A multifactorial model for predicting severe course and organ and systems damage in Lyme borreliosis in children
DOI:
https://doi.org/10.15574/SP.2023.130.6Keywords:
children, Lyme disease, Lyme borreliosis, Nigelkirk test, ANOVA analysisAbstract
Lyme disease (tick-borne borreliosis, Lyme borreliosis - LB) is a multisystem zoonotic disease transmitted by the bite of infected ticks.
Purpose - to develop a mathematical model for predicting the risk of severity of the course (PRSC) of LB by the risk factor for the development of disseminated LB in children who have had a tick attack.
Materials and methods. To build a model for PRSC of LB using multivariate regression analysis, 121 children with LB aged 13±3 years (from 1 to 18 years) were examined, including 51 boys and 70 girls. Groups of patients: 78 children with erythema migrans, 16 - with Lyme arthritis, 27 - with nervous system lesions. The quality of the prognostic model was checked by the Neigelkerk criterion (R2), and the acceptability of the model was assessed using ANOVA analysis of variance. Serological examination of patients bitten by ticks was performed by enzyme-linked immunosorbent assay. To detect immunoglobulins of classes M (IgM) and G (IgG) to B. burgdorferi s.l. complex, test systems from Euroimmun AG (Germany) were used. IgM antibodies were determined by the test system Anti-Borrelia burgdorferi ELISA, IgG - by Anti-Borrelia plus VIsE ELIS. Blood samples with intermediate and positive results of the first stage of work were examined by immune blotting: IgM antibodies were detected using the system Anti-Borrelia EUROLINE Borrelia RN-AT (IgM), and IgG antibodies - Anti-Borrelia EUROLINE RN-AT.
Results. The method of multivariate regression analysis for predicting the severe course and damage to organs and systems in children with LB, taking into account the factors and variants of the disease itself, allows to develop a mathematical model of PRSC of LB and to improve the effectiveness of treatment. Thus, all prerequisites have been created for high-quality preventive measures and reducing the risk of severe pulmonary disease.
The initial data for predicting the severity of pulmonary disease were 28 factors. According to the results of the regression analysis, 24 factors were included in the model for predicting the severity of the course of pulmonary disease.
Conclusions. For the first time, a multivariate regression model for PRSC of LB for pulmonary fibrosis in children was built. The weighting coefficients of each of the factors of the onset and progression of LB were taken into account: 0-10 points indicate the development of a localized stage (primary effect stage), while 11 or more points indicate a disseminated (generalized) stage. The results of the study make it possible to further develop standardized scales of the severity of LB and possible organ and system damage.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies.
No conflict of interests was declared by the authors.
References
Andreichyn MA, Korda MM, Shkilna MI ta in. (2021). Laim-borelioz. Monohrafiia. Za red. M.A. Andreichyna, M.M. Kordy. Ternopil: Ukrmedknyha: 376.
Balmelli T, Piffaretti JC. (1995). Association between different clinical manifestations of Lyme disease and different species of Borrelia burgdorferi sensu lato. Research in Microbiology. 146 (4): 329-340. https://doi.org/10.1016/0923-2508(96)81056-4; PMid:7569327
Belman AL, Ayer M, Coiler PK, Duttwiler R. (1993). Neurological manifestations in children with North American Lyme disease. Neurology. 43: 2609-2614. https://doi.org/10.1212/WNL.43.12.2609; PMid:8255465
Boyarchuk O. (2018). Allergic manifestations of primary immunodeficiency diseases and its treatment approaches. Asian Journal of Pharmaceutical and Clinical Research. 11 (11): 83-90. https://doi.org/10.22159/ajpcr.2018.v11i11.29059
Chukur O, Pasyechko N, Bob A, Sverstiuk A. (2022). Prediction of climacteric syndrome development in perimenopausal women with hypothyroidism. Prz Menopauzalny.12; 21 (4): 236-241. https://doi.org/10.5114/pm.2022.123522; PMid:36704769 PMCid:PMC9871991
Didyk YM, Blaňárová L, Pogrebnyak S et al. (2017). Emergence of tick-borne pathogens (Borrelia burgdorferi sensu lato, Anaplasma phagocytophilum, Rickettsia raoultii and Babesia microti) in the Kyiv urban parks, Ukraine. Ticks Tick. Borne. Dis. 8 (2): 219-225. https://doi.org/10.1016/j.ttbdis.2016.10.002; PMid:27923669
Dressler F, Ackermann R, Steere AC. (1994). Antibody responses to the three genomic groups of Borrelia burgdorferi in European Lyme borreliosis. J Infect Dis. 169 (2): 313-318. https://doi.org/10.1093/infdis/169.2.313; PMid:8106763
Dryden MS, Saeed K, Ogborn S, Swales P. (2015). Lyme borreliosis in southern United Kingdom and a case for a new syndrome, chronic arthropod-borne neuropathy. Epidemiology and Infection. 143: 561-572. https://doi.org/10.1017/S0950268814001071; PMid:24814098 PMCid:PMC9507055
Gerber MAM, Shapiro ED, Burke GS. (1996). Lyme disease in children in south eastern Connecticut. Pediatric Lyme Disease Study Group. N. Engl. J. Med. 335 (17): 1270-1274. https://doi.org/10.1056/NEJM199610243351703; PMid:8857006
Hengge UR, Tannapfel A, Tyring SK et al. (2003). Lyme borreliosis. Lancet Infect Dis. 3: 489-500. https://doi.org/10.1016/S1473-3099(03)00722-9; PMid:12901891
Kopcha VS, Vasylieva NA, Shkilna MI ta in. (2016). Diahnostychni mozhlyvosti imunnoho blotynhu pry boreliozi. Medychna hazeta «Zdorov'ia Ukrainy 21 storichchia». 11-12 (384-385): 73-74.
