Mkb tick suction. Tick ​​bite: how to recognize dangerous symptoms and provide help? Manifestations of hemorrhagic fever

Of all the blood-sucking animals, ticks cause the most disgust. It is with them that dangerous diseases such as encephalitis and borreliosis are associated. The tick bite itself is painless. The victim does not always detect the parasite on his body in time, which leads to dire consequences. But if a pest is detected, it must be properly neutralized. Wrong actions when bitten by a forest or city tick can aggravate the situation.

Briefly about ticks

Knowing everything about ticks makes it easier to understand their behavior and prevent bite complications. Let's find out where ticks live and what types they are. Interesting fact about ticks - these animals are not insects. They are arachnids from the phylum arthropods.

In nature, one encounters ixodid ticks more often. European forest tick and taiga tick are common species.

Why is a tick bite dangerous?

• tick-borne encephalitis– a most dangerous disease that causes inflammation meninges, is fraught with death;
• Lyme disease– the same disease is known as borreliosis. Provokes skin, neurological and cardiac reactions, meningitis;
• tick-borne relapsing fever – the pathogen damages the circulatory and nervous systems. The prognosis is favorable with early detection and adequate treatment;
• hemorrhagic fever– damage to the central nervous system and respiratory organs is observed. It develops rapidly and has a high mortality rate;
• tularemia– heavy bacterial infection accompanied by lymphadenitis;
• tick-borne ehrlichiosis– Causes respiratory failure and circulatory problems. The difficulty of diagnosis and treatment lies in the fact that the disease for a long time doesn't show itself at all.

ICD 10 code

If bitten by a tick, the International Classifier assigns code B88.8. The diagnosis code according to ICD 10 in case of infection with encephalitis is G04.0. If borreliosis or Lyme disease has developed due to a tick bite, ICD 10 codes the disease A69.2.

What does a tick bite look like?

Bite symptoms

The site of the tick bite is usually itchy and red. The puncture point can be seen. A red spot with a white area after a tick bite is characteristic of borreliosis, so such symptoms should alert you. But slight redness of the skin after a tick bite is a common occurrence. It appears almost immediately and is not always accompanied by other symptoms.

In humans, the characteristic signs of a tick bite are:

• redness and irritation;
• lump or lump - occurs after the bite of an infected tick;
• weakness and slight chills;
• enlarged lymph nodes;
• headache;
• decline blood pressure.

Symptoms of an encephalitis tick bite in humans are more varied. The brain functions worse, paralysis and respiratory failure. But all these signs appear over time. Ticks can carry a variety of infections, including those that are not life-threatening, but cause discomfort. This category includes inflammatory reactions dermatological properties.

First aid

If a tick bites and falls off on its own, all that remains is to treat the wound. For this purpose, use any available antiseptic. Brilliant greens, hydrogen peroxide, and chlorhexidine will do. What else can you use to treat a tick bite? If pharmacy antiseptics are not at hand, they will do soda solution, hand disinfection gel, vodka.

How to treat the area after a tick bite if the head of the pest remains under the skin? In this case, there is no need to wait acute inflammation. First, they try to pull out the broken fragment using an alcohol-treated or calcined needle. They act in the same way as in the case of a splinter. Afterwards, the puncture is sanitized with 3% peroxide, and then lubricated with brilliant green or iodine.

Diagnostics

The incubation period for diseases such as encephalitis and borreliosis is long. In order not to waste precious time, you must submit venous blood for the following studies:

• PCR – carried out from the 11th day after the bite;
• IgM type ELISA method for encephalitis - taken after 14 days;
• IgM ELISA method for borreliosis - carried out after 4 weeks;
• Western blotting method of IgM type for encephalitis - after 2 weeks;
• Western blotting method for IgM type for borreliosis - after 4 weeks.

A single test is not enough to make a diagnosis. Blood is taken again to clarify the result after a certain period of time.

Treatment

If a tick bites, local treatment is carried out and the victim is given a referral for laboratory tests. At the same time, when a tick bites, immunoglobulin is administered. It prevents the development tick-borne encephalitis, but does not exclude it completely. Self-injection is unacceptable, since the protein, once in the human body, can cause a violent reaction. Typically, the patient is observed for an hour after the administration of immunoglobulin. Then they are sent home.

If the bite site swells, becomes inflamed, or turns red, it is allowed to use Diclofenac and Fenistil. Venotonic drugs are suitable for resolving hematomas and redness.

If house mites are a concern, antiallergic therapy is prescribed taking into account the symptoms: ointments, nasal sprays, drugs for conjunctivitis, etc. Antihistamines are required.

Complications and consequences

When an ixodid tick attacks, the course of events is unpredictable. The pest can infect humans fatally dangerous diseases, therefore, the most terrible complication of a bite can safely be called death.

In case of development of encephalitis and borreliosis, emergency medical therapy is required. Ribonuclease, blood substitutes, and prednisolone can prevent inflammation of the meninges. In this case, the consequences of an encephalitis tick bite in a person will be minimal. I manage to limit myself light current illness followed by full recovery. Recovery usually takes 2 months.

With the development of tick-borne borreliosis, complications may not be felt for several months or years. Over time it gets affected nervous system, is developing rheumatoid arthritis. Neurological syndrome is treated with Azlocillin; tetracycline antibiotics are used against the pathogen. At the same time, biostatics and antihistamines are prescribed.

TO negative consequences Tick ​​bites in humans are considered permanent dermatological disorders, and marks on the skin can remain for life.

Prevention

As part of prevention, you should prepare more carefully for country walks. They try to cover the body as much as possible: trousers are tucked into socks, a hood, scarf or cap is put on the head, sweaters and jackets are tucked into the waistband of trousers. After visiting the forest, it is important to conduct an inspection. Often ticks do not have time to reach the body, but may be on clothing. They are not fast, so timely inspection will prevent bites.

Separately, prevention of diseases carried by ticks is carried out. Vaccination can prevent encephalitis. A cultured tick-borne encephalitis vaccine is usually used. It is administered twice at intervals of 1 month.

Now we’ll find out how to get rid of dust mites in an apartment. The best way struggle - maintaining cleanliness. spring-cleaning includes washing clothes and bed linen, cleaning with a vacuum cleaner, washing floors with bleach. We get rid of down pillows and replace them with synthetic ones. Dust pests are controlled special shampoos, floor cleaning gels, aerosols for treating clothing, textiles and upholstered furniture.

Dear readers of the 1MedHelp website, if you still have questions on this topic, we will be happy to answer them. Leave your reviews, comments, share stories of how you experienced a similar trauma and successfully dealt with the consequences! Your life experience may be useful to other readers.

Since 1999, the international classification of diseases, 10th revision, was introduced in Russia; it is used to this day to systematize diagnoses and includes codes and codes.

This classification includes all known diseases, including a tick bite and its consequences.

Basic data

All diagnoses in this classification are systematized and have codes and codes. Codes and ciphers are used to maintain medical confidentiality when indicating a diagnosis in medical documentation. Currently, the ICD has more than 21 classes of diagnoses. Latin and Arabic letters are used to denote ciphers and codes. Another class - 22, is used for research purposes.

The principles for forming diagnoses in ICD 10 are as follows:

• epidemic;
• are common;
• anatomical localization groups;
• conditions associated with human development problems;
• injuries.

Tick ​​bite

This condition is coded in the ICD-10 classifier as B88.8. Full description the state looks like this:

Diseases caused by ticks are borreliosis and tick-borne encephalitis, they are also encoded in the ICD-10 classification.

• chills;
• increased body temperature;
• muscle aches;
• formation of ring-shaped erythema at the site of the bite;

According to ICD-10 it has code A69.2.

Tick-borne encephalitis. Acute infection which occurs after a tick bite. The incubation period is 14 days. The clinical picture is similar to influenza: heat, muscle aches, maybe a cough. This disease is dangerous because the nervous system is involved in the process.

In the ICD-10 classification it is classified as tick-borne viral encephalitis and has code A84.0

In any industry they always install unified systems and standards. This also applies to medicine. There is a special classification - ICD-10. The abbreviation stands for International Classification of Diseases. This normative document, which is the basis. It is used by doctors and other specialists all over the world. ICD-10 is revised every 10 years. The publication includes 3 volumes with instructions.

The purpose of the ICD is to create conditions for the effective collection, processing and analysis of data on diseases and mortality in various regions of the country and around the world. Thanks to this classification, diagnoses are converted into a code value of numbers and letters. This facilitates the process of storing, retrieving and analyzing information. International classification commonality is ensured in methodological approaches for comparing information.

There are other diagnoses in this section. For example, B88.0 is a different acariasis. Code B88.1 refers to tungiasis - this disease concerns problems with the sand flea (tropical variety). All other arthropod infestations are listed under number B88.2. External hirudinosis is designated as B88.3, ​​and if the infestation has an unspecified form, then the code B88.9 is written.

If the patient became infected with spring-summer tick-borne encephalitis from a tick, then code A84.0 is set. If there is no clarification on tick-borne encephalitis, then the number A84.9 is written. If a patient is diagnosed with Lyme disease or borrelitis after a tick bite, then number A69.20 is assigned.

Symptoms of infection

Read also: The habitat of malarial plasmodium and the danger it poses to people

The first symptoms appear in a person approximately 3 hours after he is bitten. Usually the patient feels weak and is constantly in a sleepy state. He develops chills, fear of light, aching joints and muscle pain. After this, other symptoms appear. Body temperature rises to 37.5-38 ºС. At the same time, tachycardia begins (more than 60 beats per minute) and blood pressure decreases. Closest to the bite lymphatic vessels increase in size. The person feels itching, which gradually intensifies. Redness and rash appear at the site of the bite.

