#1
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Ïîäòâåðæäåí ëè áîððåëèîç?
Çäðàâñòâóéòå, óâàæàåìûå âðà÷è ôîðóìà
Æåíùèíà, 38 ëåò. Íà îñíîâàíèè ìîèõ æàëîá (ñëàáîñòü, ïîâûøåííàÿ óòîìëÿåìîñòü, ñíèæåíèå ïàìÿòè, ãîëîâíûå áîëè, áîëè â øåå è ïîÿñíèöå, ãèïåðòîíèÿ), ïîâûøåííîãî ñ-ðåàêòèâíîãî áåëêà, ïðèçíàêîâ ñàêðîèëåèòà íà ìðò ðåâìàòîëîã íàïðàâèë ìåíÿ íà àíàëèçû íà áîððåëèîç. Êëåùåé íå ïîìíþ, ÷òîáû íàõîäèëà, ñïåöèôè÷åñêèé ýðèòåìû òîæå íå ïîìíþ. Ðåãèîí ýíäåìè÷íûé (Êàëèíèíãðàäñêàÿ îáëàñòü) Ìåòîä îïðåäåëåíèÿ: Õåìèëþìèíèñöåíòíûé èììóíîàíàëèç anti-Borrelia burgdorferi IgM ïîëîæèò. anti-Borrelia burgdorferi IgM (ÊÏ) 1.1 Ìåòîä îïðåäåëåíèÿ: Èììóíîáëîò (Western blot) Àíòèãåí VisE îòðèöàò. Ñïåöèôè÷åí Áåëîê ìåìáðàííûõ âåçèêóë ð83 îòðèöàò. Ñïåöèôè÷åí BmpA, ð39 îòðèöàò. Ñïåöèôè÷åí OspA, ð31 îòðèöàò. Ñïåöèôè÷åí ð 30 îòðèöàò. Ñïåöèôè÷åí OspC, ð25, ìàðêåð ñâåæåé èíôåêöèè ïîëîæèò. Ñïåöèôè÷åí ð 21 îòðèöàò. Ñïåöèôè÷åí ð 19 îòðèöàò. Ñïåöèôè÷åí ð 17 îòðèöàò. Ñïåöèôè÷åí ÇÀÊËÞ×ÅÍÈÅ Àíòèòåëà êëàññà M ê Borrelia âûÿâëåíû ê àíòèãåíó OspC, p 25. Ðåçóëüòàò: ïîëîæèòåëüíûé 1) Ïîäòâåðæä¸í ëè ó ìåíÿ áîððåëèîç? 2) Íóæíî ëè ëå÷åíèå àíòèáèîòèêàìè? Çàðàíåå áîëüøîå ñïàñèáî |
#2
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ìíîãèå èç âàøèõ ñèìïòîìîâ ìîãóò áûòü âñëåäñòâèå íåâûëå÷åííîãî äåôèöèòà æåëåçà, êîå âíóòðü íå óñâàèâàåòñÿ íà ôîíå âîñïàëåíèÿ
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#3
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Ñïàñèáî çà îòâåò
Áûë æåëåçîäåôèöèò è àíåìèÿ, êîíñóëüòèðîâàëàñü çäåñü íà ôîðóìå.  ïðîøëîì ãîäó (ìàé è îêòÿáðü) ïîëó÷èëà ïî 500 ìã æåëåçà âíóòðèâåííî. Ñåé÷àñ ãåìîãëîáèí 149, ôåððèòèí 235 (èëè íå ñíèçèëñÿ åù¸, èëè âîñïàëèòåëüíûé...). Àíàëèç îò 03.05.2022. ×àñòü ñèìïòîìîâ óìåíüøèëàñü ïîñëå ëèêâèäàöèè æåëåçîäåôèöèòà, íî ïîëíîñòüþ íå ïðîøëè. |
#4
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à ö-ðåàêòèâíûé áåëîê ñêîëüêî? ñòðàííî âèäåòü ðåêîìåíäàöèè ìåñòå÷êîâîãî âðà÷à, êîãäà "Spondyloarthritis, for example sacroiliitis, is not a manifestation of Lyme arthritis."
