DIFFICULTIES IN DIAGNOSIS AND TREATMENT OF LYME BORRELIOSIS AT PATIENTS WITH IMMUNOSUPRATION

  • S.A. Guseva
  • G.V. Osyodlo
  • Ya. B. Savchenko
  • Ya.P. Goncharov
Keywords: Lyme borreliosis, diagnosis, treatment, non-Hodgkin’s lymphoma, anti-CD-20 therapy, immunosuppression of B-cell immunity, difficulties in diagnosis and treatment, immunoglobulin for intravenous administration.

Abstract

Lyme borreliosis (LB) is an infectious, transmissible, naturallyoccurring focal disease characterized by predominant skin lesions and multiple organ lesions The relevance of LB in Ukraine is related to the growth of this disease. In the first four months of 2016, 140 cases of LB were diagnosed and the incidence rate increased by 24% compared to the same period of 2015. In 2017-2018, 9404 cases were registered in Ukraine, which means that the increase in the incidence of LB was more than 35.9%. At present, laboratory diagnostics of LB is based both on the detection of the pathogen itself (bacterioscopic and bacteriological
methods of diagnosis) or its DNA, and antibodies to it (serological method). The most promising method of diagnosis is polymerase chain reaction, which allows the detection of Borellium DNA in various biological material. The serological methods are aimed at the detection of blood pressure in the serum, in the cerebrospinal fluid (intrathecal) and intra-articular fluid. The main etiotropic drugs are tetracyclines, cephalosporins. Evaluation of the effectiveness of therapy for LB is based on the control of the disappearance of erythema and clinical manifestations of LB. A description of a clinical case of Lyme disease in a 66-year-old woman diagnosed with non-Hodgkin’s lymphoma (NHL) from mantle cell cells was established 15 years ago (2005). About NHL received 10 courses of chemotherapy and 10 courses of immunochemotherapy with the inclusion of anti-CD-20 antibodies (rituximab). The literature and the results of studies on the
immunosuppressive effect of rituximab on the B-cell level of immunity are presented. The development of severe hypogammaglobulinemia in this patient caused difficulties of serological diagnostics (seronegative option) and low efficiency of antibiotic therapy, inclusion in the complex of therapeutic measures of immunoglobulin for intravenous administration at a dose of 0.4 mg / kg of body weight significantly improved the results of Lyme-Borreliosis treatment.

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Published
2019-12-25
How to Cite
Guseva, S., Osyodlo, G., Savchenko, Y. B., & Goncharov, Y. (2019). DIFFICULTIES IN DIAGNOSIS AND TREATMENT OF LYME BORRELIOSIS AT PATIENTS WITH IMMUNOSUPRATION. Ukrainian Journal of Military Medicine, 19(4), 79-87. Retrieved from https://ujmm.org.ua/index.php/journal/article/view/35