Analysis On Clinic Features And Therapeutic Methods Of40Cases Of Lyme Diseases

OBJECTIVETo study the clinical manifestations and laboratory features, diagnosis and treatment of Lyme disease.METHODSRetrospectively analyze40inpatients with lyme disease (LD) treated in Provincial Hospital Affiliated to Shandong University from August2010to March2013in order to compare the clinical manifestations, laboratory features, diagnosis, comprehensive treatment and prognosis. The clinical data were analyzed with SPSS13.0statistical software and quantitative data were described as mean+standard deviation while others described as median. T-test or Mann-Whitney U test for group data and Chi-square test or Fisher exact probability and ridit analysis for categorical data were adopted, p<0.05was taken as statistically significant difference.RESULTS40cases were enrolled from August2010to March2013, including7males and33females, aged16-66years with a mean age of35.95±12.62years. The number of cases of female or male in each age group showed no statistically significant difference (ridit analysis, p=0.128).95%CI(Confident Interval) of male patients’ age and female patients’ age showed no statistically significant difference(p>0.05), however, according to chart trends, the age of onset of male patients is older compared with female patients.Course varies from6days to7years and the median duration is35days.13cases (32.5%) were complicated with other rheumatic diseases including systemic lupus erythematosus (5cases), rheumatoid arthritis (2cases), ankylosing spondylitis (2cases), Behcet’s disease (2cases), microscopic polyangiitis (1case), skin necrotizing vasculitis (1case), while27(67.5%) patients were not. Constituent ratio of male or female patients in each group showed no statistically significant difference (Fisher exact probability, p=0.187).Occupational distribution of40cases indicates that outdoor workers especially farmers account for the most, which is15cases (37.5%),7staffs (17.5%),4students (10%),4workers (10%),3teachers (7.5%),1Cadres (2.5%),1doctor (2.5%),1retired person (2.5%) and4citizens (10%).9cases had clear travelling or suspicious tick bites history. Geographic distribution presents sporadic, cases can be found in14prefecture-level cities in Shandong Province, where it is rich in mountains and forest, and the onset of most people is in May to November.The most common initial symptom is erythema migrans (EM), which is17cases (42.5%) and some are accompanied by such symptoms as irregular fever, joint swelling and pain, pain of leg muscle, sore throat, headache and etc. Constituent ratio of male or female patients in each initial symptom showed no statistically significant difference (Fisher exact probability, p=0.318). Grouped by whether complicating with other AID, constituent ratio of each group in each initial symptom showed no statistically significant difference (Fisher exact probability, p=0.337).As for the laboratory features, it shows that ESR of26cases (65.0%) elevated, CRP increased in23cases (57.5%), WBC larger than10X109in9patients (22.5%), less than4X109in6patients, anemia in8patients (20.0%), abnormal liver function in9patients (22.5%), abnormal myocardial enzymes in2cases (5.0%), urine and stool routine, blood biochemistry, immunoglobulin and complement are generally normal. Positive result of anti-Borrelia burgdorferi IgM Ab in38cases and IgG Ab in9cases.According to whether patients complicated with other autoimmune diseases (AID), they are divided into two groups, the course of disease in each group showed no significant statistical difference (t=-0.720, p=0.476), age of each group showed no significant statistical difference (t=-0.371, p=0.712). ESR of each group showed no significant statistical difference (t=1.383, p=0.175). CRP of each group showed significant statistical difference (Mann-Whitney U test, p=0.009). Grouped according to gender, male patients with disease duration of163.71±151.487days, female patients with duration of148.64±360.989days, there was no significant statistical difference (t=0.108, p=0.915). Male patients aged43.86±17.024years, female patients aged34.27±11.103years, there was no significant statistical difference (t=1.883, p=0.670). Male patients with ESR38.14±32.411mm/h, female patients with ESR43.48±30.960mm/h, there was no significant statistical difference (t=-0.412, p=0.683). Male patients with CRP58.81±68.950mg/L, female patients with CRP31.73±46.299mg/L, there was no significant statistical difference (t=1.287, p=0.353).CONCLUSION1. This thesis confirms that LD patients can be found in any age group and both males and females; the onset of LD shows regional and seasonal distribution, outdoor workers (especially farmers) and tourists are apt to get LD.Shandong province is LD endemic area.2. Clinical manifestations of Lyme disease are Complex and varied, multi-systems can be involved at the late stage, which is very similar to autoimmune disease, some can be complicated with other AID, when we should pay attention and avoid misdiagnosis. Those who showed no response to treatment of AID with a history of suspected tick bite history, serological anti-Borrelia burgdorferi antibody screening is needed in order to avoid missed diagnosis. At the same time, differential diagnosis with the the Poncet syndrome (also known as tuberculous rheumatism), rheumatic fever, rheumatoid arthritis, Behcet’s disease, systemic lupus erythematosus, Reiter’s syndrome, polymyalgia rheumatica, chronic fatigue syndrome, osteoarthritis, pigmented villonodular synovitis (Pigmented Villonodular Synovitis, PVS) and etc is of great significance.3. Features of laboratory check include acute phase reactants such as ESR, CRP increased, white blood cells(WBC) can be increased or decreased, mild to moderate of anemia, abnormal liver function and myocardial enzymes, Lyme-specific IgM/IgG antibody positive. IFA or EIA is recommended for the first step of blood test. If it is positive or indeterminate, the second step called for an immunoblot test should be performed. Only if the EIA/IFA and the immunoblot are both positive can results be considered positive. We can’t examine Borrelia burgdorferi pathogen currently.4. Currently the diagnosis of Lyme disease relies on the diagnostic criteria promulgated by the U.S. Centers for Disease Control and Prevention (CDC). Some areas in China had their own diagnostic criteria which is also feasible.5. Treatment of Lyme disease can choose from penicillin, amoxicillin, ceftriaxone, tetracycline, doxycycline and other antibiotics.The dose is adjusted according to the severity. Considering autoimmune etiology may be involved in cause of PTLDS, pure antibiotics present poor clinical efficacy, which calls for NSAIDS and DMARDs drugs. Sometimes glucocorticosteroid is also needed.