As for the strongly expressed responses of the body of a bitten person, there may be headache and nausea. Some people have frequent attacks vomiting. Sometimes it becomes difficult to breathe, and the breathing itself comes with wheezing. Characteristic and nervous manifestations. Sometimes even hallucinations occur.

In general, it is quite easy to spot a tick on a person’s body. It usually resembles a raised mole, and the legs look like hair growing from it. Having attached itself to a blood vessel, it can remain on the victim’s body for a long time.

Possible consequences of infection

Getting a tick is quite easy.

RCHR (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical protocols Ministry of Health of the Republic of Kazakhstan - 2016

Tick-borne viral encephalitis (A84)

Short description

Approved
Joint Commission on Quality medical services
Ministry of Health and Social Development of the Republic of Kazakhstan
from August 16, 2016
Protocol No. 9

Tick-borne encephalitis(syn. spring-summer encephalitis, taiga encephalitis, Russian encephalitis, Far Eastern encephalitis, tick-borne encephalomyelitis) (eng. Encephalitis ocarina, Tick-borne encephalitis) is an arboviral natural focal disease with a transmissible mechanism of pathogen transmission, characterized by fever and damage to the central nervous system.

Correlation of ICD-10 and ICD-9 codes

Date of development of the protocol: 2016

Protocol users: emergency doctors emergency care, paramedics, doctors general practice, therapists, traumatologists, neurologists, infectious disease specialists, obstetricians-gynecologists, healthcare organizers, anesthesiologists-resuscitators.

Level of evidence scale:

A	A high-quality meta-analysis, systematic review of RCTs, or large RCTs with a very low probability (++) of bias, the results of which can be generalized to an appropriate population.
IN	A high-quality (++) systematic review of cohort or case-control studies, or a high-quality (++) cohort or case-control study with a very low risk of bias, or an RCT with a low (+) risk of bias, the results of which can be generalized to an appropriate population .
WITH	Cohort or case-control study or controlled trial without randomization with low risk of bias (+), the results of which can be generalized to the relevant population or RCT with very low or low risk of bias (++ or +), the results of which cannot be directly distributed to the relevant population.
D	Case series or uncontrolled study or expert opinion.

Classification

Tick-borne encephalitis (TBE) can occur in subclinical (in endemic regions) and clinical forms. The ratio of clinical and asymptomatic forms V different countries fluctuates between 1:300 - 1:1000.

Clinical classification of tick-borne encephalitis
Highlight5 clinical forms:
· febrile;
· meningeal;
· meningoencephalitic;
· meningoencephalopoliomyelitis (poliomyelitis);
· polyradiculoneuritic.

By severity:
· light;
· medium-heavy;
· heavy.

With the flow:
· acute;
· chronic (progressive);
· two-wave flow indicating the shape of the second wave.

All clinical manifest forms are divided into focal and non-focal.

Non-focal ones include:
· febrile form;
· meningeal form.

To focal:
· meningoencephalitic;
· meningoencephalopoliomyelitis;
· polyradiculoneuritic.

Classification of chronic (progressive) forms of tick-borne viral encephalitis:
Clinical form:
· hyperkinetic (syndromes: Kozhevnikov epilepsy, myoclonus-epilepsy, hyperkinetic);
amyotrophic (syndromes: poliomyelitis, encephalopoliomyelitis, disseminated encephalomyelitis, amyotrophic lateral sclerosis);
· rare syndromes not related to forms 1 and 2.

By severity:
· mild (ability to work is preserved);
· average (disability group 3);
· severe (disability of 1st and 2nd groups).

According to the time of occurrence of the chronic process:
· initial progressive (direct continuation of acute CE);
· early progressive (occurs during the first year after acute TE);
· late progressive (occurs a year or more after acute TE);
· spontaneous progressive (occurs without clear acute CE).

According to the nature of the course of chronic FE:
· recurrent;
· continuously progressing;
· abortifacient.

By stages of the disease:
· initial;
· increase (progression);
· stabilization;
· terminal.

By development time:
primary progressive form (first identified in the absence of any history of acute form CE);
· secondary progressive form (as a direct continuation of any acute form of FE, or developed in a later period after the manifest stage).

Complications:
With all the above-described clinical forms of tick-borne encephalitis, epileptiform, hyperkinetic syndromes and other signs of damage to the nervous system can be observed.

Outcomes:
· recovery;
· residual (residual) phenomena;
lethal
· transition to a chronic (progressive) course.

Residual (residual) phenomena
· flaccid paresis of the cervicobrachial (cervicothoracic) localization, arms, legs;
· atrophy of the affected muscles;
· decreased intelligence;
epilepsy.

Examples of diagnosis formulation:
Tick-borne viral encephalitis, febrile form, medium degree heaviness, acute course(IgM ELISA to TBE virus - positive).
Tick-borne viral encephalitis, meningoencephalitic form, severe severity, acute course (PCR RNA of the TBE virus is positive).
Complication: epileptiform syndrome.

Diagnostics (outpatient clinic)

OUTPATIENT DIAGNOSTICS

Diagnostic criteria:
Complaints:


· weakness, malaise;
· muscle pain;
· nausea.

Anamnesis:

Epidemiological history:

Physical examination
Fever form:
· fever 38-39 0 C;



· the illness lasts 3-7 days;

Neurological status:

During CE the following is carried out:



Meningeal form:

· Strong headache;
pain in the eyeballs;
· nausea, vomiting;

· Strong headache;
pain in the eyeballs;
· nausea, vomiting;

· pronounced tremor;

· delirium;
· hallucinations;
· excitement;

· meningeal syndrome (stiff neck, Kernig's sign, Brudzinski's symptoms);
· somnolence or psychomotor agitation(at severe forms);

Diffuse meningoencephalitis:
· fever;
· epileptic seizures;


· hand tremors;

· decreased muscle tone.

Focal meningoencephalitis:


· convulsive syndrome;

Poliomyelitis form:

Laboratory research:

· ECG;

· severe claustrophobia;

· EEG - detection of epiactivity of the brain, focal changes (in the temporal regions): inhibition of the a-rhythm, the presence of slow J - and d - waves, sharp peaks - waves of the fast range, long periods of silence are unfavorable, periodic epileptiform discharges;

Diagnostic algorithm

Diagnostics (ambulance)

DIAGNOSTICS AT THE EMERGENCY CARE STAGE

Diagnostic measures:
· assessment of the patient’s general somatic condition (examination skin and visible mucous membranes, measuring body temperature, blood pressure, pulse rate, breathing rate, etc.);
· assessment of the level of consciousness;
· determination of meningeal symptoms;
· exclusion of the state of infectious-toxic shock.

Before transportation, be sure to:
· check and note in accompanying document level of temperature, blood pressure, frequency and quality of pulse, breathing;
· condition of the skin, symptom “ white spot»;
time of last urination;
· degree of consciousness disorder;
· if necessary, ensure patency respiratory tract and oxygen supply through a face mask;
· provide peripheral venous access (venous cannula with reliable fixation) - attempt no more than 5-10 minutes.
Start transporting the patient with the leg end elevated. The patient is transported in a horizontal position on his back with a bolster under his shoulders. In case of obstruction of the upper respiratory tract - a cushion under the shoulders; in case of arterial hypotension - the legs are raised above the level of the head.

Diagnostics (hospital)

DIAGNOSTICS AT THE INPATIENT LEVEL

Diagnostic criteria at the hospital level:
Complaints:
· increase in body temperature to 38-39°C;
headache (moderate to severe);
· weakness, malaise;
· muscle pain;
· nausea.

Anamnesis:
· characteristically acute onset of the disease: a sudden rise in body temperature to 38-39 0 C after the incubation period (from 1 to 30 days, on average 7-14 days);
· a prodromal period of 1-2 days may be observed: weakness, malaise, weakness, mild pain in the muscles of the neck and shoulder girdle, pain in the lumbar region and a feeling of numbness, headache;
· fever (viremia) with TBE has a two-wave nature: short-term primary viremia, and then repeated, coinciding with the multiplication of the virus during internal organs and its appearance in the central nervous system.

Epidemiological history:
· stay in an endemic focus of tick-borne encephalitis in the spring-summer period (April-October);
· the fact of tick suction ("crawling") 3-30 days before the onset of the disease;
· consumption of raw cow's or goat's milk and products made from them (3-30 days before the onset of the disease).

Physical examination:
Fever form:
· fever 38-39 0 C;
· hyperemia of the face, neck, scleral injection;
Unstable hemodynamics (tendency to hypertension);
· no symptoms of central nervous system damage (only asthenic syndrome);
· the illness lasts 3-7 days;
· favorable prognosis, with complete recovery.

Neurological status:
Common to all forms is the presence of general cerebral symptoms, for focal forms - depression of consciousness and also a combination of general cerebral and focal neurological symptoms.
During CE the following is carried out:
· assessment of the level of consciousness using the 15-point Glasgow Coma Scale;
· determination of the severity of the cerebral syndrome (mild, moderate, severe);
· presence of meningeal signs (stiff neck, symptoms of Kernig, Brudzinsky, Bekhterev, Lessage, Bogolepov, etc.);
presence of focal neurological symptoms Meningeal form:

The initial manifestations do not differ from the febrile form. However, signs of general infectious intoxication are much more pronounced.
· fever 39 0 C and above (duration 7-14 days);
· Strong headache;
pain in the eyeballs;
· nausea, vomiting;
· somnolence or psychomotor agitation (in severe forms);
· meningeal syndrome (stiff neck, Kernig's sign, Brudzinski's symptoms);
lymphocytic pleocytosis in cerebrospinal fluid.

