Ixodic mite borreliosis (IKB) (synonyms: Lyme disease, Lime Burreliosis) are currently considered as a group natural focal infections, with a transmissive transmission mechanism, characterized by polysystem damage and large polymorphism clinical manifestations.

Prior to the opening of the causative agent, the ICB manifestation of the disease was described as separate syndromes or independent diseases with unclear etiology: lymphocytic meningoradiculitis (bannadart syndrome), serous meningitis, chronic arthritis, mite erythema, lymphocytoma, etc. (A. Bannwarth, V. Sedlacek, etc.). In Russia, the nosological autonomy of Ixodic mite borreliosis has received since 1991, and since 1992 - were introduced into the form of statistical reporting on infectious diseases.

Ixodic mite borreliosis is the most frequent associated with ticks, diseases in moderate temperature zones of the northern hemisphere. Only in Europe, about 85,000 cases of mite borreliosis are described annually. However, this number is largely underestimated, since messages are contradictory, and many cases could not be diagnosed. About 15,000-20,000 cases of disease are registered annually in the United States, and the disease occurs in 15 states. In Russia, an incidence analysis (according to official statistics of the Federal Service for Supervision of Consumer Rights Protection and Human Welfare) showed that annually over recent years is registered from 7.2 to 9.7 thousand cases of tick-borne borreliosis. In 2011, the incidence of tick-borne borreliosis in Russia amounted to 9957 cases in absolute indicators (of which children under 17 - 847) or 7.02 per 100,000 population. The Novosibirsk region in recent years has a distinct trend to increase the number of tick bites and the incidence of tick-borne borreliosis, including children. This indicator increased from 7.47 per 100,000 population in 2007 to 17.65 per 100,000 in 2011 and 12.13 per 100,000 population in 2012 (Table). High level The incidence of tick-borne borreliosis of the population of the Novosibirsk region, among other things, is due to the accommodation of people in the endemic territories and the insufficient volume of anticipating processing places of mass visits by residents (parks, cemeteries, garden sites).

Conducted studies in the natural foci themselves as in the territory Russian FederationAnd in Europe, Europe shows an increase in the number of ticks and enhance the circulation activity of the pathogen itself, which determines the tendency to increase the incidence of tick-borne borreliosis at present.

Ethiology of ticky borreliosis

Today is known (Johnson et al., 1984) that spirochetes causing tick borreliosis belong to the genus Borrelia.. This genus is a heterogeneous population of microorganisms and is divided into two large subgroups:

1) Patients of the return tick of fever: B. Recurrentis, B. Duttoni, B. Parkeri, B. Turicatae, B. Hermsii, B. Miyamotoi and etc.;
2) pathogens of Lime Borreliosis: B. Burgdorferi Sensu Stricto, B. Garinii, B. Afzelii, B. USITANIAE, B. Valaisiana, B. Andersonii, B. Bissettii, B. Japonica, B. Tanukii, B. Turdi, B. Inica.

These types of borrelia due to high phenotypic and genetic similarities were combined into a single complex B. Burgdorferi Sensu Lato. Although this complex today includes up to 18 species. Borrelia., only three of them are clearly pathogenic: B. afzelii, B. Burgdorferi and B. Garinii (including B. Garinii OSPA, type 4, or B. Bavariensis). The infection of ticks borrelia in natural foci varies from 10% to 80%. In the Novosibirsk region, both in the natural focus, and in patients with ixodic tick-borne borreliosis, DNA is more often detected. Borrelia Garinii. and Borrelia afzelii.

The main mechanism of infection with ICB is transmissive, borrelia fall into the human body with saliva infected ticks during bloodsuccia. Transmission paths: transmissive, alimentary, contact (through microtraums of the skin when removing and crushing the tick) and transplascent. Seasonality of the disease is spring-summer, due to the period of tick activity. Immunity is non-sterile, the pathogen is capable of long-term persistence in the body, and super- and reinfection are possible. After the tick bite, the probability of seroconversion in a person is in the range from 3% to 6%. Clinically, the manifest forms of the disease occur in 0.3-1.4% of cases from all tick bites.

Considering that the entrance gate of infection during tick-boring borreliosis is the skin where the pathogen is reproduced with the subsequent lymphogenic distribution of it in the coming the lymph nodes and the development of regional lymphadenitis, in the site of the pricing of the tick occurs primary affect with the formation of erythema. According to statistical data, in the opinion of both domestic and foreign authors, the erythemical forms of the disease are observed in clinical picture IKB in 40-70% of cases. When analyzing the incidence of transmissible tick-level infections of 125 children aged from 1 to 18 years living in the Novosibirsk region, for 13 years (period from 1999 to 2011), it was found that 78.5% of them fell ill with Ixodic tick-borne borreliosis (95 people ). The disease proceeded in erythim form in 94 patients IKB (98.9%). The diagnosis was exhibited in accordance with the ICD of the 10th revision on the basis of clinical and epidemiological, general-clinical, specific (serological - immunoferment analysis (ELISA), molecular genetic - polymerase chain reaction (PCR)) and biochemical methods of examination.

Damage to the skin - migrating erythema - is characterized by a period of early localized manifestations (stage of local infection) with ICB. Erythema usually occurs after 7-14 days from the moment of the tick bite (from 3 to 30 days), localizes the bite space, has a rounded or oval form and the trend towards distribution. There is an occurrence in Erythema skin itch, Parentesies, Local temperature increase. In the absence of antibacterial therapy Erythema spontaneously fades in time from several days to several weeks (on average about 4 weeks). In 10-30% of patients, the migratory erythema is accompanied by non-specific symptoms, such as malaise, subfebrile temperature, short-term migratory pain in the muscles and small joints, fatigue.

According to our data, in 44 cases (46.3%), the first signs of the disease with the IRB in children were blushing at the site of the tick bite. When monitoring children with the erythemal form of Ixodic mite borrolizov, Erythema appeared at the site of the tick bite for up to 45 days (maximum) from the moment of suction of the tick to the skin, on average - by 11 ± 7 day. Erythema dimensions ranged from 1.5 to 20 cm (on average - 6.6 ± 4 cm). In rare cases, there was an increase in erythema in size for the observation period. Erythema persisted on the skin as much as possible to 36 days, an average of 8 ± 5 days, from the moment of the beginning of the antibacterial therapy, felt on average after 7 ± 4 days. In 11 cases (11.6%) erythema fade, followed by peeling. In two cases, Erythema was noted in the form of a double ring, three children had an increase in local temperature in the migratory erythema region. In 5 cases (5.3%), the skin manifestations were represented by Exanthemia (phetechial, large and medium-satellite elements of the rash), in combination with Erythema at the site of the plug. In all five cases, the combination of erythema and rash on the torso, patients had fever to febrile numbers and rather intensive manifestations of intoxication.

