Diagnosis of Lyme disease (lime-borreliosis)

When collecting anamnesis and examining the patient pay attention to:

• seasonality (April-August);
• Visit to endemic areas, forests, attack by ticks;
• fever:
• the presence of a rash on the body, erythema at the site of a tick bite:
• stiff neck;
• signs of joint inflammation.

[1], [2], [3], [4], [5], [6]

Indications for consultation of other specialists

• Neuropathologist - with the defeat of the central nervous system and peripheral nervous system.
• Cardiologist - with hypotension, dyspnea, heart rhythm disturbances, changes in the ECG.
• The dermatologist - at an exanthema and inflammatory-proliferative diseases of a skin.
• Rheumatologist - with edema, pain in the joints.

Indications for hospitalization

Patients with lime-borreliosis do not represent an epidemic danger. The following categories of patients are subject to hospitalization:

• with moderate and severe course of the disease;
• when suspected of a mixed infection with tick-borne encephalitis virus;
• in the absence of erythema (for differential diagnosis).

Laboratory Diagnosis of Lyme Disease

In the acute period of Lyme disease, an increase in ESR, leukocytosis, is characteristic for a general blood test. In the presence of nausea, vomiting, stiff neck muscles, positive Kernig symptom, a spinal puncture with a microscopic examination of the cerebrospinal fluid (Gram staining, counting of the elemental elements, bacteriological examination, determination of glucose and protein concentration) is shown.

Specific laboratory diagnosis of Lyme disease

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

Currently, the effectiveness of PCR diagnostics in different stages of the disease is being studied, methods for studying various biological substrates (blood, urine, cerebrospinal fluid, synovial fluid, skin biopsy) are being developed. In this regard, PCR is not yet included in the standard for the diagnosis of lime-borreliosis, but is used for scientific purposes.

The basis of the diagnostic algorithm is the serological diagnosis of Lyme disease (EIA, RNIF). To prevent false positive reactions, immunoblotting is used as a confirmatory test. Studies on the presence of antibodies to borrelia should preferably be carried out in dynamics in paired sera taken at intervals of 2-4 weeks.

Instrumental diagnosis of Lyme disease

• When the nervous system is affected:
  • methods of neuroimaging (MPT, KT) - with prolonged neuritis of the cranial nerves;
  • ENMG - to assess the dynamics of the disease.
• When arthritis - X-ray examination of affected joints.
• When the heart is affected - ECG, echocardiography.

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

Differential diagnosis of Lyme disease

Migrating erythema is a pathognomonic symptom of lime-borreliosis, the detection of which is sufficient to establish a definitive diagnosis (even without laboratory confirmation). Difficulties in the diagnosis cause forms of the disease that occur without erythema, as well as chronic cardiovascular damage. Nervous, musculoskeletal system and skin.

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

Isolated joint damage must 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, with neurological disorders - from other inflammatory diseases of the peripheral and central nervous system. With the development of myocarditis, AV blockade, it is necessary to exclude infectious myocarditis of another etiology. The basis of differential diagnosis in these cases are serological tests for the presence of antibodies to Borrelia.

[7], [8], [9], [10]