Meningoencephalitic form:
· fever 39 0 C and above (from 4-10 days to 1 month);
· Strong headache;
pain in the eyeballs;
· nausea, vomiting;
lethargy or loss of consciousness;
· pronounced tremor;
· asymmetric paresis of cranial nerves, nystagmus;
· delirium;
· hallucinations;
· excitement;
· disorientation in place and time;
· meningeal syndrome (stiff neck, Kernig's sign, Brudzinski's symptoms);
· somnolence or psychomotor agitation (in severe forms);
· consequences: transient paralysis, residual encephalitic syndrome.

Diffuse meningoencephalitis:
· fever;
· epileptic seizures;
· pseudobulbar disorders (breathing disorders in the form of brady- or tachypnea, like Cheyne-Stokes, Kussmaul, etc.);
· fibrillary twitching of the muscles of the face and limbs;
· hand tremors;
· inhibition of deep reflexes;
· decreased muscle tone.

Focal meningoencephalitis:
· spastic paresis of the limbs;
· paresis of cranial nerves (III, IV, V, VI, IX, X, XI, XII): paresis of the soft palate, nasal voice, slurred speech, aphonia, impaired swallowing, increased salivation with filling of the respiratory tract with mucus, tachycardia, dyspnea;
· convulsive syndrome;
· epileptic seizures (Kozhevnikov epilepsy, Jacksonian epilepsy).

Poliomyelitis form:
· the most severe form of the disease;
· fever of varying severity;
· general weakness, increased fatigue;
· periodically occurring muscle twitching;
· sudden weakness or a feeling of numbness in a limb;
· paralysis develops 5-10 days after the temperature drops;
they may be preceded severe pain in the arms, back and legs;
· flaccid paresis of the cervicobrachial (cervicothoracic) localization;
· symptoms of “head hanging down on the chest”, “proud posture”, “bent, stooped posture”, techniques of “torso throwing the arms and throwing back the head”;
· flaccid paresis of the arms and spastic paresis of the legs;
· breathing disorder (frequent superficial with paradoxical retraction of the abdomen during inspiration, retraction of the intercostal spaces in the lower parts chest;
· atony, decrease or complete loss of tendon and periosteal reflexes;
atrophy of the muscles of the shoulder girdle;
· impairment of pain and tactile sensitivity of the segmental type;
· death can occur within 5-7 days from the onset of neurological symptoms from secondary bulbar lesions or cerebral edema.

Polyradiculoneuritic form.
· pain along the nerve trunks;
· paresthesia (feeling of “crawling goosebumps”, tingling);
Lassegue and Wasserman symptom;
· sensitivity disorders in the distal parts of the extremities of the polyneural type;
· flaccid paralysis start from the legs and spread to the muscles of the torso and arms.

Criteria for the severity of the febrile form of TBE

Severity criteria meningeal form CE

Laboratory research

:
· CBC: moderate leukocytosis with a neutrophilic shift to the left (up to 10-20x10 9 /l, moderate increase in ESR;
· CSF examination: increased intracranial pressure from 250 to 300 mm water. Art. Lymphocytic pleocytosis (in the first days of the disease, the cytosis is mixed or neutrophilic, but by the end of 1 week it becomes lymphocytic in nature). The protein content is moderately increased to 0.66 g/l, the glucose content is normal.
· By ELISA determination elevated levels antibodies of the IgM class (3-4 days of illness), IgG to the tick-borne encephalitis virus (after 5-7 days from the onset of the disease). Increase in titer of IgG antibodies in paired sera (in acute period infection and during the recovery period) has diagnostic value.
· Detection of TBEV RNA PCR method in blood and cerebrospinal fluid (in early dates illness: 1-7 days of illness.

Instrumental studies
· ECG;
· X-ray of the chest organs (according to indications);
radiography paranasal sinuses nose (according to indications);
· Ultrasound of organs abdominal cavity, kidneys (according to indications);
· ophthalmoscopy (according to indications);
· MRI of the brain: as prescribed by a neurologist (according to indications for the purposes of differential diagnosis and diagnosis of complications);
· CT scan of the brain: according to indications for the purposes of differential diagnosis and diagnosis of complications;
· Ultrasound of the brain (neurosonography).

Absolute contraindications to MRI are:
metal foreign body in the eye socket;
· intracranial aneurysms clipped with ferromagnetic material;
· electronic devices in the body (pacemaker);
· hematopoietic anemia (for contrast).

Relative contraindications to MRI are:
· severe claustrophobia;
· metal prostheses, clips located in non-scanned organs;
· intracranial aneurysms clipped with non-ferromagnetic material.

Neurophysiological diagnostic methods (according to indications, as prescribed by a neurologist):
· EEG - detection of epiactivity of the brain, focal changes (in the temporal regions): inhibition of a - rhythm, the presence of slow J - and d - waves, sharp peak - waves of the fast range, long periods of silence, periodic epileptiform discharges are unfavorable;
· Electroneuromyography (with combined damage to the central nervous system and peripheral structures) - forathy.

Diagnostic algorithm:
At the outpatient level, it is sufficient to determine a probable case for referral to hospitalization in the neurological department.

List of main diagnostic measures:
· UAC;
· OAM;
· acid-base balance, blood electrolytes (with meningeal and meningoencephalitic forms);
· SMP (for meningeal and meningoencephalitic forms);
· ELISA: determination of IgM, IgG class antibodies to tick-borne encephalitis virus;
· TBEV RNA PCR (blood and cerebrospinal fluid).

List of additional diagnostic measures:
· blood chemistry: total protein, albumin. In severe cases - potassium, sodium, glucose, creatinine, urea, residual nitrogen;
· for disorders in the vascular-platelet link: coagulogram - blood clotting time, activated partial thromboplastin time, prothrombin index or ratio, fibrinogen, thrombin time;
· bacteriological examination blood for sterility;
· ELISA for antibodies of classes M and G to Borrelia burgdorferi in the blood;
PCR of cerebrospinal fluid for viral DNA herpes simplex 1, 2 and CMV (according to indications).

Indications for cerebrospinal fluid examination:
· severe course febrile forms (tº more than 5 days and above 38º);
· differential diagnosis of the meningeal form of CE with other meningitis;
· the appearance of meningeal signs in any form of tick-borne infections;
· two-wave current (on the second wave);
· mixed infections;
· focal forms (excluding bulbar);
· seronegative variants of TBE;
· all unspecified febrile conditions.
Contraindications for lumbar puncture is: progressive cerebral edema, dislocation syndrome, hemorrhagic syndrome (or high risk its development).

Differential diagnosis

Diagnosis	Rationale for differential diagnosis	Surveys	Diagnosis exclusion criteria
Tick-borne rickettsiosis	Incubation period 1-20 days, average 3-5 days. Temperature8-10 days. The syndrome of infectious toxicosis is pronounced. Appearance characteristic of the patient (bright hyperemia of the face, neck, or rather a third of the body). Impaired consciousness and mental disorders (occasionally, somnolence, delusions, hallucinations). Moderate leukocytosis with neutrophilia and accelerated ESR.	Consultation with an infectious disease specialist	Bright hyperemia of the pharynx, uvula, enanthema on the soft palate. Primary affect. Regional lymphadenitis. Hepatolienal syndrome. Meningeal syndrome is not typical. Focal symptoms are missing.
Omsk hemorrhagic fever	Incubation period 1-10 days, average 5-7 days. The temperature is febrile for 5-7 days, there may be two waves. The syndrome of infectious toxicosis is pronounced. The patient's appearance is characteristic (bright hyperemia of the face, neck, or rather a third of the body). Lymph node involvement is not typical.	Consultation with an infectious disease specialist	Changes in the mucous membrane of the oropharynx: “flaming” pharynx, enanthema on the soft palate. There are small hemorrhagic rashes on the skin. Characterized by bronchitis and pneumonia. Meningeal syndrome is not typical. Impaired consciousness and mental disorders are not typical. There are no focal symptoms. Leukopenia, neutrophilia with a shift to the left.
Tick-borne borreliosis	The incubation period is 2-60 days, with an average of 12 days. The temperature is subfebrile or febrile, 2-7 days. The syndrome of infectious toxicosis is moderately expressed. Meningeal syndrome is moderately expressed. Possible mental disorders. cranial nerve palsies. Moderate leukocytosis with neutrophilia and accelerated ESR. CSF: Moderate lymphocytic cytosis from 200 to 300 cells per 1 µl.	Consultation with an infectious disease specialist, rheumatologist, dermatologist, neurologist, cardiologist, ophthalmologist.	Mild hyperemia of the pharynx. The patient's appearance is not typical. Primary affect, ring-shaped migratory erythema, polymorphic rash, benign lymphocytoma. Regional lymphadenitis. Damage to eyes, joints, heart, liver. Bannovart's syndrome.
Leptospirosis	The incubation period is 6-10 days, on average 6-8 days. The temperature is febrile for 5-7 days, there may be two waves. The syndrome of infectious toxicosis is pronounced. Lymph node involvement is not typical. Meningeal syndrome is pronounced. Impaired consciousness and mental disorders from doubt to coma. High leukocytosis, neutrophilia, accelerated ESR. Mixed or lymphocytic cytosis from 100 to 500 cells in 1 μl.		Bright hyperemia of the pharynx, hemorrhages on the soft palate. Characteristic. "Hood" syndrome, scleritis. Maculopapular and petechial rash, yellowness of the skin and mucous membranes. Damage to muscles, heart, liver, kidneys. Polyneuritis, cerebellar ataxia, athetosis. Anemia, thrombocytopenia.
West Nile fever	The incubation period is 1-8 days, on average 3-4 days. Febrile temperature lasts 2-14 days, there may be two waves. The syndrome of infectious toxicosis is pronounced. The patient's appearance is characteristic. Lymph node involvement is not typical. Lesions of other organs and systems are not typical. Meningeal syndrome is moderately expressed. Impaired consciousness and mental disorders from somnolence to coma. Leukocytosis, accelerated ESR. Mixed or lymphocytic cytosis from 20 to 1000 cells in 1 μl	Consultation with an infectious disease specialist, neurologist.	Moderate hyperemia of the pharynx. Maculopapular rash. Flaccid paresis and paralysis, paresis of cranial nerves. Neutrophilosis without left shift.
Subarachnoid hemorrhage	Acute headache. Vomiting, sometimes convulsions, meningeal symptom complex, mental disorders (from slight confusion, disorientation to severe psychosis). Paresis of cranial nerves, symptoms of focal brain damage (paresis of the limbs, sensory disturbances, speech disorders).	Consultation with a neurologist.	An acute headache that occurs suddenly is felt by the patient as a “dagger strike.” The pain initially has a local character in the forehead and back of the head, then becomes diffuse, localized in the neck, back, and legs. In the acute period following cerebral symptoms the temperature rises to 38-390C, but unlike CE, the rise is not noted immediately, but only 6-30 hours after the hemorrhage. Unlike CE, stroke occurs suddenly; it is not characterized by a cyclical course with the development of infectious toxicosis at the onset of the disease. Motor and sensory disorders with FE are unstable, their reverse development is observed in relatively early period diseases.
A brain tumor	Diffuse severe headache, accompanied by general cerebral symptoms, the appearance of focal symptoms, and seizures.	Consultation with a neurologist.	Distinctive features tumors are: absence of intoxication in the initial period of the disease, torpid course during therapy.

