Diagnosis of Lyme disease (lyme borreliosis)

When collecting anamnesis and examining the patient, pay attention to:

• seasonality (April-August);
• visiting endemic areas, forests, tick attacks;
• fever:
• the presence of a rash on the body, erythema at the site of the tick bite:
• stiffness of the neck muscles;
• signs of joint inflammation.

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Indications for consultation with other specialists

• Neurologist - for damage to the central nervous system and peripheral nervous system.
• Cardiologist - for hypotension, shortness of breath, heart rhythm disturbances, changes in ECG.
• Dermatologist - for exanthema and inflammatory-proliferative skin diseases.
• Rheumatologist - for swelling, joint pain.

Indications for hospitalization

Patients with Lyme borreliosis do not pose an epidemic danger. The following categories of patients are subject to hospitalization:

• with moderate to severe course of the disease;
• if there is a suspicion of mixed infection with tick-borne encephalitis virus;
• in the absence of erythema (for differential diagnosis).

Laboratory diagnostics of Lyme disease

In the acute period of Lyme disease, a general blood test is characterized by an increase in ESR and leukocytosis. In the presence of nausea, vomiting, stiff neck muscles, and a positive Kernig's sign, a spinal puncture with a microscopic examination of the cerebrospinal fluid is indicated (Gram staining of a smear; counting formed elements, bacteriological examination, determination of glucose and protein concentration).

Specific laboratory diagnostics of Lyme disease

Laboratory diagnostics of Lyme disease is based on the use of the following methods: detection of DNA fragments in PCR and determination of antibodies to Borrelia.

Currently, the effectiveness of PCR diagnostics at different stages of the disease is being studied, and methods for studying various biological substrates (blood, urine, cerebrospinal fluid, synovial fluid, skin biopsies) are being developed. In this regard, PCR has not yet been included in the standard for diagnosing Lyme borreliosis, but is used for scientific purposes.

The diagnostic algorithm is based on serological diagnostics of Lyme disease (ELISA, RNIF). To exclude false-positive reactions, immunoblotting is used as a confirmatory test. It is advisable to conduct studies for the presence of antibodies to Borrelia in dynamics in paired sera taken at intervals of 2-4 weeks.

Instrumental diagnostics of Lyme disease

• In case of damage to the nervous system:
  • neuroimaging methods (MPT, CT) - for prolonged neuritis of the cranial nerves;
  • ENMG - to assess the dynamics of the disease.
• In case of arthritis - X-ray examination of the affected joints.
• In case of heart damage - ECG, EchoCG.

The absence of erythema in the acute period of the disease complicates the clinical diagnosis of Lyme disease, so in such cases specific diagnostics play an important role.

Differential diagnosis of Lyme disease

Migratory erythema is a pathognomonic symptom of Lyme borreliosis, the detection of which is sufficient to establish a final diagnosis (even without laboratory confirmation). Difficulties in diagnosis are caused by forms of the disease that occur without erythema, as well as chronic lesions of the cardiovascular, nervous, musculoskeletal system and skin.

Differential diagnosis of Lyme disease is carried out with other transmissible diseases with a similar area of distribution.

Isolated joint damage should be differentiated from infectious arthritis, reactive polyarthritis, and in combination with skin pathology - from collagenosis. In some cases, Lyme disease is differentiated from acute rheumatism, in neurological disorders - from other inflammatory diseases of the peripheral and central nervous system. In the development of myocarditis, AV block, infectious myocarditis of another etiology should be excluded. The basis of differential diagnosis in these cases is serological studies for the presence of antibodies to borrelia.

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