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

Of all the blood-sucking ticks, the most resentful. It is with them that such dangerous diseases as encephalitis and borreliosis are associated. The tick bite itself is painless. The victim does not always identify the parasite on his body in time, which leads to sad consequences. But if a pest is detected, it is necessary to neutralize it correctly. Wrong actions when biting a forest or city tick can aggravate the situation.

Briefly about ticks

Knowing everything about ticks, it is easier to understand their behavior and prevent complications of the bite. Find out where ticks live and what they are. An interesting fact about ticks - these animals are not insects. They are arachnids of the arthropod type.

In nature, it is more common to meet with ixodid ticks. The European forest tick and taiga tick are common species.

Why is a tick bite dangerous?

• tick-borne encephalitis- the most dangerous disease, entailing inflammation of the meninges, is fraught with death;
• Lyme disease- the same disease is known as borreliosis. Provokes skin, neurological and cardiological reactions, meningitis;
• tick-borne relapsing fever- the pathogen damages the circulatory and nervous system. The prognosis is favorable with early detection and adequate treatment;
• hemorrhagic fever- there is damage to the central nervous system and respiratory organs. It develops rapidly, has a high mortality rate;
• tularemia- severe bacterial infection, accompanied by lymphadenitis;
• tick-borne ehrlichiosis- causes respiratory distress and circulatory problems. The complexity of diagnosis and treatment lies in the fact that the disease does not manifest itself for a long time.

ICD code 10

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

What does a tick bite look like?

Bite symptoms

The tick bite site usually itches and turns red. The puncture point can be distinguished. A red spot with a white area after a tick bite is characteristic of borreliosis, therefore, such symptoms should alert. But slight redness of the skin after a tick bite is a common occurrence. It manifests itself 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 induration - occurs after the bite of an infected tick;
• weakness and slight chills;
• enlarged lymph nodes;
• headache;
• lowering blood pressure.

Symptoms with a bite of an encephalitis tick in humans are more varied. The brain works worse, paralysis and respiratory failure develop. But all these signs appear over time. Ticks can carry a variety of infections, some of which are not life-threatening, but uncomfortable. This category includes dermatological inflammatory reactions.

First aid

If the tick has bitten and fell off on its own, it remains only to process the wound. For this purpose, use any available antiseptic. Brilliant green, hydrogen peroxide, chlorhexidine will do. What else can you treat the tick bite? If pharmacy antiseptics are not at hand, soda solution, hand disinfection gel, vodka will do.

How to treat the place after a tick bite if the head of the pest remains under the skin? In this case, you should not wait for acute inflammation. To begin with, they try to pull out the broken off fragment using an alcohol-treated or calcined needle. They act in the same way as in the case of a splinter. After the puncture is sanitized with 3% peroxide, and then smeared 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, it is necessary to donate venous blood for the following examinations:

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

To make a diagnosis, one analysis is not enough. Repeated blood sampling is carried out to clarify the result after a certain period of time.

Treatment

When a tick bites, local treatment is carried out and the victim is given a referral for laboratory tests. At the same time, with a tick bite, immunoglobulin is injected. It prevents the development of tick-borne encephalitis, but does not completely exclude it. Self-administration of injections is unacceptable, since the protein, once it enters the human body, can cause a violent reaction. Usually, the patient is observed for an hour after the administration of immunoglobulin. Then they let go home.

If the bite site swells, becomes inflamed, reddens, it is allowed to use "Diclofenac" and "Fenistil. For resorption of hematomas and redness, venotonic drugs are suitable.

If house ticks are disturbed, antiallergic therapy is prescribed taking into account the symptoms: ointments, nasal sprays, drugs for conjunctivitis, etc. Antihistamines are taken without fail.

Complications and consequences

When an ixodid tick attacks, the development of events is unpredictable. A pest can infect a person with deadly diseases, so the most terrible complication of a bite can be safely called a fatal outcome.

In the case of encephalitis and borreliosis, emergency medical therapy is required. Ribonuclease, blood substitutes, prednisolone can prevent inflammation of the meninges. In this case, the consequences after a bite of an encephalitis tick in humans will be minimal. Manages to be limited to the mild course of the disease, followed by full recovery. Recovery usually takes 2 months.

