Petruk A. Clinical and pathogenetic features of acute urticaria combined with Lyme borreliosis and giardiasis, optimization of diagnosis and therapy

The dissertation is devoted to the optimization of diagnosis and therapy of acute urticaria (AU) combined with Lyme borreliosis (LB) or giardiasis, based on the clarified clinical and pathogenetic features of these diseases and the results of laboratory studies. For the first time in Ukraine, the percentage of seropositive individuals for B. burgdorferi s.l. among patients with AU was determined using a two-step serological diagnostic scheme (ELISA and immunoblot). For the first time in Ukraine, the informativeness of IIFT («BIOCHIP» technology) for the detection of specific serum IgG to B. henselae in patients with AU combined with LB was evaluated. The effectiveness of the proposed scheme of complex therapy of AU combined with giardiasis using ornidazole and bilastine was evaluated by the dynamics of the main signs of the disease (rash and itching) and urticaria activity according to the UAS scale. It was found that patients with AU combined with LB were more likely to be exposed to single tick bites; the great majority of patients in both groups were exposed to tick bites in June-August when visiting a forest area/forest; patients with acute urticaria combined with Lyme borreliosis were 2.5 times more likely than patients with LB to remove ticks with active movement, p<0.05; almost a third of patients in both groups used the help of health care workers to remove ticks. For the first time in Ukraine, the clinical features of AU combined with LB or giardiasis were determined; the influence of of the presence of allergic diseases in the anamnesis, medications and contact with allergens as triggering factors on the course of the disease was found. The pathogenic palette of LB, both in combination with AU and as monoinfection, was expanded by the detection of specific class M class G antibodies to B. spielmanii, B. burgdorferi s. s., B. garinii and B. afzelii simultaneously. The etiologic structure of LB, as well as in its combination with AU, was established by determining specific serum antibodies to B. afzeli, B. burgdorferi s. s. and B. garinii by immunoblot method. An increased level of serum immunoglobulin E was detected in patients with AU, AU combined with LB or with giardiasis. The involvement of B. burgdorferi s. l. and Giardia lamblia in the allergization of the body was established by the concentration of IgE. It has been proved that AU leads to transcriptional activation of proinflammatory signaling against the background of a suppressor deficiency, accompanied by increased expression of RORC, NLRP3-inflammmasome and NFKB1 transcription factor genes. In patients with UC combined with LB, the transcriptional activity of genes of the innate immune system is activated and the induction of proinflammatory cytokine genes is more pronounced compared to patients with UC alone.