Анализ клинических и лабораторных предикторов сочетанной инфекции безэритемной формы иксодового клещевого боррелиоза и клещевого энцефалита

Abstract

Laboratory confirmation of the diagnosis of tick-borne infections is often hampered due to delayed seroconversion. Objective. Assessment of clinical and laboratory predictors to develop a differential diagnosis model between the mixed infection of Lyme borreliosis with tick-borne encephalitis and the monoinfection of Lyme borreliosis non-erythemal form at the onset of the disease. Patients and methods. In the first week of the disease, 54 clinical and laboratory parameters were studied in 27 patients with the mixed infection of Lyme borreliosis with tick-borne encephalitis (mean age: 47.2 years) and 65 patients with borreliosis monoinfection (mean age: 45.3 years). The logistic regression model was developed using Statistica 12.0. Results. Predictive factors for diagnosis of the mixed infection included painful eye movement, photophobia, nausea, meningism, intoxication syndrome intensity (AUC = 0.69) fever intensity (AUC = 0.79), neutrophil to lymphocyte ratio (AUC = 0.75), neutrophil to monocyte ratio (AUC = 0.73), neutrophils count (AUC = 0.76), immature granulocytes count (AUC = 0.80), lymphocytes count (AUC = 0.73) and reactive lymphocytes count (AUC = 0.70). A logistic regression model was developed with very good prognosis of mixed infection (AUC = 0.88). Conclusion. The model is allowed to assess the probability of a preliminary diagnosis of the mixed infection of Lyme borreliosis and tick-borne encephalitis with good sensitivity and specificity values. Key words: Lyme borreliosis, tick-borne encephalitis, mixed infection, non-erythemal form, clinical predictors, neutrophil to monocyte ratio, hemogram parameters, logistic regression model