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Treatment

Drugs ( active ingredients), used in the treatment

L-lysine aescinat

Amikacin

Aprotinin

Ascorbic acid

Vancomycin

Warfarin

Heparin sodium

Dexamethasone

Dextran

Dextrose

Diazepam

Diclofenac

Diphenhydramine

Dopamine

Immunoglobulin against tick-borne encephalitis

Potassium chloride (Potassium chloride)

Calcium chloride

Carbamazepine

Ketoprofen

Clemastine

Lidocaine

Lornoxicam

Magnesium sulfate

Mannitol

Meropenem

Metoclopramide

Sodium acetate

Sodium hydrocarbonate

Sodium chloride

Neostigmine methylsulfate

Paracetamol

Pentoxifylline

Pyridoxine

Prednisolone

Propofol

Thiamin

Tramadol

Fluconazole

Furosemide

Choline alfostserat

Cefepime

Ceftriaxone

Ciprofloxacin

Citicoline

Citicoline

Ethyl Succinate methylgidroksipiridina

Treatment (outpatient clinic)

OUTPATIENT TREATMENT

Treatment tactics:
IN outpatient setting Patients with suspected tick-borne encephalitis are not treated. Patients are sent for emergency hospitalization to a hospital (neurology department) to provide them with specialized medical care.
At the stage of primary pre-medical health care medication assistance aimed at:
· decrease in body temperature;
· prevention of complications.

Drug treatment: No.

Other types of treatment: No.

not carried out on an outpatient basis.

Preventive actions:
Emergency specific prevention of TBE is carried out by administering specific immunoglobulin against tick-borne encephalitis (titer 1:80) during the first 96 hours (4 days) after a tick bite according to the instructions for medical use medicine Human immunoglobulin against tick-borne encephalitis.
· With the aim of emergency prevention the drug is administered in a single dose to those who have not been vaccinated against TBE or who have received an incomplete course of vaccination, who have noticed tick bites in endemic areas, as well as when laboratory infection with the TBE virus is suspected.
· In cases increased risk infection (infection with TBEV of an attached tick, multiple bites or simultaneous sucking of several ticks has been detected), the drug is administered in a single dose to vaccinated individuals.
· In case of a new tick bite, a month after the first administration, the drug is re-administered in the same dose.
· The drug can be used before possible contact with the TBE virus - a tick bite in an endemic area (pre-exposure prophylaxis). The protective effect appears after 24-48 hours and lasts about 4 weeks. After this period, in case of danger of infection, it is recommended to repeat the administration of immunoglobulin after 4 weeks.
· Contraindications are severe allergic reactions history of administration of human blood products. Persons who have allergic diseases (bronchial asthma, atopic dermatitis etc.) prescribe a course antihistamines within 8 days after administration of immunoglobulin.
·
During pregnancy in the 1st trimester, the administration of specific immunoglobulin against tick-borne encephalitis is strictly contraindicated. In the 2-3 trimesters, the introduction of specific immunoglobulin according to vital signs after informed consent women, the decision is made by a commission council with the participation of an obstetrician-gynecologist, neurologist, and infectious disease specialist.
· In the future, after a tick bite, it is recommended to adhere to the regime (avoid overheating, insolation, hypothermia, overwork, drinking alcohol, working in night shift, business trips, surgical operations, dental procedures and vaccinations). Daily thermometry is carried out. When clinical symptoms the patient should immediately consult a doctor.
· In case of serological study tick removed from a human body for infection with tick-borne encephalitis virus and obtaining negative result, then immunoglobulin is not administered (if the tick is examined within permissible period prevention).

Vaccinal prevention (specific prevention)
· WHO population immunization strategy. In areas where the disease is highly endemic (average annual incidence before vaccination ≥5 clinical cases per 100,000 population), WHO recommends vaccination of all age groups, including children. Because the disease tends to be more severe among people over 50–60 years of age, these people represent an important target group for immunization. Where pre-vaccination incidence is moderate or low (annual average over a 5-year period<5/100 000) или ограничена определенной географической зоной и определенными видами деятельности на открытом воздухе, иммунизация должна быть нацелена на когорты населения, наиболее активно пострадавшие. Лица, путешествующие из не эндемичных территорий в эндемичные, должны быть вакцинированы, если их посещения включают интенсивную деятельность на открытом воздухе. Во всех эндемичных территориях информация о болезни, ее переносчике и особенностях передачи, а также о доступных профилактических мерах должна быть легко доступна, например, в школах, медицинских учреждениях и в туристических информационных брошюрах .
Vaccines for the prevention of tick-borne encephalitis:
· Post-exposure prophylaxis (vaccination after a tick bite) is not recommended.

Monitoring the patient's condition:
At the outpatient level, in a medical organization at the place of residence, a neurologist carries out dispensary observation of persons affected by a tick bite for twenty-one days with regular thermometry.

Treatment is not provided on an outpatient basis.

Treatment (ambulance)

TREATMENT AT THE EMERGENCY STAGE

Drug treatment:
Providing medical care at this stage is aimed at preventing complications:
· infectious - toxic shock
edema - swelling of the brain
· dislocation syndrome
status epilepticus

At this stage, syndromic therapy is carried out:

Syndrome	A drug	Dose and frequency for adults
Convulsive	Diazepam 0.5% -10 mg (2 ml)	10 - 20 mg once, if there is no effect after 15 minutes, the drug can be re-administered
Psychomotor agitation	Diazepam 0.5% - 0.1 ml/kg, but not more than 2 ml	10-20 mg once, if there is no effect after 15 minutes, the drug can be re-administered.
Dyspeptic	Metoclopramide hydrochloride monohydrate 5.27 mg	Adults and adolescents over 14 years of age: 3-4 times a day, 10 mg of metoclopramide (1 ampoule) intravenously or intramuscularly.
Cephalgic	Ketonal 2.0 IM, Xefocam 8 mg), in the absence - analgin 50% -2.0, diphenhydramine 1% -1.0 IM, with unstable hemodynamics MgSO 5.0 IM per 10.0 physical. solution -0.9%- NaCL	IM - 100 mg 1-2 times a day. IV, drip - 100-200 mg in 100-500 ml of 0.9% NaCl solution. Ketoprofen lysine salt: solution for injection: IM or IV 160 mg (2 ml) 1-3 times a day, Xefocampo 8 mg - two injections per day. The dose of the drug should not be higher than 16 mg/day.
Hyperthermia	Paracetamol	500-1000 mg orally
Infectious-toxic shock	Prednisolone 60-90 mg IV, or Dexamethasone 8-12 mg IV in 10.0 ml 0.9% NaCL solution. Supply of humidified oxygen through a mask at a flow rate of more than 5-6 l/min Infusion therapy: 0.9% NaCL solution.	Doses - prednisolone 10 - 15 mg/kg body weight, up to 120 mg of prednisolone can be administered at a time. 0.9% sodium chloride solution Start a rapid infusion - a bolus of at least 10 ml/kg/ in 10-15 minutes (possibly administering saline solution with syringes).

Treatment (inpatient)

INPATIENT TREATMENT

Treatment tactics:
At the inpatient stage, the patient’s observation card (medical history) daily notes temperature, hemodynamic parameters (blood pressure, pulse, heart rate), respiration and respiratory rate are assessed, the neurological status determines the dynamics of cerebral and meningeal syndrome, the severity and degree of regression of focal neurological symptoms, and It is also necessary to note the tolerability of the treatment and the correction of drug therapy with justification.