òî åñòü, åñëè ïîäòâåðæäåí ñàêðîèëåèò ïëþñ âîñïàëåíèå, òî èøóò ðåâìàòîèäíûå áîëåçíè, à íå èñêëþ÷àþò àðòðèò ëàéìà
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#5
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òêíèòå ýòèì â ëå÷. âðà÷à - îí çàáëóäèëñÿ, åñëè åìè ÷óæä ìåæäóíàð. ÿçûê ìåäèöèíû - ïåðåâåäèòå åìó íà ïîíÿòíûé
There is no single laboratory marker for the diagnosis of Lyme arthritis. High levels of IgG antibodies to B. burgdorferi s.l. are found in serum from patients with Lyme arthritis, but positive serology alone is not sufficient for confirmation, especially in regions where there is high background seroprevalence. In order to substantiate a diagnosis of Lyme arthritis, alternative explanations for the arthritis should be excluded, for example osteoarthritis, trauma, spondyloarthritis, crystal-induced arthritis, and septic arthritis. Synovial fluid analysis is recommended when feasible. Granulocytic inflammation in synovial fluid is a characteristic microscopy finding, and direct detection of B. burgdorferi s.l. by culture or PCR in synovial fluid or membrane is highly supportive of a diagnosis. Lyme arthritis is sometimes accompanied by bursitis and/or enthesitis [41], and myositis has also been proven as a rare manifestation of LB [42]. Lyme arthritis is one of the rare inflammatory joint diseases in which routine laboratory parameters of inflammation, such as C-reactive protein levels and erythrocyte sedimentation rate, are often normal. Pronounced elevation of laboratory markers of inflammation in a patient with arthritis argues against Lyme arthritis.
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#6
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Ñ-ðåàêòèâíûé áåëîê â îêòÿáðå 2021 ãîäà, ñäàâàëà â ñîñòàâå áèîõèìèè ïåðåä ãîñïèòàëèçàöèåé (ýñòåòè÷åñêàÿ îïåðàöèÿ íà âåêàõ) áûë 12.1 è 28.8 ìã/ë
Ðåçóëüòàò îò 04.05 - 15.3 ìã/ë Ñïîíäèëèò ðåâìàòîëîã ïîêà ñòàâèò ïîä âîïðîñîì Ñåé÷àñ ïîïðîáóþ ïåðåâåñòè èíôîðìàöèþ, ñïàñèáî |
#7
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äà, ïðèçíàêè âîñïàëèòåëüíîãî ïðîöåññà èìåþòñÿ, íî ïðè áîðåëëèîçå è àðòðèòå ñðá êàê ïðàâèëî ìåíåå 10 ìã/ë
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#8
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Çäðàâñòâóéòå, óâàæàåìûå âðà÷è. Ïîäíèìó ñâîþ òåìó.