With the development of tick-borne borreliosis, complications may not make themselves felt for several months or years. Over time, the nervous system is affected, and rheumatoid arthritis develops. Neurological syndrome is treated with "Azlocillin", antibiotics of the tetracycline series are used against the pathogen. In parallel, biostatics and antihistamines are prescribed.

Persistent dermatological disorders are considered to be the negative consequences of a tick bite in humans, and marks on the skin can remain for life.

Prophylaxis

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

The prevention of diseases carried by ticks is carried out separately. Vaccination will be able to prevent encephalitis. Tick-borne encephalitis culture vaccine is commonly used. It is injected with an interval of 1 month twice.

Now we will find out how to get rid of dust mites in an apartment. The best way to fight is to keep it clean. General cleaning includes washing clothes and bed linen, cleaning with a washing vacuum cleaner, washing floors with bleach. We get rid of down pillows and replace them with synthetic ones. Special shampoos, gels for cleaning floors, aerosols for processing clothes, textiles and upholstered furniture cope with dust pests.

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

Since 1999, an international classification of diseases of the 10th revision has been introduced on the territory of Russia, it is used to this day for systematizing diagnoses and includes ciphers 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 ciphers. Codes and ciphers are used to maintain medical confidentiality when indicating a diagnosis in medical records. At the current time, 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 of forming diagnoses in ICD 10 are as follows:

• epidemic;
• general;
• anatomical localization groups;
• conditions associated with problems of human development;
• injury.

Tick ​​bite

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

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

• chills;
• increased body temperature;
• muscle aches;
• the formation of annular erythema at the site of the bite;

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

Tick-borne encephalitis. An acute infectious disease that occurs after a tick bite. The incubation period is 14 days. The clinical picture is similar to the flu: high fever, muscle aches, there may be a cough. This disease is dangerous because it involves the nervous system in the process.

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

Every industry always sets the same systems and standards. This also applies to medicine. There is a special classification - ICD-10. The abbreviation stands for International Classification of Diseases. This is a normative document that is the basis. It is used by doctors and other professionals around the world. The ICD-10 is revised every 10 years. The edition 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. The international classification provides generality in methodological approaches to the comparison of information.

There are other diagnoses in this section. For example, B88.0 is another acariasis. The B88.1 code refers to tungiosa, a disease related to problems with the sand flea (tropical variety). All other arthropod infestations are listed under the 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 a patient contracted encephalitis of the spring-summer tick-borne type from a tick, then the code A84.0 is set. If there are no clarifications on tick-borne encephalitis, then the number A84.9 is written. If a patient has Lyme disease or borreliosis after a tick bite, then the number A69.20 is set.

Infection symptoms

Read also: Plasmodium malaria habitat and the danger it poses to humans

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

As for the strongly pronounced responses of the body of a bitten person, headache and nausea may occur. Some people have frequent bouts of vomiting. Sometimes it becomes difficult to breathe, and the breathing itself goes along with wheezing. Nervous manifestations are also characteristic. Sometimes there are even hallucinations.

In general, it is quite simple to notice a tick on a human body. It usually resembles a convex mole, and the legs are like hair growing out of it. Having sucked onto a blood vessel, it can be on the victim's body for a long time.

Potential consequences of infection

Getting a tick is easy enough.

RCHD (Republican Center for Healthcare Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical Protocols of the Ministry of Health of the Republic of Kazakhstan - 2016

Tick-borne viral encephalitis (A84)

Short description

Approved
Joint Commission on the Quality of Medical Services
Ministry of Health and Social Development of the Republic of Kazakhstan
dated August 16, 2016
Protocol No. 9

Tick-borne encephalitis(synonym spring-summer encephalitis, taiga encephalitis, Russian encephalitis, Far Eastern encephalitis, tick-borne encephalomyelitis)

The ratio of the codes ICD-10 and ICD-9

Date of protocol development: 2016 year.

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

Evidence level scale:

A	High quality meta-analysis, systematic review of RCTs, or large RCTs with very low probability (++) bias, the results of which can be generalized to the relevant population.
V	High quality (++) systematic review of cohort or case-control studies or high-quality (++) cohort or case-control studies with very low risk of bias or RCTs with low (+) risk of bias that can be generalized to the relevant population ...
WITH	A cohort or case-control study or controlled trial without randomization with a low risk of bias (+), the results of which can be generalized to the relevant population, or RCTs with a very low or low risk of bias (++ or +), the results of which cannot be directly extended to the relevant population.
D	Case series description or uncontrolled research 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 in different countries ranges from 1: 300 to 1: 1000.