Non-drug treatment
Strict bed rest- must be observed until 5-7 days of normal temperature and until the symptoms of intoxication disappear. In addition, bed rest should be observed for the next 1-2 weeks after the temperature normalizes. Almost complete restriction of movement, minimizing painful stimuli, prohibit balneotherapy and massive electrical procedures. Ensure the correct position of the patient: the position of the head is elevated by 30 degrees, the affected limbs are given a functional position that ensures the prevention of contractures.

Diet - individual depending on the severity, form and concomitant pathology.
Enteral nutrition in the absence of consciousness - nutritional therapy.
In focal form extract no earlier than 21 days of illness after clinical recovery and normalization of cerebrospinal fluid.

Drug treatment
Etiotropic therapy

Standard treatment regimen for febrile form of TE	Standard treatment regimen for meningeal form of TE	Standard treatment regimen for focal forms of EC	Alternatives new treatment regimen for extremely severe TBE	Alternatives treatment regimen for two-wave TE
Human serum immunoglobulin against tick-borne encephalitis virus[UD-B]
A single dose of 0.1 ml/kg body weight intramuscularly for 3-5 days (until the general condition improves and the fever disappears). The course daily dose is at least 21 ml.	Single dose 0.1 ml/kg body weight x 2 times a day with an interval of 10-12 hours, intramuscularly, for at least 5 days (until the fever disappears, regression of general infectious symptoms, stabilization and reduction of meningeal symptoms). Course dose is from 70 ml to 130 ml.	A single dose of 0.1 ml/kg body weight 2-3 times a day with an interval of 8-12 hours, intramuscularly, for 5-6 days (until the temperature decreases and neurological symptoms stabilize). Course dose is from 80 ml to 130 ml.	A single dose can be increased to 0.15 ml/kg body weight.	The drug is reused according to the treatment regimen for meningeal or focal forms, depending on the nature of the clinical manifestations.
If patients with meningeal and focal forms of EC for any reason did not receive specific therapy during the febrile stage of the disease, it is possible to administer immunoglobulin at the apyrexia stage of the acute period of the disease for 5-6 days in a single dose of 0.1 ml/kg body weight after 10-12 hours.
The decision to administer immunoglobulin against tick-borne encephalitis to a pregnant woman is made by a council consisting of an obstetrician-gynecologist, an infectious disease specialist, and a neurologist.

Pathogenetic therapy
Detoxification therapy

(the amount of fluid should be strictly controlled based on daily diuresis, blood acid-base level, volume of injected fluid, taking into account the degree of severity):
· with moderate severity of the infectious process, patients should drink plenty of fluids at the rate of 20-40 ml/kg.
· in case of severe infection - parenteral administration of isotonic solutions (under the control of blood electrolytes. The daily requirement is distributed in a minimum volume of only necessary drugs):
· 0.9% sodium chloride solution, 400 ml IV, drip [UD-S];
· 0.5% dextrose solution, 400.0 ml IV, drip [UD-S].

Dehydration therapy(for intracranial hypertension, prevention of cerebral edema):
· L-Lysine - escinate 5-10 ml 2 times a day intravenously [UD - V]
MgSO4 5.0-10.0 ml i.v.

Treatment of cerebral edema:
· mannitol 15% solution 1-1.5 g/kgv/v slowly in a stream or drip. The daily dose should not exceed 140-180 g with furosemide 20-40 mg (2-4 ml) IV.
· and/or L-lysine escinate 5-10 ml x 2 times a day for 3-5 days (UD - B]
under the control of blood Na+ content. When the blood Na+ content is at the upper limit of normal or higher, the administration of mannitol is contraindicated due to changes in blood osmolarity and the threat of swelling of brain cells. In these cases, the administration of a concentrated glucose solution of 10%, 20% or 40% and a 0.45% NaCl solution is indicated.

Nonsteroidal anti-inflammatory drugs ( when body temperature rises above 38.5 0 C, in the presence of a head injury and a history of convulsive syndrome).
Duration 1-3 days:
Diclofenac 3 ml IM [UD - B]
or
· ketoprofen 2 ml IM [UD - B]
· paracetamol 500 mg, orally, with an interval of at least 4 hours [UD - B].
With severe pain syndrome (severe headache, muscle pain, bone aches, polyradiculoneuritis)
Tramadol 50-100 mg IV, IM, s.c. The maximum daily dose is 400 mg (in exceptional cases it can be increased to 600 mg). [UD - B]
or
· xefocam 8 mg intravenously in 200 ml of saline or as a bolus.

Glucocorticosteroids:
For meningoencephalitic, meningoencephalopoliomyelitis, polyradiculoneuritic forms and the development of ITS for 3-7 days, prednisolone 5-10 mg/kg, IV [UD - V]
or
dexamethasone 8-12 mg IV, bolus [UD - V]

Antihistamines:
clemastine 1ml, IM [UD - V]
or
Diphenhydramine 1% -1.0 with analgin 50% -2.0, IM

To improve microcirculation and rheological properties of blood, for antiplatelet purposes(taking into account coagulogram indicators):
· pentoxifylline 2% solution 100 mg/5 ml, 100 mg in 20-50 ml of 0.9% sodium chloride, IV drop, course from 10 days to 1 month [UD - B]
or
Heparin subcutaneously (every 6 hours) 50-100 IU/kg/day 5-7 days [LE - A]
or
warfarin 2.5-5 mg/day, orally

Symptomatic therapy:
Relief of convulsive syndrome:
· diazepam 2 ml per 10.0 ml 0.9% sodium chloride, IV bolus [UD - V]
or
carbamazepine 200 mg for seizures, as prescribed by a neurologist (from 200 mg to 600 mg) [UD - B]

Improving cerebral circulation:
In the acute period, with depression of consciousness and fever, vascular drugs are contraindicated, after normalization of temperature and clarity of consciousness, as well as in the presence of cognitive disorders, add antioxidants (if at the time of examination and there is no history of epileptic seizures):
Mexidol 5.0 IV drip per 200.0 ml 0.9% sodium chloride [UD - B],
· Ceraxon 500 mg-1000 mg intravenously in 200.0 ml of 0.9% sodium chloride [UD - B],
· gliatillin 1000 mg IV drip [UD - V]

Neuroprotection:
· ascorbic acid in the acute period 5.0 -8.0 intravenous drops of 0.9% sodium chloride [UD - V]
· thiamine chloride 1.0-2.0 w/m [UD - V]
· pyridoxine hydrochloride 1.0-2.0 v/m [UD - V]

Antibacterial drugs (for severe forms of tick-borne encephalitis, complicated by the addition of a bacterial infection):
· ceftriaxone 1.0 - 2.0g x 2 times/day, IM, IV, 10 days;
or
cefepime 1.0 g every 12 hours (i.m., i.v.). [UD - V]
· ciprofloxacin 100ml x 2 times/day, IV 7-10 days

Reserve antibacterial drugs:
· amikacin 15 mg/kg/day, IM, but not more than 1.5 g/day for 10 days. [UD - V]
Vancomycin 1.0 g every 12 hours, intravenously, for 7-10 days. [UD - V]
Meropenem 2.0 g every 8 hours IV, for 7-10 days [LE - B]

Combination of 2 or more antibacterial drugs according to indications:
Antifungal drugs ( according to indications ):
· Fluconazole 100 ml IV once a day, every other day, 3-5 times [UD - B]

Other drugs for general anesthesia during emergency medical care, intubation and other invasive procedures:
· Propofol at a rate of 0.3-4 mg/kg per 1 hour IV drip to provide sedation during intensive care and during mechanical ventilation [LE - B]
or
Lidocaine 1%, 2% 4-5 ml

For infectious-toxic shock:
Prednisolone 5-10 mg/kg IV [UD - B]
· dopamine 10-15 mcg/kg per 1 min. i.v. The infusion is carried out continuously for from 2-3 hours to 1-4 days or more. The daily dose reaches 400-800 mg. The administration is carried out under ECG control. [UD - V]

With the development of respiratory failure:
· Mechanical ventilation from the moment the first signs of respiratory failure and edema and brain swelling appear, tracheostomy (if indicated).
· To combat hypoxia, systematically administer humidified oxygen through nasal catheters (20-30 minutes every hour).
· Conducting hyperbaric oxygenation (10 sessions under pressure p 02-0.25 MPa)

For bulbar disorders:
· IVL;
· Prozerin 1.0 ml s.c.

If hemostasis is impaired:
· FFP - according to indications;
· aprotinin 20-60 thousand. units bolus every 6 hours.

List of essential medicines:
· human serum immunoglobulin against tick-borne encephalitis virus - solution for injection, 1 ml in an ampoule.

