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Obraz kliniczny boreliozy z Lyme

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Prevalence of Lyme borreliosis in Europe has been well esablished during the last decade. The highest morbidity in Poland, exceeding 100 cases (100.000) year, was demonstrated in north-estern part of the country. Additional small endemic areas were also described in south-western and central part of the country. Clinical picture of the disease do not differ significantly from observed in other parts of Europe. Lyme borreliosis is characterized with a wide variety of manifestations recognized as typical: erythema migrans, borrelial lymphocytoma, acrodermatitis chronica atrophicans, arthritis, facial palsy, lymphocytic meningitis and cardiac transduction disturbances. However there are also controversial syndroms, that have confinned etiology of Borrelia burgdorferi but only in some cases, such as: morphea sclerodermatous lesions, cardiomyopathy and some neurologic disorders. Diagnosis of Lyme borreliosis is still based on typical signs of the disease and laboratory techniques can not solve clinical doubts.
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Lyme borreliosis

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Lyme borreliosis is an infectious disease caused by spirochaetal bacteria, Borrelia burgdorferi sensu lato, which is transmitted by Ixodes spp. ticks. Several of Borrelia burgdorferi genospecies are pathogenic to humans. Endemic areas of the disease in Europe include: Scandinavia, Eastern Europe, Austria, Germany, Slovenia. In Poland the number of reported cases has increased since 1996 and large majority of all cases are diagnosed in Podlasie and Warmia-Mazuria provinces. The earliest symptom of Lyme borreliosis is characteristic skin rash, erythema migrans. If untreated, it can affect the nervous system, joints and the heart. Initial diagnosis of Lyme borreliosis is based on symptoms, physical findings, and the history of a tick-bite. Centers for Disease Control recommended two-step laboratory testing. The first step is immunoserological testing with enzyme immunoassay (EIA) for the presence of specific antibodies. Only in case of positive or equivocal EIA, the second step with western blot technique should be carried out. Other diagnostic methods are not recommended. In early stages of the disease patients should receive oral antibiotics, e.g. amoxicillin, doxycycline or cefuroxime axetil, with treatment lasting 14–21 days. In some cases (neuroborreliosis, carditis and chronic arthritis) patients require intravenous treatment usually with ceftriaxone or penicillin for 14–28 days. Superiority of longer therapy with higher doses of antibiotics, combination treatment with two or more antibiotics, or sequence therapy is not supported by any results of clinical trials, therefore it should not be applied and recommended according to the principles of evidence based medicine.
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