Clinical classification of tick-borne encephalitis
Allocate5 clinical forms:
Febrile;
Meningeal;
Meningoencephalitic;
Meningoencephalopoliomyelitis (poliomyelitis);
· Polyradiculoneuritic.

By severity:
· Lightweight;
· Moderate;
· Heavy.

With the flow:
· Spicy;
· Chronic (progressive);
· Two-wave flow with indication of the shape of the second wave.

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

Non-focal 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's epilepsy, myoclonus-epilepsy, hyperkinetic);
· Amyotrophic (syndromes: poliomyelitis, encephalopoliomyelitis, disseminated encephalomyelitis, amyotrophic lateral sclerosis);
· Rare syndromes, not related to forms 1 and 2.

By severity:
· Easy (working capacity is preserved);
· Average (disability group 3);
· Severe (disability groups 1 and 2).

By the time of the onset of the chronic process:
· Initial progreduated (direct continuation of acute EC);
· Early progressive (occurs within the first year after acute CE);
· Late progreduated (occurs a year or more after acute CE);
Spontaneous progreduated (occurs without a distinct acute EC).

By the nature of the course of chronic TBE:
· Recurrent;
· Continuously progressing;
· Abortive.

By stages of the disease:
· Initial;
· Build-up (progression);
· Stabilization;
· Terminal.

By development time:
· Primary progreduated form (first identified in the absence of any acute form of TBE in the anamnesis);
· Secondary-progressive form (as a direct continuation of any acute form of TBE, or developed in a later period after the manifest stage).

Complications:
With all the above 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;
· Decrease in intelligence;
Epilepsy.

Examples of wording a diagnosis:
Tick-borne viral encephalitis, febrile form, moderate severity, acute course (ELISA IgM to TBE virus - positive).
Tick-borne viral encephalitis, meningoencephalitis form, severe severity, acute course (PCR RNA of the TBE virus - positive).
Complication: epileptiform syndrome.

Diagnostics (outpatient clinic)

DIAGNOSTICS AT THE AMBULATORY LEVEL

Diagnostic criteria:
Complaints:


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

Anamnesis:

Epidemiological history:

Physical examination
Feverish form:
Fever 38-39 0 С;



· The illness lasts 3-7 days;

Neurological status:

With 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 symptom, Brudzinsky's symptoms);
· Somnolence or psychomotor agitation (in severe forms);

Diffuse meningoencephalitis:
Fever;
· Epileptic seizures;


Hand tremor;

· Decrease in muscle tone.

Focal meningoencephalitis:


· Convulsive syndrome;

Poliomyelitis form:

Laboratory research:

ECG;

Severe claustrophobia;

EEG - identification of brain epiativity, focal changes (in the temporal regions): inhibition of a-rhythm, the presence of slow J - and d - waves, acute peak - fast range waves, unfavorable long periods of silence, periodic epileptiform discharges;

Diagnostic algorithm

Diagnostics (ambulance)

DIAGNOSTICS AT THE STAGE OF EMERGENCY EMERGENCY

Diagnostic measures:
· Assessment of the general somatic state of the patient (examination of the skin and visible mucous membranes, measurement of body temperature, blood pressure, pulse rate, respiratory rate, etc.);
· Assessment of the level of consciousness;
· Definition of meningeal symptoms;
· Exclusion of the state of infectious-toxic shock.

Before transportation, be sure to:
· Check and mark in the accompanying document the level of temperature, blood pressure, frequency and quality of pulse, respiration;
· Condition of the skin, a symptom of a "white spot";
· Time of the last urination;
• the degree of disorder of consciousness;
· If necessary, ensure airway patency and oxygen supply through the face mask;
· To provide peripheral venous access (venous cannula with reliable fixation) - an attempt no more than 5-10 minutes.
Start transporting the patient with an elevated leg end. The patient is transported in a horizontal position on his back with a roller under his shoulders. In case of violation of the patency of the upper respiratory tract - a roller under the shoulders, with arterial hypotension - the legs are raised above the level of the head.

Diagnostics (hospital)

DIAGNOSTICS AT STATIONARY LEVEL

Diagnostic criteria at the inpatient level:
Complaints:
· Increase in body temperature up to 38-39 ° С;
Headache (moderate to severe);
• weakness, malaise;
· muscle pain;
· nausea.