The presence of migrating erythema is a pathognomonic symptom of tick-borne borreliosis. Subsequently, the dissemination of the pathogen: hematogenically, lymphogenically and perioreural borrelia apply to other areas of the skin, in the internal organs (liver, spleen, kidneys, heart), joints, brain shells, central and peripheral nervous systems.

Generalization of infection (stage of dissemination of borrelium) in adults is most often characterized by defeat nervous system In the form of meningoradiculoneuritis (bannadart syndrome): a combination of serous meningitis, radiculitis and damage to the cranial nerves (most often in the form of a single or bilateral peripheral paralysis of the face nerve). The generalized stage of the disease may also proceed with the formation of carditis, lymphocytoma (benign tumor of red-violet color), which is usually localized on the ear of the ear in children, and in adults in the area of \u200b\u200bAreol, scrotics, nose and forearm.

By late and persistent clinical manifestations SDS (organ lesions stage) are chronic atrophic acrodermatitis (acrodermatitis chronica atrophicans of Herxheimer, ACA) and chronic arthritis, as well as polyneuropathy, chronic progressive meningoencephalitis, and multifocal cerebral vasculitis which characterized by irreversible neurological deficit and the progressive course of the disease . Typically, such manifestations are developing no more than 5% of patients undergoing neuroborreliosis. Also rarely describe cases of extrapyramidal disorders against the background of chronic borreliosis infection. The articular lesions may arise delayed, in the absence of therapy, after a few months and even years after the tick bite, and usually occur in the form of chronic oligoarthritis, with an asymmetric lesion of one of the joints (more often knee and elbow). Chronic forms of ixodic tick-borne borreliosis are the most difficult in terms of diagnosis and treatment. This is due to the fact that the disease has nonspecific symptoms, which can also be characteristic of diseases of other etiology (for example, arthritis, encephalomyelitis or peripheral neuropathy), which do not allow to clarify the diagnosis of negative or dubious laboratory and clinical criteria.

In children during the ICB, the following clinical features can be distinguished.

• Most often, the IKB is ill children aged 3 to 10 years.
• The migrating erythema develops in children in 70-80% of cases and most patients have a ring-shaped form.
• The characteristic localization of erythema in children is maspress part Heads, near-key region, face, upper body.
• The general infective syndrome is observed in 60-70% of patients with IKB children and is usually more pronounced than adults.
• In most sick children, there is an increase in the regional to the place of bite of lymphatic nodes.
• 10% of patients with children with acute course of the ICB are involved in the pathological process brain shells With the development of serous meningitis.
• The development of chronic flow after transferred acute ICB in children is observed in 15-20% of cases.

Diagnostics ICB

To form a diagnosis of the ICB, it is necessary to take into account the information of the epidemiological history (sinking of a tick, visiting places with a high probability of a tick attack - departure to nature, exit to the forest) for the time of year (spring-autumn period), clinical manifestations: the emergence of migratory ring-shaped erythema, increasing the regional lymph nodes, presence of neurological, articular and cardiac symptoms.

Tests of laboratory diagnostics are used to confirm the diagnosis. To date, in the arsenal of a practical doctor, there are diagnostic tests aimed at direct diagnosis of pathogen, and serological tests to identify antibodies to the causative agent in different biological environments of the human body. Direct detection of the pathogen is possible with the help of direct microscopy, but this method has not received widespread practical application, since the results of light microscopy are subjective and contradictory. In the samples under study, a small amount of borrelia may be contained, in addition, they can lose the clarity of morphology when painting and fixing the smear - all this makes it difficult to diagnose. The culture method is considered to be the "gold standard", but also does not fulfill the requirements of practical health due to its duration (from 3-4 to 10 weeks), high costs and insufficient effectiveness. Molecular methods of diagnosis using PCR are more often used in the stages of the infectious process, where the serological method of diagnostics is not enough informative: Lime arthritis, early borreliosis and neuroborrium. In this case, a significant limitation in the use of molecular methods of diagnostics determines the variability of the borreli genome sections circulating in Europe and Russia.

Serological diagnostic serological methods are more accessible in practical. The most common methods for determining anti-elevation antibodies include an immunofermental analysis (ELFA and ELISA), an indirect immunofluorescence method, a complement binding reaction, a passive hemagglutination reaction, as well as immunoblotting.

With ICB, IGM class antibodies in maximum quantities are produced by 3-4 weeks of the disease, the IGG class antibodies appear to the second month. Some patients with IGM synthesis can linger or absent at all. Serocco is observed in 20-50%, and according to some data, in 80% of patients with early borreliosis. The presence of IgM antibodies to borrels in serum, as a rule, indicates an early infection. The presence of IgG antibodies indicates the dissemination of borrelia or to the transition to the stage of chronic persistence. Both classes of antibodies can be determined for a long time (up to 10 years), including after successfully carried out antibacterial therapy.

In order to increase the diagnostic accuracy, the American Center for Disease Control was proposed to verify the positive or borderline results of screening tests using immunoblotting, using standardized criteria for the method of the method of the method. The main screening test in this scheme is ELISA. The studied samples with positive or dubious results in the ELISA must be additionally tested by the method of immune blotting. According to these recommendations, serological testing on Lyme disease is considered positive if in one serum both the screening method and immunoblotting gave positive results. In the Russian Federation, there are no such standardized diagnostic criteria, however, given the complex immunopathogenesis during borreliosis, one should not be based for diagnosis only on one diagnostic test. Extended examination using all available methods gives an advantage, especially in the diagnosis of non-educated forms and late stages of the disease, and also avoids diagnostic errors associated with false-positive reactions.

Timely diagnosis and early appointment of etiotropic drugs are an effective means of preventing the development of organ lesions and chronic disease. Early appointment of antibacterial therapy for ixodic tick-borne borreliosis allows reliably to reduce the risk of developing neurological, articular and cardiac complications.

