Platonov A E, Toporkova M G, Kolyasnikova N M, Stukolova O A, Dolgova A S, Brodovikova A V, Makhneva N A, Karan L S, Koetsveld J, Shipulin G A, Maleev V V
Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Welfare, Moscow, Russia.
Medical Association "New Hospital", Yekaterinburg, Russia.
Ter Arkh. 2017;89(11):35-43. doi: 10.17116/terarkh2017891135-43.
Ixodes tick-borne borreliosis caused by Borrelia miyamotoi (ITBB-BM) is a previously unknown infectious disease discovered in Russia.
The present study continues the investigation of the clinical features of ITBB-BM in the context of an immune system-pathogen interaction.
The study enrolled 117 patients with ITBB-BM and a comparison group of 71 patients with Lyme disease (LD) that is ITBB with erythema migrans. All the patients were treated at the New Hospital, Yekateringburg. More than 100 clinical, epidemiological and laboratory parameters were obtained from each patient's medical history and included in the general database. A subset of patients hospitalized in 2015 and 2016 underwent additional laboratory examinations. Namely, the levels of B. miyamotoi-specific IgM and IgG antibodies were measured by the protein microarray containing GlpQ protein and four variable major proteins (VMPs): Vlp15/16, Vlp18, Vsp1, and Vlp5. The blood concentration of Borrelia was estimated by quantitative real-time PCR.
In contrast to LD, first of all (p<0.001) the following clinical features were typical for ITBB-BM: the absence of erythema migrans (in 95% of patients), fever (93%), fatigue (96%), headache (82%), chill (41%), nausea (28%), lymphopenia (56%), thrombocytopenia (46%), the abnormal levels of alanine aminotransferase (54%) and C-reactive protein (98%), proteinuria (61%). Given the set of these indicators, the course of ITBB-BM was more severe in approximately 70% of patients. At admission, only 13% and 38% of patients had antibodies to GlpQ and VMPs, respectively; at discharge, antibodies to GlpQ and VMPs were detected in 88% of patients. There was no statistically significant association of the antibody response with individual clinical manifestations and laboratory parameters of the disease. However, patients with more severe ITBB-BM produced less IgM antibodies to VMPs and GlpQ at the time of discharge.
ITBB-BM is a moderate systemic disease accompanied by the production of specific antibodies in virtually all patients.
由宫本疏螺旋体引起的硬蜱传播的疏螺旋体病（ITBB - BM）是在俄罗斯发现的一种此前未知的传染病。
本研究在免疫系统与病原体相互作用的背景下继续对ITBB - BM的临床特征进行调查。
该研究纳入了117例ITBB - BM患者以及71例莱姆病（LD）患者作为对照组，莱姆病即伴有游走性红斑的ITBB。所有患者均在叶卡捷琳堡的新医院接受治疗。从每位患者的病历中获取了100多项临床、流行病学和实验室参数，并纳入通用数据库。2015年和2016年住院的部分患者接受了额外的实验室检查。具体而言，通过包含GlpQ蛋白和四种可变主要蛋白（VMPs）：Vlp15/16、Vlp18、Vsp1和Vlp5的蛋白质微阵列检测宫本疏螺旋体特异性IgM和IgG抗体水平。通过定量实时PCR估计疏螺旋体的血液浓度。
与莱姆病相比，首先（p<0.001），以下临床特征是ITBB - BM所特有的：无游走性红斑（95%的患者）、发热（93%）、疲劳（96%）、头痛（82%）、寒战（41%）、恶心（28%）、淋巴细胞减少（56%）、血小板减少（46%）、丙氨酸转氨酶水平异常（54%）和C反应蛋白水平异常（98%）以及蛋白尿（61%）。鉴于这些指标，约70%的患者ITBB - BM病程更为严重。入院时，分别只有13%和38%的患者有针对GlpQ和VMPs的抗体；出院时，88%的患者检测到针对GlpQ和VMPs的抗体。抗体反应与疾病的个体临床表现和实验室参数之间无统计学显著关联。然而，ITBB - BM病情较重的患者出院时产生的针对VMPs和GlpQ的IgM抗体较少。
ITBB - BM是一种中度全身性疾病，几乎所有患者都会产生特异性抗体。