Anamnesis:
· Characterized by an acute onset of the disease: a sudden rise in body temperature to 38-39 0 С after the incubation period (from 1 to 30 days, on average 7-14 days);
· There may be a prodromal period of 1-2 days: 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 in time with the multiplication of the virus in the 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 suction ("creeping") of the tick 3-30 days before the onset of the disease;
· The use of raw cow or goat milk and products made from them (3-30 days before the onset of the disease).

Physical examination:
Feverish form:
Fever 38-39 0 С;
Hyperemia of the face, neck, injection of the sclera;
Unstable hemodynamics (tendency to hypertension);
· No symptoms of CNS damage (only asthenic syndrome);
· The illness lasts 3-7 days;
· A 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 cerebral and focal neurological symptoms.
With CE, the following is carried out:
· Assessment of the level of consciousness using the 15-point scale of Glasgow coma;
· Determination of the severity of cerebral syndrome (mild, moderate, pronounced);
· The presence of meningeal signs (rigidity of the occipital muscles, symptoms of Kernig, Brudzinsky, Bekhterev, Lessazh, Bogolepov, etc.);
Presence of focal neurological symptoms Meningeal form:

The initial manifestations do not differ from the febrile form. However, the 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 symptom, Brudzinsky's symptoms);
· Lymphocytic pleocytosis in the 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 cranial nerve paresis, nystagmus;
• delirium;
· Hallucinations;
• excitement;
• disorientation in place and in time;
Meningeal syndrome (stiff neck, Kernig's symptom, Brudzinsky's symptoms);
· Somnolence or psychomotor agitation (in severe forms);
· Consequences: transient paralysis, residual encephalitic syndrome.

Diffuse meningoencephalitis:
Fever;
· Epileptic seizures;
· Pseudobulbar disorders (breathing disorder in the form of brady- or tachypnea, like Cheyne-Stokes, Kussmaul, etc.);
Fibrillar twitching of the muscles of the face and extremities;
Hand tremor;
• suppression of deep reflexes;
· Decrease in 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, blurred speech, aphonia, impaired swallowing, increased salivation with mucus filling the airways, tachycardia, dyspnea;
· Convulsive syndrome;
· Epileptic seizures (Kozhevnikovsky epilepsy, Jacksonian epilepsy).

Poliomyelitis form:
· The most severe form of the disease;
Fever of varying severity;
General weakness, increased fatigue;
· Recurrent muscle twitching;
• sudden weakness or numbness in an extremity;
Paralysis develops 5-10 days after the temperature drops;
they may be preceded by severe pain in the arms, back, and legs;
Flaccid paresis of the cervicobrachial (cervicothoracic) localization;
· Symptoms of "head hanging on the chest", "proud posture", "stooped stooped posture", techniques of "trunk throwing of arms and throwing back the head";
Sluggish paresis of the hands and spastic paresis of the legs;
• respiratory failure (frequent superficial with paradoxical retraction of the abdomen while inhaling by retraction of the intercostal space in the lower parts of the chest;
Atony, decrease or complete loss of tendon and periosteal reflexes;
· Atrophy of the muscles of the shoulder girdle;
· Violation of pain and tactile sensitivity according to 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 "creeping", tingling sensation);
· A symptom of Lassegh and Wasserman;
• sensitivity disorders in the distal extremities of the polyneural type;
Flaccid paralysis begins in the legs and spreads to the muscles of the trunk and arms.

Criteria for the severity of febrile TBE

Criteria for the severity of the meningeal form of TBE

Laboratory research

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

Instrumental research
ECG;
· X-ray of the chest organs (according to indications);
· X-ray of the paranasal sinuses (according to indications);
· Ultrasound of the abdominal organs, kidneys (according to indications);
Ophthalmoscopy (according to indications);
· MRI of the brain: as prescribed by a neuropathologist (according to indications for the purpose of differential diagnosis and diagnosis of complications);
· CT of the brain: according to indications for the purpose of differential diagnosis and diagnosis of complications;
· Ultrasound of the brain (neurosonography).

Absolute contraindications for MRI are:
· Metallic foreign body in the eye socket;
Intracranial aneurysms clipped with ferromagnetic material;
· Electronic devices in the body (pacemaker);
· Hematopoietic anemia (for contrasting).

