Lyme disease

An overview of Lyme disease (lyme diseade) is a by Borrelia burgdorferi caused, Hard ticks by the media as the main focus of the natural disease. The clinical manifestations of chronic inflammatory multi-system damage, in addition to chronic erythema migrans and arthritis, also accompanied heart damage and nervous system involvement, and other symptoms. Etiology of Lyme disease pathogens as a spirochete, called spirochetes Burgdorfer, belong to borrow Spiral's body is reduced. Its long 11-39μm and a width of 0.18 ~ 0.25μm a 7-11 root flagellum. Gram staining, Giemsa staining was purple. In 316 medium to 30 ~ 37 ?栦or good growth. Susceptible animals are mice, hamsters and rabbits, and so on. Epidemiology (1) the source of infection for storage Nie host animals and ticks category, the sick and infected animals are the source of infection. (2) transmission of the disease to a variety of media Ixodidae dammini (Ixodes dammini) Pacific ticks (Ixodes pacificus). texas Ricinus (Ixodes ricinus) and Ixodes persulcatus (Ixodes persalcat us). From being carried spirochetes the hard bite of infected ticks. (3) generally susceptible population groups susceptible, but more common in entering or living in forest areas and rural populations, Men slightly more than women. (4) epidemiological characteristics of the disease are widely distributed across the world's five continents, but to the United States and Europe and the United States for more. China's Heilongjiang, Xinjiang, Jilin and Henan provinces have jaw section due to the report. Seasonal incidence of 5 -9 month. Pathogenesis and pathological changes spirochete enters the human body after the blood disseminated to the skin, in vivo may exist for a long time, induce a complex inflammatory response. From the skin erythema, blood, cerebrospinal fluid, synovial fluid and other tissues can be detected spirochetes. Moreover, the patients there may be circulating immune complexes positive, inhibit T cell activity in the lower and interleukin-1 activity increased immune abnormalities. Therefore, the mechanism of this disease spirochetes and the role and direct the body abnormalities related to the immune response. Also with chronic arthritis patients with the B-cell antigen types of HLA-DR3 and DR4 increasing frequency. Erythematous skin biopsy only see epithelial hyperplasia, keratosis with mild mononuclear cell infiltration and edema surface, non-suppurative and granulomatous reaction. Arthritis synovial cyst fluid containing lymphocytes and plasma cells. Minorities may occur in patients with rheumatoid arthritis similar to the pathological changes such as the synovium, neovascularization, bone and cartilage erosion chronic damage. Clinical manifestations latency 3 ~ 32 days, with an average of seven days. Clinical symptoms can be in three phases. Phase I : The main manifestations of chronic skin erythema migrans, found in the majority of cases. Common in the early Tick bites were parts of the appearance of erythema or papule, and gradually expand to form ring, the average diameter of 15 centimeters. center slightly stiffen, peripheral red border unclear. For a disease or multiple ranges. Was particularly prevalent in the thigh, groin and axillary regions. Local burning and itching are. Accompanied disease early weakness, chills, fever, headache, nausea, vomiting, joint and muscle pain and other symptoms that can arise meningeal irritation. Local and systemic lymph node enlargement can. Occasionally, splenomegaly, hepatitis, pharyngitis, conjunctivitis, iritis or testicular swelling. Skin lesions usually lasted 3 ~ 8 weeks. 2nd period : incidence after a few weeks or a few months, about 15% and 8% of the patients were apparently nervous system symptoms and signs of cardiac involvement. Nervous system can be expressed as meningitis, encephalitis, chorea, cerebellar ataxia, cranial neuritis. motor and sensory nerve root and spinal cord Yan rheumatoid multiple lesions, but with meningitis, paralysis and cranial nerve roots Yan styles. Recurrent lesions, can be even dementia and the development of personality disorder. In a few cases there skin lesions after 10 weeks 3 ~ varying degree atrioventricular block, myocarditis, pericarditis and left ventricular dysfunction, and other cardiac damage. Heart damage is typically only a few weeks, but relapsed. In addition, this phase often joints, muscles and bone marrow migration pain, but usually no joint swelling. Stage III : infection after a few weeks to two years, About 80% of patients had varying degrees of joint symptoms such as joint pain, arthritis or chronic erosion synovitis. To the knee, elbow, hip and other joints multiple large and small organizations around the joints can also be involved. The main symptoms are joint pain and swelling, the knee may be a small amount of fluid. Often repeated attack, a small number of patients with arthritis disease can become chronic, accompanied by cartilage and bone destruction. This period of a few patients have chronic nervous system damage and chronic atrophic Aerodermatitis performance. Diagnosis and differential diagnosis (1) epidemiology in the pathogenesis have entered the season or living in affected areas, have been the history of tick bites. (2) clinical features of chronic erythema migrans lesions and after nerve, Cardiac symptoms or joint involvement; (3) laboratory blood as normal, ESR slightly faster, Serum immunoglobulin cryoprecipitate can be positive, be elevated transaminase. With nerve damage CSF increased lymphocytes and protein, sugar normal or slightly lower. From the blood, cerebrospinal fluid and other specimens of skin lesions can be detected spirochetes. Immunofluorescence and Western blot methods in patients with specific antibodies detected. Isolation and pathogen-specific antibodies were diagnosed with significance. Differential diagnosis of the disease and needs a variety of other causes of the skin, heart, joints and nervous system diseases such as rheumatic fever, erythema multiforme, rheumatoid arthritis and other equivalent identification. Room laboratories should also check with syphilis and other spirochete infection as well. Treatment of a patient, the first choice tetracycline, adult 250 mg / time, the 1st four. Green can also be used for the treatment of endotoxin or erythromycin. Right two, three patients, use of high-dose penicillin treatment. Adult intravenous penicillin G2000 10,000 units once a day, and continued for 10 days. or benzyl - penicillin G240 million units, intramuscular injection once a week for 3 weeks. Can also be used for cefotaxime triazine 1 ~ 2g / day for 2 weeks. Damage to the heart, could increase use of glucocorticoid therapy. Prevention and the strengthening of personal protective eliminate ticks, rodent control.