List of additional medicines:
· prednisolone - solution for injection in ampoules 30 mg/ml 1 ml;
· dexamethasone - solution for injection in ampoules 4 mg/ml 1 ml;
· dopamine - concentrate for the preparation of injection solution in ampoules of 25 mg (5 ml), 50 mg (5 ml), 100 mg (5 ml), 200 mg (5 ml);
· NaCl solution 0.9% - 100, 200, 400 ml;
· sodium bicarbonate solution 5% - 200.0 ml, 400.0 ml;
· Ringer's solution for infusion, 200 ml and 400 ml;
Acesol - solution for infusion 400.0 ml;
· trisol - solution for infusion 400.0 ml;
· Chlosol - solution for infusion 400.0 ml;
· dextran - solution for infusion 400.0 ml;
· dextrose - solution for infusion 100 ml;
· fresh frozen plasma for infusion;
· mannitol - solution for injection 15% 200 ml and 400 ml;
· furosemide - solution for injection in ampoules 1% 2ml (UD - B);
· L-lysine escinate - solution for injection in ampoules of 5 ml;
· paracetamol - tablets of 0.2 and 0.5 g, rectal suppositories 0.25; 0.3 and 0.5 g;
Diclofenac - tablets, dragees 25 mg, 50 mg, 75 mg, 100 mg, 150 mg; ointment, gel; injection solution 75 mg/3 ml, 75 mg/2 ml;
· ketoprofen - solution for injection 100 mg/ml, 100 mg/2 ml; solution for intramuscular injection 50 mg/ml; capsule 50 mg, 150 mg; tablets, film-coated tablets 100 mg, 150 mg;
· heparin, 1 ml/5000 units, ampoules 1.0 ml, 5.0 ml, bottles of 5.0 ml;
Warfarin - tablets 2.5 mg, 3 mg, 5 mg
· pentoxifylline - 2% solution 100 mg/5 ml, 100 mg in 20-50 ml of 0.9% sodium chloride, ampoules.
· aprotinin - solution for injection in ampoules of 10 ml (100,000 units);
· ceftriaxone - powder for the preparation of injection solution for intramuscular and intravenous administration in a 1 g bottle;
· cefepime - powder for the preparation of injection solution for intramuscular and intravenous administration in a bottle of 500 mg, 1.0 g, 2.0 g.
· ciprofloxacin - solution for infusion 0.2%, 200 mg/100 ml; 1% solution in ampoules of 10 ml (concentrate to be diluted); film-coated tablets 250 mg, 500 mg, 750 mg;
· meropenem - powder for the preparation of a solution for infusion of 1000 mg in 100 ml bottles;
· vancomycin - powder, lyophilisate for the preparation of solution for infusion 500 mg, 1000 mg;
· amikacin - powder for the preparation of solution for injection 0.5 g; injection solution 100 mg/2 ml, 500 mg/2 ml;
· fluconazole - solution for infusion 200 mg/100 ml; solution for intravenous administration 2 mg/ml;
· tramadol - injection solution 100 mg/2ml, 50 mg/ml;
· propofol - emulsion for intravenous administration 10 mg/ml; 20 mg/ml; 200 mg/20ml; 500 mg/50 ml; fat emulsion for intravenous infusions 1%;
· ascorbic acid - injection solution 5%;
· thiamine chloride - solution for injection 5%;
· pyridoxine hydrochloride - solution for injection 5%;
Mexidol - injection solution 2 ml;
· diazepam - injection solution 10 mg/2 ml;
Carbamazepine - film-coated tablets 200 mg;
· cerakson solution for injection 4 ml;
· gliatillin - solution for injection 2 ml;
· lidocaine - solution for injection 1%, 2%, 10%; aerosol 10%;
· clemastine - injection solution 1 mg/ml.

Surgery: No.

Other types of treatment: No.

Indications for consultation with specialists:
· consultation with a neurologist: in an infectious diseases hospital or department to assess the neurological status, exclude organic diseases of the central nervous system that are not accompanied by inflammation of the brain, spinal cord and soft meninges;
· consultation with a resuscitator: determination of indications for transfer to the ICU;
· consultation with an ophthalmologist: examination of the fundus to determine signs of intracranial hypertension, dynamics of hyperemia, congestion of the optic nerves, correction of dehydration therapy, determination of indications for radiological diagnostics (CT/MRI) of the brain;
· consultation with a neurosurgeon: identification or exclusion of a brain space-occupying lesion (intracerebral hematoma, hemorrhage into a brain tumor, abscess);
· consultation with an oncologist: to exclude a brain tumor (if indicated);
· consultation with a cardiologist in case of development of cardiovascular disorders;
· consultation with an endocrinologist for concomitant diseases - diabetes, obesity.
· consultation with an ENT doctor for diseases of the ENT organs;
· consultation with an allergist;
· consultation with a psychiatrist for mental and behavioral changes.

Indications for transfer to the intensive care unit:
If complications develop:
· bulbar disorders;
· disturbances of consciousness;
· edema - swelling of the brain;
· infectious-toxic shock;
· severe and extremely severe degree of neurological disorders;
hemodynamic instability;
· respiratory dysfunction;
· pneumonia, sepsis;
· anaphylactic shock (risk of possible complications of treatment).

Indicators of treatment effectiveness:
After a person recovers, tick-borne encephalitis leaves long-lasting and lasting immunity. Virus neutralizing antibodies accumulate in the blood rather slowly, reaching a maximum after 1.5-2.5 months and persist for many years. The accumulation of virus-neutralizing antibodies is also observed in vaccinated people and people living for a long time in areas of encephalitis.

Clinical indicators:
· stable normalization of temperature;
· no intoxication;
· regression of neurological symptoms.

Laboratory indicators:
· normalization of UAC indicators;
· sanitation of cerebrospinal fluid.

Further management:
The period of dispensary observation by an infectious disease specialist and a neurologist for those who have recovered from tick-borne encephalitis is up to 2 years. A medical examination and blood ELISA for markers of the tick-borne encephalitis virus are carried out in recovered individuals over time after 1, 3, 6, 12, 24 months. In addition to laboratory examination methods, if indicated, consultations with a neurologist and an ophthalmologist are prescribed, as well as instrumental studies (REG, EEG, nuclear MRI of the brain, etc.). Within 3-6 months. after suffering from the disease (if indicated, for longer), limit physical activity, exclude balneotherapy and physiotherapy, and vaccination.

Hospitalization

Indications for planned hospitalization: No.

Indications for emergency hospitalization:
· tick-borne encephalitis, regardless of the form and severity of the disease.

Information

Information

ABBREVIATIONS USED IN THE PROTOCOL

IgM, IgG	Immunoglobulins of classes M, G
VKE	Tick-borne encephalitis virus
WHO	World Health Organization
ITS	Infectious-toxic shock
ELISA	Linked immunosorbent assay
CT	CT scan
KSH	Acid-base state
CE	Tick-borne encephalitis
ICD	International Classification of Diseases, Injuries, and Conditions Affecting Health, 10th Revision
MRI	Magnetic resonance imaging
UAC	General blood analysis
OAM	General urine analysis
PCR	Polymerase chain reaction
RNA	Ribonucleic acid
CSF	Cerebrospinal fluid
SMP	Spinal tap
ESR	Erythrocyte sedimentation rate
Ultrasound	Ultrasonography
CNS	central nervous system
ChMN	Cranial nerves
ECG	Electrocardiogram
EEG	Electroencephalography

List of protocol developers:
1) Kosherova Bakhyt Nurgalievna - Doctor of Medical Sciences, Professor, RSE at the Karaganda State Medical University, Vice-Rector for Clinical Work and Continuing Professional Development, Chief Freelance Adult Infectious Diseases Specialist of the Ministry of Health of the Republic of Kazakhstan.
2) Egemberdieva Ravilya Aitmagambetovna - Doctor of Medical Sciences, RSE at the PVC “Kazakh National Medical University named after S.D. Asfendiyarov”, professor of the department of infectious and tropical diseases.
3) Duysenova Amangul Kuandykovna - Doctor of Medical Sciences, Professor, RSE at the PVC “Kazakh National Medical University named after S.D. Asfendiyarova”, Head of the Department of Infectious and Tropical Diseases.
4) Ivasiv Ivan Vasilievich - PhD, Candidate of Medical Sciences, Central Asian Office of the Center for Disease Control (CDC), clinical epidemiologist.
5) Sarzhanova Saule Myrzabekovna - State Public Enterprise “City Clinical Hospital No. 7” of the Almaty Health Department, head of the neurology department, neuropathologist of the highest category.
6) Mazhitov Talgat Mansurovich - Doctor of Medical Sciences, Astana Medical University JSC, Professor of the Department of Clinical Pharmacology.

Conflict of interest: absent.

List of reviewers:
-Baesheva Dinagul Ayapbekovna - Doctor of Medical Sciences, Professor, RSE at the Astana Medical University, Head of the Department of Children's Infections, Chairman of the Republican Public Association "Society of Infectious Disease Doctors".
-Kulzhanova Sholpan Adlgazyevna - Doctor of Medical Sciences, Astana Medical University JSC, head of the department of infectious diseases and epidemiology.

Conditions for reviewing the protocol: review of the protocol 3 years after its publication and from the date of its entry into force or if new methods with a level of evidence are available.

Attached files

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During the summer, there is a high probability of getting a tick bite. This topic must be treated extremely scrupulously. Today, tick bites in humans are quite common. This combination of circumstances can lead to serious consequences and even a threat to life. When going on a picnic in the forest, you must follow some rules of behavior there. If a tick is found, submit it for examination. These and many other questions will be discussed below.

ICD-10 code

A84 Tick-borne viral encephalitis

A69.2 Lyme disease

Incubation period after a tick bite in humans

Infection occurs directly through the bite of an arthropod. The tick is a carrier of many dangerous diseases for humans. There have been cases where infection occurred through the gastrointestinal tract. No, you don't need to eat a tick to do this. But cases of ticks entering the body in this way have been recorded, but only in animals. It is enough for a person to simply consume the milk of an animal that is infected. The incubation period in humans after a tick bite can last up to 30 days. In some cases it drags on for 2 months.

Most often, the first symptoms begin to manifest themselves 7-24 days after the bite. There have been cases where a sharp deterioration in the condition was observed after 2 months. Therefore, it is necessary to monitor your health status. The incubation period is entirely dependent on the blood-brain barrier. The weaker it is, the faster the disease, if any, will manifest itself. You need to pay attention to all strange symptoms, including an ordinary headache. This will allow you to quickly identify the disease and eliminate it.