Relative contraindications for MRI are:
Severe claustrophobia;
· Metal prostheses, clips that are in non-scannable organs;
· Intracranial aneurysms clipped with non-ferromagnetic material.

Neurophysiological diagnostic methods (according to indications, according to the prescription of a neuropathologist):
EEG - identification of brain epiativity, focal changes (in the temporal regions): inhibition of a - rhythm, the presence of slow J - and d - waves, acute peak - fast range waves, unfavorable long periods of silence, periodic epileptiform discharges;
· Electroneuromyography (with combined lesions of the central nervous system and peripheral structures) - withathy.

Diagnostic algorithm:
At the outpatient level, it is sufficient to determine the 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);
· EMS (with meningeal and meningoencephalitic forms);
ELISA: determination of antibodies of the class IgM, IgG to tick-borne encephalitis virus;
· PCR RNA TBEV (blood and cerebrospinal fluid).

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

Indications for the study of cerebrospinal fluid:
· Severe course of febrile forms (tº more than 5 days and above 38º);
· Differential diagnosis of meningeal form of TBE with other meningitis;
· The appearance of meningeal signs in any form of tick-borne infections;
· Two-wave flow (on the second wave);
· Mixed infections;
Focal forms (excluding bulbar);
· Seronegative variants of TBE;
All unspecified febrile conditions.
Contraindications for lumbar puncture are: progressive cerebral edema, dislocation syndrome, hemorrhagic syndrome (or a high risk of its development).

Differential diagnosis

Diagnosis	Rationale for differential diagnosis	Surveys	Diagnosis exclusion criteria
Tick-borne rickettsiosis	Incubation period 1-20 days, on average 3-5 days. Temperature 8-10 days. 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). Disturbances of consciousness and mental disorders (occasionally dubiousness, delirium, hallucinations). Moderate leukocytosis with neutrophilia, acceleration of 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 uncommon. There are no focal symptoms.
Omsk hemorrhagic fever	Incubation period 1-10 days, on average 5-7 days. The febrile temperature is 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). The defeat of the lymph nodes is not typical.	Consultation with an infectious disease specialist	Changes in the mucous membrane of the oropharynx "flaming" pharynx, enanthema on the soft palate. Small hemorrhagic eruptions on the skin. Characterized by bronchitis, pneumonia. Meningeal syndrome is uncommon. Impairments of 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, on average 12 days. Temperature is low-grade or febrile, 2-7 days. The syndrome of infectious toxicosis is moderately pronounced. Meningeal syndrome is moderately pronounced. Mental disorders are possible. paresis of the cranial nerves. Moderate leukocytosis with neutrophilia, acceleration of ESR. CSF: Moderate lymphocytic cytosis from 200 to 300 cells in 1 μl.	Consultation of an infectious disease specialist, rheumatologist, dermatologist, neuropathologist, cardiologist, ophthalmologist.	Slight hyperemia of the pharynx. The patient's appearance is not typical. Primary affect, erythema annular migrans, polymorphic rash, benign lymphocytoma. Regional lymphadenitis. Damage to the eyes, joints, heart, liver. Bannowart's Syndrome.
Leptospirosis	The incubation period is 6-10 days, on average 6-8 days. The febrile temperature is 5-7 days, there may be two waves. The syndrome of infectious toxicosis is pronounced. The defeat of the lymph nodes is not typical. Meningeal syndrome is pronounced. Disturbances of consciousness and mental disorders from sleepiness 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. Spotty-papular 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. The febrile temperature is 2-14 days, there may be two waves. The syndrome of infectious toxicosis is pronounced. The patient's appearance is typical. The defeat of the lymph nodes is not typical. Lesions of other organs and systems are not typical. Meningeal syndrome is moderately pronounced. Disturbances of consciousness and mental disorders from doubtfulness to coma. Leukocytosis, ESR acceleration. Mixed or lymphocytic cytosis from 20 to 1000 cells in 1 μl	Consultation of an infectious disease specialist, neuropathologist.	Moderate hyperemia of the pharynx. A maculopapular rash. Flaccid paresis and paralysis, paresis of the cranial nerves. Neutrophilia without left shift.
Subarachnoid hemorrhage	Acute headache. Vomiting, sometimes convulsions, meningeal symptom complex, mental disorders (from slight confusion, disorientation to severe psychosis). Paresis of the cranial nerves, symptoms of focal brain damage (paresis of the limbs, impaired sensitivity, speech disorders).	Consultation with a neurologist.	A sharp headache that occurs suddenly is felt by the patient as a "blow with a dagger." The pain initially has a local character in the forehead, back of the head, then becomes diffuse, with localization in the neck, back, legs. In the acute period, after cerebral symptoms, the temperature rises to 38-390C, but unlike CE, the rise is noted not immediately, but only 6-30 hours after the hemorrhage. Unlike CE, a 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 in CE are unstable, their reverse development is observed in a relatively early period of the disease.
A brain tumor	Spilled severe headache, accompanied by cerebral symptoms, the appearance of focal symptoms, seizures.	Consultation with a neurologist.	Distinctive features of tumors are: absence of intoxication in the initial period of the disease, torpid flow during therapy.