Ïî íàçíà÷åíèþ èíôåêöèîíèñòà, ÷òîáû íå ïðîïóñòèòü âîçìîæíóþ ñâåæóþ èíôåêöèþ, ïðîïèëà äîêñèöèêëèí 2 íåäåëè, çàêîí÷èëà 31.05. 11.07 ñäàëà êîíòðîëüíûå àíàëèçû. Ig M ïîëîæèòåëüíûé ê OspC, p 25 ìåòîäîì èììóíîáëîòà. Ig G îòðèöàòåëüíî ìåòîäîì èììóíîáëîòà. Íó è ñîîòâåòñòâåííî æàëîáû ìîè íèêóäà íå äåëèñü, êàê è ÷àñòûå âîñïàëèòåëüíûå çàáîëåâàíèÿ (ïîñëåäíèå - íà÷àëî èþíÿ, íà÷àëî èþëÿ ÎÐÂÈ). Àíàëèçû îò 03-05 ìàÿ: Ãëþêîçà 6.4 ììîëü/ë (èç âåíû) HbA1c 5.5% ÎÕ 6.83 ììîëü/ë ÕËÏÍÏ 4.91 ììîëü/ë ÑÐÁ 15.3 ìã/ë Ôåððèòèí 235 ìêã/ë HLA B27 íå îáí Ðåâìàòîèäíûé ôàêòîð <20 Àíàëèçû îò 12 ìàÿ: Ãëþêîçà 5.8 ììîëü/ë (èç âåíû) ÎÕ 6.52 ììîëü/ë ÕËÏÍÏ 4.44 ììîëü/ë ÑÐÁ 10.4 ìã/ë Àíòèíóêëåàðíûå àíòèòåëà Ig G îòðèö ÀÒ ê íàòèâíîé (äâóõñïèð.) ÄÍÊ Ig G 2.2 ME/ìë (0-20) Àíàëèçû îò 11 èþëÿ: Ãëþêîçà 6.4 ììîëü/ë (èç âåíû) ÀÑË-Î 76 åä/ìë (<200) ÑÐÁ 22.8 ìã/ë Ëàòåíòíàÿ æåëåçîñâÿç. ñïîñîáíîñòü 43 ìêìîëü/ë Òðàíñôåððèí 2.68 ã/ë Ôåððèòèí 182 ìêã/ë Ig A 2.43 ã/ë (0.7 - 4.0) Ig M 1.01 ã/ë (0.33 - 2.93) Ig G 11.01 ã/ë (5.52 - 16.31) Ig E (total) 7 ÌÅ/ìë (< 100) Êëèíè÷åñêèé àíàëèç êðîâè îò 11 èþëÿ: Ãåìàòîêðèò 40.0 % 35.0 - 45.0 Ãåìîãëîáèí 14.0 ã/äë 11.7 - 15.5 Ýðèòðîöèòû 4.53 ìëí/ìêë 3.80 - 5.10 MCV (ñð. îáúåì ýðèòð.) 88.3 ôë 81.0 - 100.0 RDW (øèð. ðàñïðåä. ýðèòð) 11.9 % 11.6 - 14.8 MCH (ñð. ñîäåð. Hb â ýð.) 30.9 ïã 27.0 - 34.0 ÌÑHÑ (ñð. êîíö. Hb â ýð.) 35.0 ã/äë 32.0 - 36.0 Òðîìáîöèòû 365 òûñ/ìêë 150 - 400 Ëåéêîöèòû 11.17* òûñ/ìêë 4.50 - 11.00 Íåéòðîôèëû (îáù.÷èñëî), % 79.8* % 48.0 - 78.0 Ïðè èññëåäîâàíèè êðîâè íà ãåìàòîëîãè÷åñêîì àíàëèçàòîðå ïàòîëîãè÷åñêèõ êëåòîê íå îáíàðóæåíî. Êîëè÷åñòâî ïàëî÷êîÿäåðíûõ íåéòðîôèëîâ íå ïðåâûøàåò 6% Ëèìôîöèòû, % 13.7* % 19.0 - 37.0 Ìîíîöèòû, % 5.6 % 3.0 - 11.0 Ýîçèíîôèëû, % 0.5* % 1.0 - 5.0 Áàçîôèëû, % 0.4 % < 1.0 Íåéòðîôèëû, àáñ. 8.90* òûñ/ìêë 1.56 - 6.13 Ëèìôîöèòû, àáñ. 1.53 òûñ/ìêë 1.18 - 3.74 Ìîíîöèòû, àáñ.0.63 òûñ/ìêë 0.20 - 0.95 Ýîçèíîôèëû, àáñ. 0.06 òûñ/ìêë 0.00 - 0.70 Áàçîôèëû, àáñ. 0.05 òûñ/ìêë 0.00 - 0.20 ÑÎÝ 36* ìì/÷ < 20 Øêàëà Âåñòåðãðåíà, ñåäèìåíòàöèîííûé ìåòîä Áîððåëèîç, íàñêîëüêî ÿ ïîíèìàþ, èñêëþ÷åí? ×åì ìîæåò áûòü îáóñëîâëåí ëîæíîïîëîæèòåëüíûé ðåçóëüòàò àíàëèçà? Êàê èñêàòü ïðè÷èíó âîñïàëåíèÿ? Êàê èñêëþ÷èòü àóòîèìóííûå çàáîëåâàíèÿ? Åñòü ëè ó ìåíÿ æåëåçîäåôèöèò? Çàðàíåå áîëüøîå ñïàñèáî |
#9
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íàëè÷èåì åñòåñòâ. àíòèòåë â îðã-ìå
ñ î÷íûì âðà÷îì ðåâìàòîëîãîì, íà ôîðóìå òàêèõ íåò äåôèöèò íà ôîíå âîñï. ïðîöåññà íå âèäåí
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#10
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Ñïàñèáî Âàì áîëüøîå
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