Symptoms of a tick bite in humans

If the bite was made by an infected tick, then the person has a risk of getting serious illnesses. One of them is tick-borne encephalitis. When it develops rapidly, it damages the nervous system and can lead to inflammation of the brain. Disability and death cannot be ruled out. The main symptoms after a tick bite begin to plague a person after a week.

Symptoms after a bite are very similar to the onset of an acute respiratory disease. A person feels general malaise, body temperature rises, and body aches appear. All this may indicate the presence of an infection in the body. Slightly different symptoms are observed with borreliosis. The whole danger is that there may not be any signs for up to six months. Then the bite site begins to turn red and all the symptoms described above appear.

Additional symptoms may include vomiting, migraine, and chills. The person's condition deteriorates sharply. On the fourth day after the onset of the disease, flaccid paralysis may develop. Sometimes it affects the larynx and pharynx, making it difficult for a person to swallow. There have been cases where the reaction was so strong that disturbances in the functioning of the respiratory system and heart occurred. Epileptic seizures are possible.

What does a tick bite look like on a person?

The tick attaches to the human body through an organ called the hypostome. It is an unpaired outgrowth capable of performing the functions of sensory organs. With its help, the tick attaches itself and sucks blood. Most often, a tick bite on a person is observed in places with delicate skin, and looks like a red spot with a dark dot in the middle. You need to look for it on the stomach, lower back, groin area, armpits, chest and ear area.

Allergic reactions may occur at the site of suction. After all, flare saliva and microtraumas negatively affect human skin. The suction is painless, so the person does not feel it. The bite site is red and round in shape.

The bite of a tick, a carrier of borreliosis, looks more pronounced. It is characterized by the appearance of a specific macular erythema. The speck can change sizes and reach up to 10-20 cm in diameter. In some cases, all 60 cm were recorded. The spot has a round shape, sometimes it takes the form of an irregular oval. Over time, a raised outer border begins to form and takes on a bright red hue. In the center of the spot, the skin becomes bluish or white. The stain somewhat resembles a donut. Gradually a crust and scar form. After a couple of weeks, the scar disappears on its own.

Signs of an encephalitis tick bite in humans

It is necessary to understand that a small tick bite can lead to serious health problems. Thus, encephalitis can cause paralysis of the limbs and lead to death. There is no need to panic ahead of time. You should be able to distinguish symptoms and, if they appear, immediately consult a doctor. The likelihood of a favorable outcome is high if a person showed signs of an encephalitis tick bite at an early stage.

The first thing that appears is chills. A person thinks that he has an acute respiratory viral infection or the flu. Therefore, he begins treatment according to his own standard regimen, but it does not help. Chills are accompanied by an increase in temperature, sometimes reaching 40 degrees. At the next stage, headache and nausea appear, sometimes all this is supplemented by vomiting. The person is still sure that it is the flu. Severe headaches are replaced by body aches. Breathing gradually begins to become difficult, the person is unable to move normally. His face and skin rapidly turn red. This indicates that the virus has begun its harmful activities. After this, irreversible processes begin in the body. Possible paralysis or death.

Diseases after a tick bite in humans

A tick bite is safe, but only if the tick was not a carrier of any disease. The whole danger lies in the fact that most diseases manifest themselves over time. The person forgets about the bites and continues to live as before. Meanwhile, the disease begins to actively progress, all this is accompanied by certain symptoms. Therefore, it is worth noting that after a tick bite, a person can develop the following diseases: tick-borne encephalitis, borreliosis, tick-borne acarodermatitis and dermatobiasis. The first two diseases are especially dangerous.

Ehrlichiosis in humans from a tick bite

This is a dangerous infection that can enter the body after a tick bite. It can be cured with effective treatment. If it is not started, the person will die. Ehrlichiosis is caused by bacteria that are transmitted into the body by a tick bite. The likelihood of contracting this disease increases if a person is often in areas where ticks are common. It is worth noting that a person can develop ehrlichiosis from a tick bite. However, not all ticks are carriers of the disease.

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Borreliosis in humans from a tick bite

Lyme disease is caused by spirochetes of the genus Borrelia. The phenomenon is widespread on all continents, so avoiding infection is not so easy. A person who has Lyme disease is not dangerous to others. Bacteria, along with saliva, enter the human skin, and after a few days they begin to actively multiply. The danger is that a person can develop borreliosis from a tick bite, with further damage to the heart, joints and brain. Bacteria can live in the human body for years and gradually lead to a chronic form of the disease.

The incubation period is 30 days. On average, symptoms begin to manifest themselves after 2 weeks. In almost 70% of cases, this is redness of the skin, the so-called erythema. The red spot can change in size and change. Ultimately, the bite site becomes covered with a crust, and the skin may remain pale or become bluish. A red hill appears around the site of the lesion, all of which visually resembles a donut. After a couple of weeks everything disappears. But the danger has not passed; in a month and a half, damage to the nervous system and heart may occur.

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Tick-borne encephalitis from a tick bite

Tick-borne encephalitis is a natural focal infection that in most cases affects the human nervous system. This can lead to disability and even death. Infection occurs from a tick bite, which can cause tick-borne encephalitis. People who like to spend a lot of time in nature are susceptible to this influence. They need to take extra care and constantly inspect their body for ticks.

The first signs after a bite may appear as early as a week later. Sometimes it takes a whole month. The first thing that happens is chills, accompanied by an increase in body temperature and a feverish state. The person sweats intensely, suffers from a severe headache and body aches. If symptoms do not manifest themselves for a long time, even mild muscle weakness can be a cause for panic.

It is necessary to seek help if there is a sharp increase in body temperature, severe headaches, or sleep disturbances. Often the disease can cause hallucinations and seizures. All these symptoms should be a reason to go to the hospital.

Consequences of a tick bite in humans

A tick bite can cause a number of diseases. Naturally, if you do not pay attention to this, serious consequences are possible. So, most often, a person can develop irreparable consequences from a tick bite. They arise due to untimely treatment of encephalitis, borreliosis, akarodermatitis and dermatobiasis.

• Encephalitis can lead to serious consequences. It often affects the central nervous system and heart. The person may develop difficulty breathing and eventually paralysis. If treatment is not started in time, the victim may remain disabled or die.
• Borreliosis. The danger of defeat is that the disease can be “silent” for six months. During this period, irreparable changes can occur in the body. Thus, borreliosis manifests itself in the form of erythema. Redness may appear at the site of the bite, progress over time and eventually disappear. The worst thing begins later: after a month, serious disorders of the central nervous system and heart develop. A fatal outcome cannot be ruled out.
• Acarodermatitis. There are no consequences after such a defeat. A person may be bothered by local allergic reactions, but all this passes over time. The disease does not affect internal organs and systems.
• Dermatobiasis. The disease is especially dangerous for children. If eggs from the tick's abdomen begin to hatch in the body, death is possible. The child’s body is not able to cope with this problem, even with high-quality treatment.

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Complications after a tick bite in humans

After a tick bite, various complications can develop. The central nervous system is primarily affected. Possible development of epilepsy, headaches, paralysis. The cardiovascular system is also particularly affected. The appearance of arrhythmia and constant surges in blood pressure cannot be ruled out. The lungs also suffer, pneumonia can develop and, as a result, pulmonary hemorrhages. The kidneys and liver are negatively affected. In this case, after a tick bite, a person develops complications in the form of nephritis and digestive disorders.

Encephalitis is especially dangerous. At best, everything will end in chronic weakness. The body is able to recover on its own after a couple of months. In severe cases, the process can drag on for six months. In the worst case, a person will develop defects that will interfere with his normal life. Persistent changes in the body lead to epilepsy and disability.

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Temperature during a tick bite in a person

A sharp increase in body temperature a few hours after the bite indicates that the body responded to such an invasion with an allergic reaction. This happens due to the saliva of a sterile or infected tick getting under the skin. Therefore, when a tick bites, a person’s temperature must be constantly recorded; moreover, the victim must be monitored for 10 days. Body temperature should be constantly measured. Fever may manifest itself 2-10 days after the bite. This symptom indicates the onset of infectious pathogenesis.

With tick-borne encephalitis, the temperature may rise 2-4 days after the bite. It lasts for two days and then returns to normal on its own. A repeated increase is recorded on the 10th day. with borreliosis, body temperature does not change so often. With ehrlichiosis, fever appears on the 14th day. Moreover, it can be elevated for 20 days. Therefore, it is imperative to monitor temperature indicators.

Redness after a bite

This symptom is characteristic of Lyme disease. The tick site is redder and resembles a ring. This can happen 3-10 days after the defeat. In some cases, a skin rash occurs. Over time, the redness after the bite changes in size and becomes much larger. Borreliosis is characterized by the appearance of erythema. It is accompanied by severe fever, headache, and fatigue. Motor restlessness, muscle and joint pain are possible. Swelling of the tonsils is often observed.

Over the next 3-4 weeks, the rash begins to gradually subside and the spot may disappear completely. A person, as a rule, does not pay attention to all this. The danger still remains. So, after a month and a half, severe complications from the central nervous system may appear. Therefore, it is imperative to monitor redness and tick bites in general!

Lump at the site of a tick bite

Often the human body responds negatively to the introduction of a tick into it. So, the bite site begins to turn red, and in some cases a lump appears. Why does all this happen and is there any danger in this? It should be understood that a common allergic reaction can cause a lump at the site of a tick bite. It occurs due to the piercing of the skin with the proboscis and the ingress of saliva into them. Moreover, it is not necessary that saliva be infected; even in sterile form it can provoke an allergic reaction. Itching, redness and slight swelling are normal reactions of the body. But there’s no point in relaxing.