Treatment and prevention of IKB

Currently, the use of oxodic mite therapy is considered in children over 8 years old and adult patients of doxycycline (100 mg 2 times a day) or amoxicillin (500 mg 3 times a day) within 14 days during acute ICB. In generalized forms (neuroborreliosis) therapy is carried out by parenteral administration of penicillin or drugs of the Cephalosporins group (cefotaxim, ceftriaxone) at least 14 days. The effectiveness of antibacterial therapy is estimated by the nature of clinical manifestations.

Attempts to create vaccines against tick-borne borreliosis were undertaken in the United States, but turned out to be ineffective due to the large variety of genes of the pathogen. Currently, vaccine creation work continues.

The most effective preventive measures are measures to protect against the bites of infected ticks when visiting their probability habitats: Special clothing, the use of protective repellents, acaricidal processing of forest parking zones, self-and-inspections. Tick \u200b\u200bbites can also be avoided by carefully inspecting and removing ticks from pets.

When the tick is detected, it is necessary to remove it as soon as possible using a tweezers, avoiding insect crushing. Delete ticks are fully necessary, since the remaining insect parts can lead to allergic reactions and secondary bacterial infection. Using Vaseline When removing a tick to disrupt the breathing function at the insect is not effective, since the ticks have a low respiratory rate (3-15 inhales per hour) and the time required for the death of an insect may be sufficient to transmit the pathogen to the person.

The possibility and necessity of preventive antibiotic popilaxis after the bite of an infected tick is currently widely discussed by domestic and foreign authors. In the US, the antibioticoprophylaxis after the bite of an infected tick is carried out if:

• the tick was on the skin more than 72 hours;
• the duration of the tick is unknown;
• the tick dropped himself after saturation.

Preventive antibiotic therapy is not shown if:

• the bite of the tick happened outside the endemic territories;
• the tick was on the skin less than 24 hours;
• from the moment of bite, more than 72 hours passed.

If the tick was on the skin from 24 to 72 hours, the question is solved individually, for example, if a tick analysis is made and it is infected with borrelia. For antibioticoprophylaxis, doxycycline 200 mg is used - one-time reception. For children over 8 years old, the dose is 4 mg / kg of body weight to the maximum 200 mg. Pregnant and lactating women, child for up to 8 years are prescribed amoxicillin. Time before the start of receiving an antibiotic should be not more than 72 hours after removing the tick.

In Russia, the following antibacterial prevention options are offered:

• doxycycline at a dose of 0.1 g 2 times a day with a course of 3 to 5 days, alternative preparations for the treatment and prevention of ICB may be ampicillin, azithromycin (N. N. Vorobyeva, E. I. Korenberg);
• tetracycline 0.5 g 4 times a day 5 days, benzitin benzylpenicillin + benzylpenicillin plose + benzylpenicillin 1.2-2.4 million u intramuscularly once, benzatina benzylpenicillin in a dose of 2.4 million union intramuscularly, doxycycline 0.1 g 2 times a day for 10 days, amoxicillin + clavulanic acid of 0.375 g 4 times a day for 5 days. Treatment is carried out no later than the 5th day from the moment of bite. The risk of disease is reduced to 80% (Yu. V. Lobsin, S. S. Kozlov, A. N. Uzolez).

If we talk about the choice of an optimal drug for the prevention of the ICB, the antibiotic used for this purpose should have, on the one hand, high activity against borrelius, even with a single reception, on the other - a favorable security spectrum. Doxycycline is the most commonly used for the prevention of the ICB drug, as it meets both requirements. In order to minimize the risk side phenomena It is preferable to use doxycycline in the form of its neutral salt - a monohydrate, which is practically not associated with the development of acid-dependent gastrointestinal diseases (such as esophagite, esophagus ulcer). In addition, doxycycline monohydrate, presented in the form of Soluteab, is characterized by the maximum convenience of use, which is important for patients receiving an antibiotic without separation from everyday activity.

By summarizing the foregoing, it can be concluded that the tactics of conducting patients with the risk of the development of tick-borne borreliosis should provide for the rational purpose of an effective antibacterial drug, which allows preventing disease and its potential complications.

Literature

I. V. Kimova 1,
O. A. Radionova
E. I. Krasnova, doctor of Medical Sciences, Professor

GBOU VPO NGMU MW RF, Novosibirsk

ABSTRACT. The Article Reveals The Basic Information on the Clinical and Epidemiological Characteristics of Tick-Borne Borreliosis In Children Living In The Novosibirsk Region. OBServation Has Indicated A Certain Tendency of Increasing The Amount of Ixodes Tick-Bore Borrelioses.

Borellosis, the disease is also known as Lyme disease, is a bacterial disease transmitted through a tick bite, if this insect is infected with Borrelia Burgdorferi bacteria. The disease is distributed throughout Russia.

Fortunately, only about 5 percent of cases (1 of 20) tick bites ends with infection. Doctors have a wealth of experience in combating this disease, it is important only to recognize it on time and seek help.

Let's look at the reasons what borreliosis causes? Borrelia Burgdorferi is a bacterium that causes Lyme disease. The life area of \u200b\u200bthis bacterium is very extensive, but it is most common inside ticks and some mammals, for example, in mice and deer. People do not enter the habitat of these bacteria, but nevertheless, a person can become infected with them at the time of the tick bite.

Symptoms of borreliosis.

The first few days after infection, as a rule, no symptoms are observed, or they are so insignificant that they are most often ignored. Among the earliest and weak-reason symptoms are: a slight deterioration of well-being, as if your child picked up light flu. Also sometimes performs rash on the skin.

Then the characteristic symptom of the disease appears - redness of the skin at the bite area, which increases over time. This redness of the doctors is called migrating erythema. Within a few weeks, redness may increase from a small point to a circle or oval with a diameter of 5 or more centimeters. As Erythema grows, the skin is closer to the center brightens, with the result that redness acquires the type of ring.

This is the first stage of the disease, during which you need to begin treatment, because Over time, after the transition of the disease to the next stage, this will be much more complicated.

If the disease does not start to treat, later other more serious symptoms associated with the damage in the internal organs may appear:

• Paralicity of facial nerve, causing face muscle asymmetry
• Meningitis with strong headaches, fever and neck
• Nervous inflammation with dizziness and tingling in hands and legs
• Disorders of the brain function, causing a lag in development
• The development of periodic arthritis, which can last during the week or two, and most affects the joints of the wrists and knees.

