CLINICAL AND LABORATORY FEATURES OF LYME ARTHRITIS AND ARTHRITIDES OF OTHER ETIOLOGIES IN CHILDREN OF LVIV REGION

Abstract

Introduction. Lyme disease is one of the most common transmissible infections, which is characterized by the predominant damage to the skin, cardiovascular system, nervous system, and musculoskeletal system. Lyme arthritis is almost twice as common in children as in adults, and is the most common manifestation of late-stage Lyme disease without the presence of erythema migrans.
 Aim. To study and analyze the clinical and laboratory features of Lyme arthritis and arthritides of other etiology.
 Materials and Methods. A total of 16 children under observation applied to the "Lviv Regional Infectious Disease Clinical Hospital" with suspicion of Lyme arthritis. ELISA and immunoblot to B.burgorferi, complete blood count, C-reactive protein, interleukin-6, and creatine phosphokinase-MB were used to identify the cause of the joint syndrome.
 Results and Discussion. The participants were subdivided into 2 clinical groups: the first included patients with suspicion of Lyme arthritis, while the second consisted of children with confirmed Lyme arthritis. In group 1, boys comprised 66.7%, and in group 2 - 42.9%. Conversely, girls accounted for 33.3% and 57.1% of the respective groups. CRP was found to be four times higher in patients from group 2, reaching 16.9 mg/l, whereas in patients from group 1, it was 4.0 mg/l. The IL-6 level was observed to be <1.5 pg/ml more frequently (in 71.4% of cases) in group 2 compared to clinical group 1, where the proportion of patients with such levels of this indicator was 44.4%. None of our patients in group 2 and only 1 patient in group 1 (11.1%) had an IgM level <2 IU/ml. Significantly (p=0.02) higher levels of IgG >200 IU/ml were more often found in group 2, where the percentage of such patients was 42.9%, while in group 1, IgG was not detected in any of the patients.
 Conclusions. The cause of Lyme arthritis in children is a combination of several types of Borrelia. The laboratory criterion for Lyme arthritis is positive IgG to B. burgdorferi in enzyme immunoassays and immunoblot analyses. Significantly (p=0.02) higher levels of IgG >200 IU/ml were more often found in 42.9% of patients with Lyme arthritis. To identify the causes of joint syndrome in children, in the absence of a history of tick bites and erythema migrans, a two-stage method for diagnosing Lyme arthritis is necessary.