If the tick was submitted for examination, and it confirmed the absence of dangerous bacteria in it, there is no reason to worry. When a lump appears after a while, but the tick has not been checked, there is reason to worry. You need to go to the hospital immediately. This may indicate infection. Diseases caused by ticks have been described above.

The lump may occur due to improper removal of the tick. In some cases, the body of the tick is safely removed, but its proboscis remains in the skin. Therefore, the removal process must be monitored more carefully. If a lump appears and additional symptoms such as fever and headache, you should immediately go to the hospital.

Diarrhea after a tick bite

Intestinal upset is not observed very often, but it can be one of the signs of serious damage to the body. Each person is individual, and even a bite from an uninfected tick can lead to a number of negative reactions. The affected area may become red and, over time, itching and a rash appear. The intestines can also react negatively after a tick bite, causing diarrhea.

This symptomatology is twofold. In one case, it may indicate a weakness of the body, in another, it may indicate infection. Therefore, if negative symptoms appear, including intestinal upset, you should go to the hospital. Even if a person feels better after a while. Many tick-borne diseases begin to manifest themselves 2 weeks after the bite. During this period, an infection can develop in the body and lead to irreversible processes.

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Seal after a bite

A lump after a bite may indicate an infection has entered the body. If this symptom appears along with redness, itching and rash, you should immediately consult a doctor. This can be either improper removal of the tick or the development of a serious disease. Often, after a bite, a lump forms; its development is provoked by an allergic reaction. This is perhaps the most harmless thing that can happen.

By piercing the skin with its proboscis, the tick begins to attach itself. This process can cause itching, redness and even rawness. Often after removal a compaction appears. True, this symptom is not so harmless. It is likely that an infection has begun to develop in the human body. This could be encephalitis or borreliosis. You should immediately seek help from a hospital.

Often people do not remove the tick itself correctly. This causes its proboscis to remain embedded in the skin. In this regard, the inflammatory process begins, severe irritation and compaction appear. Doctors will help you cope with this problem.

Treatment after a tick bite in a person

The first step is to remove the tick. This can be done either independently or by going to the hospital. The live tick must be preserved and taken for examination. If it was killed during removal, it is worth placing it in a container with ice. In any case, the tick must be submitted for examination! After all, bites can cause a number of dangerous diseases. It is important that after a tick bite a person has the disease correctly diagnosed and effective treatment is prescribed.

The bite is treated with antibiotics. True, they are not always used to eliminate the infectious agent. To eliminate encephalitis, antibiotics are not used.

• Tick-borne encephalitis. The first thing a person needs to do is provide bed rest. It is advisable that it be at least a week. For the first three days, the victim should take human immunoglobulin. It is recommended to resort to the help of such means as: Prednisolone, Ribonuclease. Blood substitutes that are also suitable are Reopoliglyukin, Poliglyukin and Hemodez. If meningitis occurs, an increased dose of B vitamins and ascorbic acid is recommended. In case of respiratory failure, intensive ventilation is used.
• The treatment regimen for borreliosis is somewhat different. The first step is to hospitalize the patient. At the stage of manifestation of erythema, he should take Tetracycline. Bacteriostatics play a special role in treatment. This may be Lincomycin and Levomycetin. If a neurological syndrome is observed, it is treated with intravenous injections of bactericidal antibiotics. This may be Azlocillin and Piperacillin. Water balance is restored using blood substitutes, such as Reopoliglyukin and Poliglyukin

Where to go if you have symptoms of a tick bite in a person?

When bitten by a tick, you need to follow a special algorithm. The first step is to remove the tick. After which it is submitted to a special accredited laboratory. This will reveal the presence of infectious agents. The study is carried out using the PCR method, directly in the body of the tick. A person needs to donate blood to detect antibodies. After all, bites can cause serious consequences. The victim is recommended to undergo a course of treatment based on the results of laboratory tests. If symptoms of a tick bite appear in a person, you need to know where to go.

Where can you submit a tick and how to check it. It is necessary to find a hospital that does such research. Laboratory addresses and telephone numbers can be found on the Internet. Just visit the Ukrpotrebnadzor website. In fact, every hospital that has a laboratory should accept ticks. Most importantly, the research is completely free! It is recommended to clarify this information. Results are provided on the day the tick is submitted or the next day.

How to treat a tick bite on a person?

If a tick is found on the body, it must be removed immediately. An experienced specialist can help with this. In the hospital, the tick is immediately submitted for examination, because a tick bite in a person can provoke the development of serious diseases, so you need to know how to treat the affected area. In outpatient treatment, a person is recommended to use immunoglobulins. The most commonly prescribed drug is Rimantadine. It is taken for 3 days, one tablet in the morning and evening.

At home, ticks can be removed using oil. You need to drop a lot of it on the head of the tick. Alcohol is also used for these purposes. After 15 minutes you can begin removal. In most cases, the tick comes out on its own. Removing it is much easier this way; just use tweezers and pull out the tick in a circular motion. It is recommended to treat the bite site with hydrogen peroxide. Further advice can be obtained from the hospital. Usually, the affected area is not treated with anything else.

Tablets for tick bites in humans

If there is a risk of developing encephalitis in a person or the diagnosis has been confirmed, they begin to take human immunoglobulin. This could be Prednisolone and Ribonuclease. Blood substitutes such as Reopoliglyukin, Poliglyukin are actively used. All these tablets for tick bites do not allow infection to spread throughout the human body and lead to serious damage to the body.

• Prednisolone. The dosage regimen is individual. Usually the product is used once a day. It is actively used to eliminate the consequences of tick bites. It is not recommended to take the drug if you have fungal infections or intolerance. Hypokalemia, flatulence, sleep disturbances and negative nitrogen balance may develop.
• Ribonuclease. For the treatment of tick-borne encephalitis, the drug is administered intramuscularly 6 times a day. The dose may be adjusted. The product should not be used in case of respiratory failure, bleeding and tuberculosis. Allergic reactions may develop.
• Reopoliglyukin and Poliglyukin. The drugs are administered intravenously at a rate of 60 drops per minute. The maximum quantity is 2.5 liters. They cannot be used for skull injuries and diabetes. May lead to the development of allergic reactions. It extremely rarely causes arterial hypotension.
• For borreliosis, slightly different drugs are used. Reopoliglyukin and Poliglyukin are also used as hematopoietic medications. At the initial stages of erythema, Tetracycline is used, as well as bacteriostatics: Levomycetin and Lincomycin. Azlocillin and Piperacillin are used as bactericidal antibiotics.
• Tetracycline. The product can be used both in the form of tablets and ointments. The ointment is applied to the affected area every 6 hours. As for tablets, they are used in doses of 250-500 mg with the same frequency. The product should not be used by children under eight years of age, as well as by pregnant women. The development of diarrhea, constipation, and allergic reactions is possible.
• Levomycetin and Lincomycin. When taken orally, the dose is up to 500 mg. This amount of product is used up to 4 times a day. The duration of treatment is usually 10 days. The drugs should not be used if the functionality of the liver or kidneys is impaired. A similar requirement is made for children and pregnant women. Possible development: leukopenia, depression and skin rash.
• Azlocillin. The drug is administered intravenously. The maximum dosage is 8 grams. That is, 2 grams 4 times a day. It should not be taken by people with allergic reactions. Can cause nausea, vomiting, and anaphylactic shock.
• Piperacillin. The drug is administered intravenously over 30 minutes. The daily dose is 100-200 mg. The medication is administered up to 4 times a day. It should not be taken in case of hypersensitivity, pregnancy or lactation. Can lead to headaches, skin hyperemia and dysbacteriosis.

Prevention of tick bites in humans

Prevention is entirely based on a few basic rules. First of all, it is necessary to vaccinate. This will avoid serious consequences in the future. If a person is already infected, it is not advisable to carry out this procedure. The second criterion for prevention is specific immunotherapy. It is a therapeutic measure in which immunoglobulin is introduced into the human body. Prevention of tick bites should be carried out more carefully in people whose activities are directly related to working in nature.

It is important to dress properly when going to the forest or nature. Special clothing will help prevent ticks from getting under it. You can use special repellents. These can be either sprays or creams that are applied to the skin. All this will help avoid a bite and further infection. Following simple rules and checking the body after returning from nature will protect a person and prevent possible serious consequences.

Forecast

The further course depends on how quickly the person reacted to the defeat. If he ignored the symptoms and did not see a doctor, the prognosis is extremely unfavorable. The fact is that tick bites can only manifest themselves after a while. This is the main danger. The first symptoms may appear within a week and fade away after a few days. Then it flares up with renewed vigor, but already entails serious damage to the central nervous system and brain. This can lead to the development of epilepsy, paralysis, disability and even death. Naturally, the prognosis in this case is unfavorable.

If a person notices a tick in time, removes it and submits it for examination, the likelihood of a good outcome is high. After all, even if the tick is infected, based on the results of the examination, the person will be prescribed high-quality treatment. This will prevent all serious consequences. The favorable prognosis depends entirely on the person himself.

Death from a tick bite in humans Death after a bite can occur for a number of reasons. In most cases, this is due to infection with serious diseases such as encephalitis and borreliosis. Many people ignore the symptoms and are in no hurry to see a doctor. Meanwhile, the disease begins to actively progress. Encephalitis is especially dangerous; such a tick bite can cause death in humans.

The disease may manifest itself at the initial stage and then fade away. After which it returns with renewed vigor and leads to serious damage to the central nervous system and brain. This often causes death. Borreliosis is also dangerous. It can manifest itself six months after infection. And everything happens instantly. Animals may die instantly. Finally, dermatobiasis. This disease is fatal in children. The body of adults is more adapted to this infection.