If the disease is not treated, with the time arthritis goes into chronic form. In addition, inflammation of the tissues of the heart may appear, leading to arrhythmias and other serious consequences.

Diagnosis Burreliosis

A reliably diagnosis of borreliosis or Lyme disease can be delivered only after the clinical examination of the child and the delivery of special laboratory tests. The doctor will definitely ask you if your baby tick or whether you have recently been on a picnic, cottage or in the forest, if you suspect borreliosis from your child. If there is a migrating erythema on the body or there will be other signs of the disease, you will need to pass the blood for laboratory analysis for antibodies to Borrelia Burgdorferi bacteria.

In the first days after the disease of the antibody, borreliosis bacteria in the child's blood may be absent. So it is recommended to take tests on immediately after the tick bitter, and a few days later.

Treatment Burreliosis

Begin treatment of Lyme disease is recommended in the early stages of the disease. The disease is treated with antibiotics, such as doxycycline, penicillin or erythromycin. Late stages of Lyme disease with pronounced symptoms of neurological and heart disorders require mandatory hospitalization for intravenous antibiotic therapy.

How to avoid borreliosis infection

Do not go to the forest without special protective clothing, especially in the summer.

Dress on the child socks, and the bottom edge of the child's pants fill in the socks.

Dress on a child clothes from light cloth, so you can quickly notice a dangerous insect on it.

The use of special aerosols against insects should be limited to children, and spray them only on clothing, and not on the skin of the child.

If the tick still bites the child, try to remove it as soon as possible. For the transmission of borreliosis, it is necessary that the tick stays on the body of a child for a while.

Carefully inspect the baby's body every time after a trip to the cottage, to the forest or on a picnic. Remember that ticks are most often embarrassed to a warm and wet area of \u200b\u200bthe body: groin, armpits, neck and hair.

If you find a tick, remove it as soon as possible. To do this, it is best to use tweezers. Capture a tick as close as possible to his head and slowly pull it out of the wound, slightly rotating.

Process the bite of alcohol or another antiseptic agent.

About tick and baby. What you need to immediately do when bite

Greeting readers Mom Doctor.

Spring and summer - time of walking in the park, forest, hiking and all sorts of communication with nature. In some regions, it is high enough to pick up a tick.

Contrary to general opinion, ticks are not necessarily "attack" on us from trees. They calmly live in the grass and can climb under the shoes. Apply a tick into the house can even your dog!

It is not a bite of tick itself, although he is somewhat and painful. Scary 2 diseases that he can infect you:

• ticky encephalitis (viral),
• lime borreliosis (bacterial).

The tick can be absolutely incomprehensible, but may be a carrier of one or two causative agents of the disease. Therefore, today we will analyze where to run and what to do if the baby bit the tick.

Signs of the bite of a tick in a child

After a walk, the skin should be viewed, especially those places where the skin is soft and thin: elbow bends, a popliteal area, inguinal folds, armpits.

The symptoms appearing in the bite of tick in the child include: redness of the wounds around the bite. Often the tick is visible in the rickest. If he has already got drunk, it falls off and then it can be found on clothes. Redness keeps up to 3 days. It is not necessary to treat it, the wound process is processed by an antiseptic.

Since with the bite of the tick produces anesthetic substance, then the bite does not hurt. After children may have a small sickness of the skin.

What to do if the child bit the tick?

1. Ticks need to be removed. And the faster, the better. The fact is that the peculiarity of the physiology of the Ixode Tick is such that if he was in contact with blood less than a day, then the probability of infecting a man borreliosis is zero.
2. Optimally for its removal should be considered tweezers. This will minimize the risk that parts of the tick will remain in the rink.

It is necessary to extract it smoothly, pull vertically. "Unscrew" the tick is impossible!

It is impossible. Use alcohol, ointment, acetone, lacquer removal fluid, sunflower oil. Everything chemicals Can accelerate the separation of infected saliva.

1. Ticks need to be closed in a glass jar and attribute to SanEpidemstan for examination for 2 days (alive). To do this, in the jar, put paper moistened with water, and the jar itself in the refrigerator. With tick, you can also contact the trauma.
2. Ticks are examined for infection. In the case of a positive response, the child will have to go preventive treatment .

Prevention of borreliosis after tick bite in children

Burrelioz call the defeat of organs and tissues by microorganisms called Borrelia Burgdorferi. The disease proceeds in several stages and at the initial stages are successfully treated with antibiotics.

An antibiotic when the tick bite, children are assigned if the tick stayed on the skin more than 24 hours. If less than a day, even if it was infected with borrelia, it is impossible to become infected with them.

The only antibiotic, the effectiveness of which is proved in the prevention of borreliosis - this Doxycycline. For up to 8 years old, he is contraindicated due to adverse effects on the bone, cartilage tissue and enamel of teeth.

After 8 years, children receive it in a dosage of 4 mg / kg body weight once. There are recommendations to carry out the prevention of children under 12 years of amoxicillin for 10 days or clarithromycin for 2 weeks. Despite this, their effectiveness has not been proven.

The skin of the child is observed for 30 days, for the identification of a classic purple spot, increase temperatures above 38 ° from more than 3 days.

If suspicious symptoms begin, then the child will analyze the antibodies to the causative agent of the disease (IFA or IFL). However, if there are no paintings of the disease, it is not necessary to treat anything, since these methods are capable of giving false-positive results.

Vaccines for the prevention of Lime Burreliosis currently does not exist.

Prevention of tick-borne encephalitis

The probability of becoming encephalitis, even from the infected tick is 1: 200.

To prevent encephalitis use immunoglobulin. By the way, this is done only in our CIS, and in Europe it is kept for placebo. And still. You need to enter it, if since the bite passed less than 72 hours. Otherwise it remains to watch incubation period - About 14 days behind a busted child for fever, headaches, nausea, vomiting, loss of appetite and muscle pain.

Announced to Anaferon contains information that it can be used to prevent tick-borne encephalitis, but there are no convincing data on this account! In general, there are children antiviral drugsRead here.

As for the drug iodantipirin, it cannot be used as prophylaxis, since it does not have evidence of efficiency.

For the prevention there are tick-e-vaccine vaccines, IMMUN Junior FSME, Enceptur children. We have broken a serious discussion about the need to vaccinate newborns. Join now! I will be glad!

