The dissertation is devoted to studying the clinical features of Lyme borreliosis and its stages in children depending on the type of borrelia that caused the disease, the peculiarities of the immune response of the organism to the pathogen, and the inflammatory potential of borrelia.
115 children with Lyme borreliosis (LB) were examined. According to the inclusion criteria, 102 children with clinical signs of Lyme borreliosis (isolated erythema migrans (IEM), multiple erythema migrans (MEM)) and non-erythematous forms (NEF) of LB (Lyme carditis, neuroborreliosis, borrelial lymphocytoma, Lyme arthritis) were included in the study, facial nerve palsy) with positive results of ELISA and immunoblot analysis. From the cohort of studied children, groups of patients were formed: the main group consisted of 80 children with the erythematous form (EF) of LB, 64 children were diagnosed with IEM, 16 with MEM; the comparison group included 22 children with NEF of LB. The control group consisted of 27 practically healthy children (17 boys, 10 girls), who had no history of tick bites and who had no clinical manifestations of LB.
The etiological factors of erythematous and non-erythematous forms of Lyme borreliosis in children were investigated using immunoblot analysis of IgM and IgG to B. burgdorferi. It was found that in 38 patients (59.38%) with IEM, the disease was caused by a combination of three types of borrelia (B. burgdorferi, B. afzelii, B. garinii). The most common combination of B. afzelii and B. burgdorferi was found in 17.19% of children with IEM. In 6.25% of cases, IEM was caused by only one type - B. garinii. Among the 16 children with MEM, the disease was caused by a combination of three borrelia in 14 individuals (87.5%). None of the patients had MEM caused by a single borrelia.
In children with NEF of LB, a combination of three borrelia was the cause of the disease in 10 individuals (45.45%). The combination of B. afzelii and B. burgdorferi was observed in four cases, and B. burgdorferi was detected in one patient.The cause of Lyme arthritis in children was a combination of several types of borrelia. In three patients (42.86%), LA developed due to simultaneous infection with B. burgdorferi, B. afzelii, B. garinii, in three others through a combination of two, B. afzelii and B. burgdorferi, and B. afzelii and B. garinii, while only one patient developed LA caused by a single type of borrelia (B. burgdorferi).
The epidemiological aspects of erythematous and non-erythematous forms of LB in children were analyzed. It was found that children with isolated erythema migrans (IEM) (23.44%) and multiple erythema migrans (MEM) (25%) most frequently experienced tick bites in June. 43.75% of patients with MEM and 17.19% of children with IEM did not recall the episode of tick attachment.
Patients with non-erythematous forms of LB most commonly experienced tick bites both in June and July (13.64%), however, 50% of patients did not remember the tick bite.
In children with IEM, the most common sites of tick bites were the lower extremities (18%), while in patients with MEM, it was the trunk and lower extremities (19%). In children with non-erythematous forms of LB, the most common site of tick attachment was the head (23%).
The clinical manifestations and laboratory indicators of erythematous forms (EF) and non-erythematous forms (NEF) of LB were studied and analyzed in 102 children. It was found that 62.75% of children were diagnosed with isolated erythema migrans (IEM), multiple erythema migrans (MEM) was detected four times less frequently, and NEF of LB was confirmed in 21.57% of patients. The average age of children with IEM and NEF of LB was the same - 8 years, while the average age of patients with MEM was 5.5 years. In the group of patients with IEM and MEM, boys accounted for 64.1% and 43.8%, respectively, while girls accounted for 35.9% and 56.3%, respectively. In the structure of patients with NEF of LB, boys and girls accounted for 50.0%.
Among the 64 children with IEM, MEM was most commonly observed on the lower extremities (36%) and trunk (25%), and only in 5% of patients in the neck area. In children with MEM, the most common observation was a combination of erythema on the trunk and upper extremities (25%), on the head, upper, and lower extremities (19%).Markers of the inflammatory process were found to be significantly higher in children with NEF of LB. The highest median levels of IL-6 were observed in patients with NEF of LB (4.2 [3.0; 4.4] pg/ml). Median levels of CK-MB in patients with MEM were significantly higher than in patients with IEM (p=0.03) and NEF of LB (p=0.03).
None of the patients had IgM or IgG levels >200 IU/ml after treatment.
Keywords: Lyme borreliosis, infection, children, immunoblot, enzyme-linked immunosorbent assay (ELISA), Lyme arthritis, Lyme carditis, Borrelia, interleukins, antibodies, regression model, cytokines, Lyme disease.