Lohr B, Fingerle V, Norris DE, Hunfeld KP. (2018). Laboratory diagnosis of Lyme borreliosis: Current state of the art and future perspectives Crit. Rev. Clin. Lab. Sci. 55; 4: 219-245. https://doi.org/10.1080/10408363.2018.1450353; PMid:29606016
Musiienko V, Marushchak M, Sverstuik A, Filipyuk A, Krynytska I. (2021). Prediction Factors For The Risk Of Hypothyroidism Development In Type 2 Diabetic Patients. Pharmacology On Line. 3: 585-594.
Musiienko V, Sverstiuk A, Lepyavko A, Mazur L, Danchak S, Lisnianska N. (2022, Apr). Prediction factors for the risk of diffuse non-toxic goiter development in type 2 diabetic patients. Pol Merkur Lekarski. 19; 50 (296): 94-98. PMID: 35436270.
Nigrovich LE, Thompson AD, Fain AM, Kimia A. (2008). Clinical predictors of Lyme disease in children with peripheral facial paralysis in the emergency room in the endemic area of Lyme disease. Pediatrics. 122: e1080-1085. https://doi.org/10.1542/peds.2008-1273; PMid:18931349
Norman GL, Antig JM, Bigaignon G, Hogrefe WR. (1996). Serodiagnosis of Lyme borreliosis by Borrelia burgdorferi sensu stricto, B. garinii, and B. afzelii western blots (immunoblots). J Clin Microbiol. 34 (7): 1732-1738. https://doi.org/10.1128/jcm.34.7.1732-1738.1996; PMid:8784579 PMCid:PMC229104
Nykytyuk S, Boyarchuk O, Klymnyuk S, Levenets S. (2020). The Jarisch-Herxheimer reaction associated with doxycycline in a patient with Lyme arthritis. Reumatologia. 58 (5): 335-338. https://doi.org/10.5114/reum.2020.99143; PMid:33227092 PMCid:PMC7667941
Nykytyuk S, Klymnyuk S, Levenets S. (2019). Laboratory diagnostics of Lyme borreliosis in children with ticks bites in Ternopil Region. Georgian Med. News. 296: 32-36.
Nykytyuk S, Klymnyuk S, Marchuk O, Panichev V, Klishch I. (2022). Experience of PCR research in Lyme borreliosis in children of Ternopil region. Family Medicine & Primary Care Review. 24 (4): 334-335. https://doi.org/10.5114/fmpcr.2022.120857
Nykytyuk S, Klymnyuk S, Podobivsky S, Levenets S, Stelmakh O. (2020). Lyme borreliosis-endemic disease in Children of Ternopil Region. Georgian Med. News. 307: 95-103.
Pańczuk A, Kozioł-Montewka M, Tokarska-Rodak M. (2014). Exposure to ticks and seroprevalence of Borrelia burgdorferi among a healthy young population living in the area of southern Podlasie, Poland. Annals of agricultural and environmental medicine: AAEM. 21 (3): 512-517. https://doi.org/10.5604/12321966.1120593; PMid:25292120
Wormser GP, Brisson D, Liveris D et al. (2008). Borrelia burgdorferi. Genotype Predicts the Capacity for Hematogenous Dissemination during Early Lyme Disease. The Journal of Infectious Diseases. 198 (9): 1358-1364. https://doi.org/10.1086/592279; PMid:18781866 PMCid:PMC2776734
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