I hope now if you find a tick, you will act correctly and not be panic.

And now to protect:

Hello. I did not hear that in order to infect borreliosis, you needed to go through day.
We had a case when one of my sons bit the tick. He stayed a few hours on the back of her hair.
When they arrived at the reception room, Med.Eseta crushed him with a tweezers, thumping the contents in the child, and then she also did not want to give it to us, they say, he was dead.
They said to drink Anaferon children's 3 weeks 3 tablets.
After 2 weeks of the child, it turned out the allery, we stopped drinking tablets.
And after a couple of days he fell ill. Picked up some kind of virus. Here you and Anaferon strengthened immunity!
Never drank any pills to raise immunity and antiviral. And correctly did.

Hello! Before the day, borrelia do not penetrate the blood. This is confirmed by all epidemiologists.
But Anaferon is really useless and will not help with viral encephalitis. (I doubt that in general can help :-))
Actions of nurse, of course, no comment

Disposable sprays and ointments will eat very quickly. It is very uncomfortable. In the past year, we were bitten by the tick, despite all these means of protection, and hemomycin was prescribed in the hospital for Lyme disease profylastic.

Yes, I also know that if the tick stayed on the skin for less than a day, then the Lyme disease will not get to infected. Therefore, it is important to carefully examine the children and yourself after each picnic or a campaign (especially in May-June we have -then in the ticks generally a full all-wheelhang). Already more than once they took ticks with themselves, it happened that both more than a dozen goal, but for now, the pah-pah, there was no consequences.

Ixodic ticks may be carriers dangerous infectionsOne of which is mite borellosis, or Lyme disease. What kind of disease is how to cope with it, informs the chronicle. Info with reference to my child.

Symptoms and flow of Borelliosis

The pathogen of Borelliosis is a group of pathogenic bacteria united by Borrelia title, which belong to the spirochet family. Microbial carriers are warm-blooded animals: rodents, large cattle, Predators, including dogs and even birds.

The first signs of borreliosis can appear after a few days after the bite, but more often the manifestation is delayed for a long time - from two weeks to a month. At the time of the bite, the tick launches the victim's blood in the blood, which contains a small number of borrelia, which begin to actively multiply, with a large concentration with blood flow can penetrate various organs, including the central nervous system, heart, joints, liver and others. Borrelia are capable of forming disputes, and during death, dangerous endotoxin is distinguished, which causes general intoxication of the body.

If the baby bit the tick, carefully follow the place of bite - if redness appeared immediately, most likely it is just a reaction to leather damage, which takes place for several hours. When infecting borreliosis, redness will appear a few days after the bite - a round spot, which gradually expands and changes the outline. Gradually, the spot acquires the view of the pale rings in the center of which red elevated above the skin level. With the appearance of migratory erythema (this is the name of this spot), it is necessary to urgently consult a doctor - the earlier treatment has begun, the greater the chances for recovery without consequences.

The development of erythema may be accompanied by an increase in temperature, in addition, quite rarely, but it happens that Lyme disease develops without erythema, but signs of bacterial infection occur - increased temperature, headache, chickens, general weakness.

Treatment of Lyme disease

Migrating Erythema is one of the main signs that allow you to diagnose, but confirm it laboratory methods on the early stage It is not always possible. In suspected borellosis, hospitalization will be required, since treatment is not only in the appointment of antibiotics, but also to the general purification of the body from intoxicating borrelia endotoxins.

The cunning of Lyme disease is that Erythema can spontaneously disappear in 2-3 weeks after occurrence, but this does not always mean that the disease is defeated. 1-2 months after that, signs of internal organs may well be manifested, this is the second, more serious and dangerous stage of the disease, which can be treated significantly worse.

Burreliosis infection is dangerous during pregnancy, since there are cases when bacteria overcomed the placental barrier and hit the fetus fabrics.

The prophylactic vaccine against Lime disease currently does not exist, but the treatment is quite efficient, especially if it starts at the stage of skin manifestations.

We regularly examine the child, especially paying attention to the open areas of the body - the tick does not bite immediately, it can wander in search of a comfortable place to several hours.

Towing a tick Try to save it alive - place in the container and close the lid tightly. Any jar is suitable, as well as pharmacy containers for collecting urine and feces. Take the test tick - if you succeed, treatment can be started, without waiting for the appearance of symptoms. Well, if the insect is healthy, it will be possible to sigh with relief.

Write down the date when the trouble happened, it is important because the symptoms of borreliosis, like other tick-borne infections, can manifest a long time.

Severe 3 stages of the disease. The incubation period is from 2 to 30 days, the average is 1-2 weeks. In the clinical picture, the early and late periods are distinguished. In the early period, there is a distinguish / stage - localized infection (the accumulation of borrelia in the skin after the creation of the tick) and II stage - the dissemination of the pathogen in various organs. The late period (III stage) is determined by the persistence of Borrelia in any organ or system.

The stage I continues from 3 to 30 days and is characterized by generalfeit and skin manifestations. Inxication syndrome is manifested by headache, weakness, fast fatigue, nausea, vomiting. Often there is pain and stiffness in the neck, arthralgia, Malgia, migrating pain in the bones. The body temperature is more likely subfebrile, but can reach 38.5-39 ° C. Fever lasts 1-3 days, less often up to 7-9 days. Typical forms of the disease occur with the ring-shaped erythema (Pato-gnomonic symptom). The favorite localization of the lesion in children is an near-wing area, a face, a sickness of the head, the upper part of the body. In the place of the tick bite, there is a slight itching, pain, redness and skin infiltration. First, a red stain appears (or papula), which is rapidly increasing in size (up to 60 cm in diameter). Erythema form rounded or oval; The center of it is pale, often acquires a cyanotic tint, the outer edge is the wrong shape, more intensely hypertized, towers above the level healthy skin. Regional lymphadenitis occurs: the lymph nodes are increased, painful when palpation. Children may have various nonspecific rashes, vasculitis, conjunctivitis, catarrhal phenomena, hepatosplegegaly. Erythema is preserved without treatment for several hours or days, less often - weeks and even months. Then she disappears, leaving pigmentation. In some patients, in addition to the primary erythema, multiple erythemas of smaller diameter can occur in other skin sections in other areas of skin due to migration of borrelia (secondary, child erythema). They are brighter, differ from the main erythema. The lack of primary affect can recur, merge among themselves, do not have clear boundaries. At this stage, the process can end up or go to the next step.

