| Abstract | Borrelia burgdorferi uzročnik je lajmske bolesti (LB) te pripada koljenu spiroheta. Visoko je invazivna bakterija prilagođena krpeljima i sisavcima. Patogeneza LB nije u potpunosti razjašnjena, ali ovisi o pokretljivost i citotoksičnost bakterije, antigenskoj varijabilnosti i imunološkom odgovoru domaćina. Klinička slika LB se dijeli na rani lokalizirani stadij, rani diseminirani stadij te kasni stadij. Erythema migrans (EM), ujedno i patognomoničan znak LB, je najčešća manifestacija u ranom stadiju bolesti, dok se u kasnijim stadijima javljaju neurološki simptomi, srčane manifestacije i artritis. Dijagnostika lajmske bolesti (LB) uključuje različite mikrobiološke metode u otkrivanju uzročnika, a dijeli se na izravne i neizravne metode. Izravne metode uključuju kultivaciju, mikroskopiju i PCR, dok su neizravne metode utemeljene na serološkom testiranju. PCR je brza dijagnostička metoda, ali ne može razlikovati akutnu od kronične infekcije. Serološki testovi detektiraju protutijela IgM i IgG u krvi, likvoru i sinovijalnoj tekućini. Serološka dijagnostika se provodi u dva koraka. Nakon primjene osjetljivih probirnih (EIA, IFA, CLIA i dr.) testova, reaktivni se rezultati potvrđuju potvrdnim visokospecifičnim imunoblot/Western blot testom. Serološki testovi imaju zadovoljavajuću osjetljivost i specifičnost, no interpretacija ovisi o kvaliteti testova i kliničkim podacima. U dijagnostici LB kombinira se klinička slika s laboratorijskim testovima te integracija različitih metoda osigurava pravodobno postavljanje dijagnoze i pravovremeno liječenje. Liječenje lajmske bolesti ovisi o stadiju bolesti. U ranim stadijima, koriste se oralni antibiotici tijekom 10-14 dana, dok se neurološke i reumatske manifestacije liječe primjenom parenteralnih antibiotika tijekom 2-4 tjedna. |
| Abstract (english) | Borrelia burgdorferi is the causative agent of Lyme disease (LB) and belongs to the spirochete phylum. It is a highly invasive bacterium, adapted to ticks and mammals. The pathogenesis of LB is not fully understood but depends on the bacterium's motility, its cytotoxicity, its antigenic variability, and the host immune response. The clinical presentation of LB is divided into early localized, early disseminated, and late stages. Erythema migrans (EM), which is also a pathognomonic sign of LB, is the most common manifestation in the early stage, while neurological symptoms, cardiac manifestations, and arthritis occur in later stages. Diagnosis of LB involves various microbiological methods to detect the causative agent, categorized as direct and indirect methods. Direct methods include cultivation, microscopy, and PCR, while indirect methods are based on serological testing. PCR is a rapid detection method but cannot differentiate between acute and chronic infections. Serological tests detect antibodies (IgM and IgG) in blood, cerebrospinal fluid, and synovial fluid. A two-step testing process for LB is currently recommends. The most commonly screening tests are EIA, IFA and CLIA followed by confirmatory immunoblot/Western Blot test. Serological tests have satisfactory sensitivity and specificity, but interpretation depends on the test quality and clinical data. LB diagnosis combines clinical presentation with laboratory tests, and integration of different methods ensures timely diagnosis and treatment. Treatment of LB depends on the disease stage. In early stages, oral antibiotics are used for 10-14 days, while neurologic and rheumatic manifestations are treated with parenteral antibiotics for 2-4 weeks. |
