Lymskú boreliózu tvoria v 60–70 % prípadoch skoré kožné manifestácie, s dominantným erythemamigrans (EM). Všetky vegetatívne formy kliešťa Ixodes ricinus (napr. dospelý kliešť, nymfy, larvy)prenášajú vyvolávateľa spirochétu Borrelia burgdorferi sensu stricto a Borrelia burgdorferi sensulato (B. garinii, B. afzelii). Cieľom práce bolo vyhodnotenie klinických a epidemiologických para-metrov a overením a spresnením diagnostických kritérií prispieť k včasnej a exaktnej diagnostikeochorenia.V súbore 50 pacientov sa vyhodnocoval časový údaj vzniku erythema migrans, spôsob prenosu,inkubačná doba, lokalizácia, príznaky diseminácie B. burgdorferi, dĺžka liečby a použité antibioti-kum. Dynamika titru protilátok proti B. burgdorferi (IFA test) sa zisťovala u 21 pacientov s erythemamigrans po dobu 1–22 mesiacov a u 5 pacientov s acrodermatitis chronica atrophicans (ACA) podobu 3–55 mesiacov.Erythema migrans vzniklo u 50 % osôb v letných mesiacoch. Ako vektor infekcie udáva 66 % kliešťa,14 % hmyz a 20 % nevie udať. Inkubačná doba jeden a dva týždne bola v 34 %, dolné končatiny bolipostihnuté v 52 %. Prejavy diseminácie boli u 6 pacientov, u 2 pacientov erythema migrans recidi-vovalo. Protilátky (Ab) proti B. burgdorferi boli prítomné u 38 pacientov. U 21 pacientov sa sledovaladynamika titru protilátok po dobu 1–22 mesiacov a nezistili sa podstatné zmeny. Séropozitivitau pacientov s acrodermatitis chronica atrophicans pretrvávala bez zmeny titru niekoľko rokov.V liečbe erythema migrans bol najčastejšie použitý doxycyklín po dobu 14 dní.Erythema migrans ako skoré štádium lymskej boreliózy je sezónne ochorenie s prírodnou ohnisko-vosťou. Ak sa s liečbou začne v skorom období infekcie, protilátky proti B. burgdorferi sa nemusiavytvoriť. Nevyskytuje sa korelácia medzi klinickými ťažkosťami a sérologickými výsledkami, ako ajspôsobom liečby. Prognóza ochorenia je u väčšiny pacientov dobrá. Vakcinácia predstavuje novémožnosti v aktívnej ochrane proti boréliovej infekcii, najmä v endemických oblastiach. Pre európ-ske krajiny sa pripravuje toho času rekombinovaná vakcína z povrchového lipoproteínu A (OspA)pochádzajúca z prevalentných kmeňov B. afzelii a B. garinii.

60–70 % of Lyme borreliosis is formed by early manifestations, in particular erythema migrans (EM).All vegetative forms of the tick Ixodes ricinus (e.g. full grown tick, nymphae and larvae) transmitthe causal organism, the spirochete Borrelia burgdorferi sensu stricto and Borrelia burgdorferisensu lato (B. garinii, B. afzelii). The objective of the work was to evaluate clinical and epidemiolo-gical parameters and to contribute by testing and investigating in greater detail criteria to the earlyand exact diagnosis of the disease.In a group of 50 patients the time of development of EM was evaluated, the mode of transmis sion,the incubation period, localization, symptoms of dissemination of B. burgdorferi, the period oftreatment and the antibiotic used. The dynamics of the antibody titre against B. burgdorferi (IFAtest) were assessed in 21 patients with EM for a period of 1 to 22 months and in 5 patients withacrodermatitis chronic atrophicans (ACA) for 3 to 55 months.In 50% EM developed during the summer months. 66% reported as the vector a tick, 14% insects and20% did not know. An incubation of 1 and 2 weeks was reported in 34%, the lower extremities wereaffected in 52%. Manifestations of dissemination were found in 6 patients, in 2 patients EM relapsed.Antibodies (Ab) against B. burgdorferi were present in 38 patients. In 21 patients the dynamics ofthe antibody titre were followed up for 1 to 22 months and no substantial changes were found. Serumpositivity in patients with ACA persisted without change of the titre for several years. In thetreatment of EM most frequently doxycycline was administered for two weeks.EM as the early stage of LB is a seasonal disease with a natural focus. If treatment is started in theearly stage of infection, antibodies against B. burgdorferi need not develop. There is no correlationbetween clinical complaints and serological results and the type of treatment. The prognosis of thedisease is favourable in the majority of patients. Vaccination offers new possibilities in activeprotection against Borrelia infection, in particular in endemic areas. For European countries atpresent a recombined vaccine is being prepared from the surface lipoprotein A (OspA) made fromprevalent strains of B. afzelii and B. garinii.

1 dermatovenerologická klinika LF Univ Kom Bratislava

Dermatological manifestations of Lyme borreliosis in patients of the First Dermatovenerological Clinic, Medical Faculty Comenius University, Bratislava, Slovak Republic, in 1996-1998

Kožné prejavy lymskej boreliózy u pacientov 1. dermatovenerologickej kliniky LF UK v Bratislave v rokoch 1996-1998 = Dermatological manifestations of Lyme borreliosis in patients of the First Dermatovenerological Clinic, Medical Faculty Comenius University, Bratislava, Slovak Republic, in 1996-1998 /

Dermatological manifestations of Lyme borreliosis in patients of the First Dermatovenerological Clinic, Medical Faculty Comenius University, Bratislava, Slovak Republic, in 1996-1998 /

Lit: 19

Souhrn: eng