The stage II is associated with the dissemination of Borrelia into various organs with a predominant damage to the nervous system, heart, joints. Clinical manifestations are usually marked after 4-6 weeks. After the start of the disease. The damage to the nervous system (neuro-borreliosis) is most often flowing in the form of serous meningitis, myelopolyra-diculonurite, neurites of cranial nerves, radiculoneuritis. Under meningitis, there is a headache of various intensity, decreasing over time, nausea, re-vomiting, light source, soreness when driving eye apples. The rigidity of the occipital muscles is revealed with the weakly pronounced symptoms of Kernig and Brudzin. Likvore transparent, pressure within the normal range, a lymphocytic lamp is detected (about 100 cells in 1 μl), the protein content is somewhat increased (up to 0.66-0.99 g / l), the glucose level is more often normal. In some cases, it is possible to identify antibodies to borreliam only in cerebrospinal fluid. In 30% of patients are determined by moderate encephaliacressuretvas: sleep inversion, anxiety, disorders of the concentration of attention, emotional disorders. They persist for a long time - 1-2 months. The cranial nerve neurites are observed in 50-70% of patients. The depth of lesion of the facial muscles does not reach the degree of complete paralysis. Restoration begins with 2-3rd weeks, residual phenomena are minimal. Often paresis of fairy nerve is combined with defeat trigeny nervewhat is manifested by numbness, tingling in the affected half of the face, pain in the mouth and lower jaw. Skin sensitivity is usually not broken. It is also possible to damage the glasses and bulbar groups, as well as vestibular and spectator nerves. Pares of limbs are distributed asymmetrically, at different times with a period of several weeks and even months. Possible residual phenomena in the form of paresis and muscle atrophy. Breast radiculites are manifested by pain syndrome, a sense of compression, (pressure. In the damage zones, both hypo and hyperesthesia are possible. Neurological symptoms in treatment are usually started to disappear after 1-2 months, but they can recur, and the disease acquires a protracted or chronic character. Defeat Hearts ("Lime Carditz") are developing in 5-10% of patients on average after 1-2 months. from the onset of the disease. They manifest themselves to the unpleasant sensations in the heart, heartbeat, tachycardia (less often - bradycardia), the expansion of the heart boundaries, systolic noise . Atrioventri-Cool blockades are detected on ECG various degrees. There is also a blockade of other levels of the conductive heart system - a beam of Gis, fibers Purkinier, as well as inside-atrial blockages. It is possible to defeat the heart in the form of pericarditis, pankarditis, dilatation myocardiopathy with deficiency of left ventricle. In an earlier period, on the 1st week. Diseases, there may be changes from the heart of a toxic-dystrophic nature, disappearing in the treatment simultaneously with intoxication syndrome. Quite often there are mosses and arthralgia. These changes are observed, as a rule, at the height of intoxication in the first weeks of the disease. On the 5th 6th week. And later, arthritis arises with a predominant lesion of large joints (knee, shoulder, elbow), less often - small (brushes, stop, temporous-jaws). The affected joints are usually not externally changed, rarely can slightly increase due to the swelling of the surrounding tissue. The duration of arthritis ranges from 3 days to 8 months. In the absence of etiotropic treatment, recurrences are possible (with a protracted and chronic flow). Skin lesions can occur with secondary ring-shaped elements, erythematous rash on the palms along the type of capillaries, diffuse erythema, urticular rash, benign lymphocyte skin (Sarcoid Spiglera-Fendt, skin lymphoplasia, lemphidenosis of the skin of Befechtedta). The leaf lymphocyte represents the peasotic blue color of the nodule or plaques, painful when palpation, with phenomena of regional lymphadenitis. The most frequent localization in children is a face, the ear of the ear, in adults - the nipple of the breast. Focis exist for a long time, allowing spontaneously, without atrophy. There are both single and disseminated forms. In the second stage of tick-boring borreliosis, hepatitis, keratitis, irrit, chorioretinite, panofalmite, orchitis can be observed.

III Stage (chronic) occurs in time from several months to several years from the beginning of the disease, sometimes after a long latent period. Characterized by the defeat of the nervous system, joints, leather, hearts. In the diagnosis, carefully assembled history and clinical laboratory data helps. Complications damage to the nervous system. Chronic neuroborreliosis is most often manifested by the development of encephalopathy (long-term headache, worsening memory, fast fatigue, emotional lability, sleep disturbance, etc.) and polyradiculopathy. Encephalomyelitis, Me-Ningoenefalitis, recurrent serous meningitis are significantly less. Arthritis have a recurrent nature during remission inflammatory process Eat, but does not completely disappear. Mostly large joints are affected (more often - knee). However, small joints can be affected. Typical signs of chronic process are determined in the joints: osteoporosis, chipping, sometimes degenerative changes (subarticular sclerosis, osteofitosis). In the synovial fluid - the number of leukocytes to 500-100,000 in 1 μl is often determined by the increase in the content of protein (3-8 g / l) and glucose, sometimes borrelia can be allocated. Skin lesion. Later lesion of the skin (after 1-3 years and more after infection) is developing gradually and is manifested by chronic atrophic aquirrelmatitis. On the infrunning surfaces of the limbs, drain cyanotic red spots with edema and infiltration in subcutaneous fat tissue appear; accompanied by regional lymphadenitis. The process develops for a long time for many years, moving to sclerotic stage. There is a pronounced skin atrophy, which acquires a type of cigarette paper. In 30% of patients at the same time there is a damage to bones in the type of syphilitic dactylitis, arthropathy. Heart damage in chronic flow proceeds in the form of myocarditis, pankarditis, myocardiodestrophia. Atypical forms. The uncerichemical form is characterized by the lack of typical ring-shaped erythema in the I stage of the disease and is manifested only by general infective syndrome and regional

The diagnosis is based on clinical and serological data.The causative agent can be isolated from affected skin, cerebrospinal fluid, blood, synovial fluid, for which the crops of material use with the selection of culture. The most informative reef is the detection of antibodies to the causative agent in the blood, the cerebrospinal fluid, which gives a positive result in 60% of cases in the I stage of the disease and 100% in II and III stages. Differential diagnosis Conduct with different types of erythem, scleroderma.

