Optimization of treatment of patients with lyme borelliosis and human granulocytic anaplasmosis

Abstract

Summary. Lyme borreliosis (LB) is a tick-borne infectious disease with multisystemic manifestations caused by the genes of the Borrelia burgdorferi s complex. l. From 2000 to 2020, more than 30,000 diseases were registered in Ukraine. LB occurs in two forms: erythema (migrating erythema) and erythema-free (EF) (lesions of the musculoske­letal, nervous, cardiovascular systems, eyes). The aim of the study – to improve the comprehensive treatment of patients with Lyme borreliosis, including those with concomitant human granulocytic anaplasmosis, by the combined use of ceftriaxone and doxycycline hydrochloride. Materials and Methods. 45 patients with Lyme borreliosis aged from 22 to 77 years who received outpatient or inpatient treatment were followed up in Ternopil Regional Clinical Hospital and the Infectious Department of Ternopil City Clinical Emergency Hospital. In 23 (51.1 %) examined, besides Lyme borreliosis, human granulocytic anaplasmosis was diagnosed. Two treatments of Lyme borreliosis regimens were tested: ceftriaxone for 28 days (Scheme I) and ceftriaxone for 14 days followed by doxycycline hydrochloride for 14 days (Scheme II). The efficacy of treatment was assessed by the activity of joint damage, using the DAS 28 index, the disappearance of clinical manifestations and the dynamics of pro-inflammatory TNF-α, IL-6 and anti-inflammatory IL-4 cytokine in the serum of patients. Results. The combination of ceftriaxone with doxycycline hydrochloride increased the number of low activity patients by a factor of 10 relative to the start of treatment and by a factor of 2 relative to therapy on day 14 with ceftriaxone alone, decreasing the percentage of high activity patients by a factor of 8 relative to the start of treatment and by a factor of 4 relative to that of the same group treated on day 14 with ceftriaxone alone. The use of this regimen to treat Lyme borreliosis patients with not-erythematous form of Lyme borreliosis and human granulocytic anaplasmosis resulted in the disappearance of fever, lymphadenopathy and fatigue/general weakness in the treated patients and achieved a 12-fold reduction in the percentage of patients with headache relative to the start of treatment and a 7-fold reduction relative to day 14 of therapy. Therapy with ceftriaxone and doxycycline hydrochloride using a tested regimen for the treatment of patients with co-infections (Lyme borreliosis and human granulocytic anaplasmosis) resulted in a statistically significant reduction of TNF-α and IL-6 proinflammatory cytokines by a factor of 2 and 3 in the blood, respectively. Conclusions. For the treatment of patients with Lyme borreliosis associated with human granulocytic anaplasmosis, two antibacterials (ceftriaxone and doxycycline hydrochloride) are recommended in sequence

Keywords

• lyme borreliosis
• human granulocytic anaplasmosis
• arthralgia
• cytokines
• ceftriaxone
• doxycycline hydrochloride