lesion is possible.

Chronic arthritis affects both large and small joints. Since the course of the disease is characterized by relapses, the joints gradually become deformed, the cartilage tissue becomes thinner and destroyed, and osteoporosis develops in the bone structures. Nearby muscles are involved in the process: chronic myositis develops.

Atrophic acrodermatitis is characterized by the appearance of bluish-red spots on the extensor surfaces of the knees, elbows, on the backs of the hands, and on the soles. The skin in these areas swells and thickens. When the process recurs and the disease persists for a long time, the skin atrophies and resembles tissue paper.

The damage to the nervous system in stage III is very diverse. It manifests itself in the motor (paresis), and in the sensitive (decreased, increased sensitivity, various types of pain, paresthesia), and in the coordination (impaired balance), and in the mental (impaired memory, thinking, intelligence) spheres. Possible visual impairment, hearing impairment, epileptic seizures, and pelvic organ dysfunction. Patients almost constantly feel weak, lethargic, and are haunted by emotional disorders (in particular, depression).

Lyme disease: diagnosis

The basis for diagnosing Lyme disease is clinical data (history of a tick bite, ring-shaped erythema) and laboratory results.

Detection of Borrelia in humans is difficult; they can be found in affected tissues and body fluids: the outer edge of annular erythema, skin areas with atrophic acrodermatitis or lymphocytoma, blood and cerebrospinal fluid.

In addition, to clarify the diagnosis, it is advisable to use indirect diagnostic methods:

• analysis for Lyme disease using PCR (polymerase chain reaction);
• serological diagnosis.

Diagnostics

The diagnosis of borreliosis is made on the basis of epidemiological anamnesis (established facts of visiting the forest and tick bites), patient complaints and external manifestations of the disease, mainly ring-shaped erythema.
To confirm it, patients are prescribed blood tests - general, biochemical, PCR, ELISA, as well as ultrasound, X-ray, CT, MRI and other instrumental diagnostic methods, and, if necessary, a study of cerebrospinal fluid is performed.

If a tick that bit him was brought to a medical facility with the victim, the insect is examined for the presence or absence of infection, after which a treatment strategy for the patient is chosen.

Lyme disease: treatment

When choosing a treatment method, first of all, the stage of the disease is taken into account. The prognosis for treatment is most favorable at the first stage of tick-borne borreliosis.

Conservative therapy can be:

• etiotropic - the pathogen is affected with the help of antibacterial drugs;
• symptomatic and pathogenetic - they treat the affected organs and systems of the body (nervous system, heart, joints, etc.).

At the first stage of the disease, etiotropic therapy involves the use of oral antibacterial drugs (Tetracycline, Doxycycline, Amoxicillin, Cefuroxime, etc.). The duration of the therapeutic course is at least 10-14 days. Reducing the dosage or shortening the duration of use may lead to the survival of some Borrelia and their further reproduction.

At the second stage of tick-borne borreliosis, experts give preference to the parenteral use of antibacterial drugs to ensure a destructive concentration of the drug in the cerebrospinal fluid, blood, synovial fluid (Penicillin, Ceftriaxone, etc.). Antibacterial therapy is continued for 14 to 21 days.

To treat Lyme disease detected at the third stage of development, penicillin antibiotics (Penicillin, Extensillin, etc.) are used. The duration of the course of therapy is at least 28 days.

Symptomatic and pathogenetic therapy of tick-borne borreliosis involves the use of antipyretic, detoxifying, anti-inflammatory, antihistamine, tonic drugs, as well as drugs for the treatment of the heart and vitamin complexes. When choosing a therapeutic agent, the clinical form and stage of the disease are taken into account.