Treatment: Penicillin - 2,000,000 units and more per day for 2-3 weeks (depending on the stage), tetracycline - 1,000,000-2,000,000 units per day, amoxicillin - 1,000,000- 2,000,000 units in day (children 20-40 mg / kg per day); Erythromycin of 1,000,000 units per day (for children of 30 mg / kg per day). With damage to the nervous system and arthritis, Penicillin G and Ceftriaxone are used.

Prevention. Basic prevention measures are aimed at reducing the risk of contact with the tick. Before entering the habitat of the ticks, it is necessary to take care of protective clothing with the presence of dense cuffs and a collar, headdress. For repellent ticks, repellents (Deta, Difftalar, Bibun) and Acaricides (Pretiks, Permann, Permes) are additionally used. After each visits to the forest or the park, it is necessary to carefully examine the child, especially the area of \u200b\u200bthe ears, the scalp. When the tick is detected, it is necessary to remove it. In the case of suction of an infected tick, it is recommended to use oral antibiotics within 5 days, which reduces the risk of developing a disease by 80%.

Tick \u200b\u200bborreliosis in children relates to infectious diseases, is distributed by ticks. There are other names of this ailment: Lyme disease, chronic erythema migrating, Balnamert syndrome, tick-free meningopoline. At the beginning, after the bite, the manifestation tick is visible only on the skin, but in the future, the disease has a negative impact on the nervous system and the absence of treatment may cause irreversible consequences.

Cleaning borreliosis cannot be attributed to rare diseases. All CIS countries, Eastern Europe, Canada, USA and Australia are known about him. The image of Lyme disease in Russia is the same as the tick-borne encephalitis, so the survey is carried out on both diseases.

Until the mid-eighties of the last century, this disease in children and adults was considered a variety. The peak of morbidity accounted for spring-summer time, the period of insect activation.

Burreliosis is diagnosed, mostly in adults and children over 7 years old. Preschoolers are subject to Lyme disease extremely rarely.

Initially, the tick of borreliosis develops in the organisms of wild and pets (goats, cows) or small rodents. For them, the consequences are not terrible and they do not need treatment. And distribute infesses of pincers that feed on the blood of infected animals.

The percentage of infected ticks varies depending on the region and can be from 3% to 90%. The infection enters the body with a gem-contact path through a tick bite. An enteral path of infection is also not excluded, the honor through the use of milk of infectious goats and cows. Regardless of the method of infection, the consequences will be the same and treatment too. It is also possible to infect the fetus from the patient of the mother.

Infection enters the body through. In the skin of the causative agent and its lymphogenic distribution into the nearest lymph nodes. In place of the defeat there is a papule. The likelihood that the exudative-proliferative inflammation with erythema will be distinguished from 40% to 70%.

Further, the infection is sent to the internal organs: the heart, liver, kidney and spleen, also the infection is susceptible to the brain, joints and CNS. The immune system Currently activated and produces an IGM class antibodies. This happens by the end of the first month after infection. To the second month, the class of antibodies is changing at IgG.

The causative agent may be in the body for a very long time. The incubation period can be up to 32 x days.

But if the virus fell into the blood, the first period of the infectious process begins. From the hearth of the disease, which is the place of bite, borrelia is sent to blood and lymph, and with their current and all internal organs. And at this time, skin erythema is increasingly increasing in size. Hitting the nervous fibers, the path for borreli is open, they may well go to the head or spinal cord And cause inflammatory processes there.

Some of Borrelius dies, traveling through the body. At the same time, they distinguish a specific toxin, dangerous for the immune system.

Under its influence, joints, kidneys, skin, subcutaneous fat layer, head brain spleen. Inflammation begins in internal organs And they are tightened for a long time. Alive borrelia in turn allocate lipopolysaccharides, which lead to the appearance of interleukin-1. It destroys the joints, cartilage and bones. Borrelia very lively and even after a full course of treatment are capable of lingering in the body. Most often they settle in the lymphatic system and are able to spend there up to 10 years.

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Symptoms

Lyme disease has a large incubation period, which sometimes lasts up to 50 days. Therefore, the first symptoms in children do not appear immediately. Borreliosis develops with stages, each of which has its own individual symptoms.An early period of the disease is divided into 2 stages, at this time all processes are acute. The third, late period is rarely developed, they are trying to not bring it. This phase will be considered chronic borreliosis and is delayed for several years.

As a rule, the symptoms of the first stage are visible, it is extremely rare, it proceeds asymptomatic. The infection causes intoxication of the body as well:

• Elevated temperature;
• Chills;
• General weakness;
• Head, muscular and articular pain;
• Lomotia in the body;
• Fatigue.

In addition to the standard borroeliosis set, the muscles shoves, and sometimes it causes nausea and vomiting. In rare cases, the disease is masked under the usual cold and show such symptoms as a runny nose, sore throat or conjunctivitis.

The symptoms of the first stage also include erythema at the site of the bite, but it does not always manifest - it is a small nodule or a red bubble. Redness gradually diverges and turns into a ring. The skin inside the ring can redden or remain normal. Erythema causes itching, burning and soreness. The duration of the first stage is about a month, after which the disease passes into the second, or the patient recovers.

The second stage of tick-borne borreliosis has symptoms associated with the impaired nervous system and heart work. If you do not start treating antibiotics, the disease will delay the month. During the second stage, signs of the disease may be such symptoms as, orchitis, weakness. Start the second stage up to 6 months.

If the disease goes to the third stage and acquires the chronic shape of the symptoms will be such:

• Defeat joints in the form of arthritia, arthritis;
• Manifestation of bursts or osteoporosis;
• Inflammation of the eye cornea;
• Atrophic acrodermatitis.

In children, the symptoms of Lyme disease are exactly the same as in adults. The only difference is that meningitis develops in children more often due to lesions of the nervous system. Treatment will differ only by dosage.

Treatment

You can only cure tick borreliosis with antibiotics. And the treatment on direct depends on the stage of the disease and how the symptoms are revealed. The treatment of the first stage is carried out by amoxicillin-based preparations - It may be amosyn or solutab. Reception of drugs lasts from 10 to 21 days. Most. effective antibiotic Of all is tetracycline. Therefore, treatment often begins with it, and other means are resorted in the absence of a positive result.

In addition to antibiotics, borreliosis treatment in children should include drugs that take concomitant symptoms. Anti-inflammatory drugs, antihistamines, disintegration solutions can be assigned. Treatment of borreliosis in children is accompanied by a reception of vitamins A, C, groups B and generalifying funds. The consequences of Lyme disease depend on what bodies were amazed and how strong changes caused borreliosis. Therefore, treatment should be timely.

Prevention

Protect children from with some preventive Mer will not work. There are no medicines or developed techniques. The only thing that can be done is to reduce the risk of ticks on the body. During the active life of insects, you do not need to carry children in the forests and parks.And for walking in nature, choose clothes that will close the body as much as possible.

With the onset of spring everyone wants to relax in nature, in the forest park. On a hot summer day, many parents also prefer rest outside the apartment. Here in such cases there is a danger of infection by borreliosis. After all, the carriers of this infection are inhabitants in the grass, on the bushes. The most danger of ticks represent for children, as they love to play or lie down in the grass.

Cause of the disease

Causative agent infectious disease Burreliosis (Lyme's disease) is spirochete (born borrel). Pliers contain them in salivary glands and are injected into the wound when the bite with saliva. Insects convey infection by inheritance to their generation.

Makes are especially active from May to August, but they can infect the bite and in other months of the warm season. In different regions of the country, the infection of ticks range from 10 to 50%.

The spirochete from the wound at the site of the tick bite penetrates the blood and lymphatic system and is distributed throughout the body, falling in almost all organs. From person to person, the disease is not transmitted.

Symptoms

The hidden period (from infection to the manifestation of the disease) can be 2-30 days, on average it lasts 7-10 days. In the clinic, the disease distinguish 3 stages.

• The 1st stage of the disease has a sharp start: there is a general weakness, pain in the muscles, may be vomiting ,. Some children may have a runny nose, the temperature rises within 38 ° C, an increase in the spleen may appear and. Limph nodes are surrounded by the place of deployment.

Most a characteristic symptom Lyme disease is the appearance of a red spot bite (up to 1 cm in diameter) with a pronounced itch and pain. The size of the spots increases rapidly (sometimes up to 20 cm), acquires oval or round shape. The center of the spot is pale, and the bright pink edges rise slightly above the skin surface - rash is formed in the form of a ring.

Gradually, such spots (somewhat lighter and without a clear boundary) appear on other parts of the body. Such rashes are called migratory erythema. They can merge with each other. Elements of rash are saved from several days to several weeks. After the disappearance of the rash remains pigmentation.

• The 2nd stage develops in the absence of treatment after 2-3 weeks from the beginning of the disease. It is characterized by the defeat of various organs. The most pronounced manifestations from the nervous side, cardiovascular systems, joints.

Frequent manifestations are the neurites of the cranial brain nerves (eye-sounding, facial, auditory), or meningoencephalitis with paresis and paralysis of the limbs. With inflammation of the brain shells (meningitis), a sharp headache with nausea and vomiting arises, dizziness, light-wide.

There may be numbness in the limbs, the feeling of crawling goosebumps. A dream is disturbed, the child is worried. Sudden disturbances of consciousness may be celebrated convulsive attacks. In this stage neurological manifestations They are reversible and disappear in the treatment after 1-2 months.

For 2-3 months, the heart is amazed: heart pains, heartbeat appear. These symptoms are reversible.

From other organs may be affected by: the liver (increases in size, yellowness and dark urine color appear), the organ of view (inflammation of one of the shells of the eye or all of them), joints (knee, elbow, shoulder, small joints of the stop and brushes).

It is not necessary for each diseased child all the symptoms of the defeat of different systems will appear, so the diagnosis in some cases is predicted.

• For the 3 stages of borreliosis, the transition of disease in chronic form is characteristic. Changes from organs and systems are persistent irreversible. Treatment brings, as a rule, only a minor improvement.

Diagnostics

In the study of the ticks check the presence of borreli infection. This study is very important, as it allows you to spend timely treatment of the child in the event of a tick contamination detection.

2-3 weeks after the bite, the blood of a child was examined from veins to identify antibodies to borreliam. Several tests have been developed to detect antibodies: immunoassay analysis (ELISA), indirect immunofluorescence reaction (viforous), etc.

Currently, there is also a test for detection in the blood of the antigen of the borreliosis pathogen - faster and reliable.

Quite often, the diagnosis can be put on the basis of clinical manifestations of the disease, not expecting the results of blood test.

A special difficulty in diagnostics represent the so-called uncericious forms of the disease (without rash characteristic of borreliosis). These forms are more often moving into chronic, as the pathological manifestations of organs and systems are difficult to associate with possible infection during the walk.

Treatment

The medical course is carried out in the hospital. Assigned in the age dosage of antibiotics with wide spectrum Actions (macrolides, cephalosporins). Depending on the severity of the disease, they can be used in the form of injections or inside. The duration of the course (5-14 days) depends on the specific situation.

Under neuromuscular lesions, drugs that improve blood supply and conductivity are used nervous impulse: Prezero, cerebrolysis, galantamine, vitamins of group B, Galidor, etc. In some cases, oxygen treatment is used (hyperbaric oxygenation).

From drugs that reduce the collapse of muscle proteins, it is used by retabular, nero and others. Immunocormers (cycloferon, polyoxide, etc.) can be assigned to stimulate cellular immunity.

An indicator of the effectiveness of treatment is the disappearance of the manifestations of the disease and a decrease in the titer of specific antibodies.

After treatment, the child is subject to the observation of an infectiousnessist, a neurologist and an oculist for 2 years. The control examination is carried out quarterly in the first year of observation and after 2 years. Such observation is necessary to completely exclude the chronicization of the process and recurrence.

Prevention

There are no vaccines against borreliosis. It is necessary to take measures to protect the child from tick bites. Thoroughly inspect the baby after a walk and rest in nature. When a tick on the body is detected, it is necessary to remove the insect immediately (with all precautions), and then send it to the study.

For a month, to ensure careful observation for the child. When any signs appear to consult a doctor and fulfill all its appointments and recommendations.

Summary for parents

It must be remembered that ticks can be in the grass and within the city, so the child's inspection must be held after each walk. When the tick bite is detected, it should be removed in the hospital or independently. Do not neglect any symptoms of the disease, since untimely treatment or its complete absence can lead to disability of a child, mental and physical backwardness.