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Treatment

Preparations (active ingredients) used in the treatment

L-lysine aescinat (L-lysine aescinat)

Amikacin

Aprotinin

Ascorbic acid

Vancomycin (Vancomycin)

Warfarin

Heparin sodium

Dexamethasone

Dextran

Dextrose

Diazepam

Diclofenac (Diclofenac)

Diphenhydramine

Dopamine

Immunoglobulin against tick-borne encephalitis

Potassium chloride

Calcium chloride

Carbamazepine

Ketoprofen (Ketoprofen)

Clemastine

Lidocaine

Lornoxicam

Magnesium sulfate

Mannitol (Mannitol)

Meropenem

Metoclopramide

Sodium acetate

Sodium hydrocarbonate

Sodium chloride

Neostigmine methylsulfate

Paracetamol (Paracetamol)

Pentoxifylline

Pyridoxine

Prednisolone

Propofol

Thiamin

Tramadol (Tramadol)

Fluconazole (Fluconazole)

Furosemide

Choline alfostserat

Cefepime

Ceftriaxone

Ciprofloxacin (Ciprofloxacin)

Citicoline

Citicoline

Ethyl Succinate metilgidroksipiridina

Treatment (outpatient clinic)

TREATMENT AT THE AMBULATORY LEVEL

Treatment tactics:
On an outpatient basis, 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, drug care is aimed at:
· Decrease in body temperature;
· Prevention of complications development.

Drug treatment: no.

Other treatments: no.

on an outpatient basis is not carried out.

Preventive actions:
Emergency specific prevention of TBE is carried out by administering a 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 of the drug Human immunoglobulin against tick-borne encephalitis.
For the purpose of emergency prophylaxis, the drug is administered in a single dose to those who are not vaccinated against TBE or who have received an incomplete course of vaccination, who have noted tick sucking in endemic areas, as well as if there is a suspicion of laboratory infection with the TBE virus.
In cases of increased risk of infection (infection with TBEV of an adherent tick, multiple bites or simultaneous suction of several ticks), the drug is administered in a single dose to vaccinated persons.
In the case of a new tick bite, after a month after the first injection, the drug is re-administered at the same dose.
· The drug can be used before probable 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.
· A history of severe allergic reactions to the administration of human blood products is a contraindication. Persons with allergic diseases (bronchial asthma, atopic dermatitis, etc.) are prescribed a course of antihistamines within 8 days after the administration of immunoglobulin.
·
During pregnancy in the 1st trimester, the introduction of specific immunoglobulin against tick-borne encephalitis is strictly contraindicated. In 2-3 trimesters, the introduction of specific immunoglobulin according to vital indications after the informed consent of the woman, the decision is made by a committee of the council with the participation of an obstetrician-gynecologist, neuropathologist, 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 the night shift, business trips, surgical operations, dental procedures and vaccinations). Daily thermometry is carried out. When clinical symptoms appear, the patient should immediately consult a doctor.
· In the case of a serological study of a tick removed from the human body for infection with the tick-borne encephalitis virus and obtaining a negative result, then the immunoglobulin is not administered (if the tick was examined during the permissible prophylaxis period).

Vaccine prophylaxis (specific prophylaxis)
· WHO strategy for immunization of the population. In areas where the disease is highly endemic (average annual incidence before vaccination is ≥5 clinical cases per 100,000 population), WHO recommends vaccination for all age groups, including children. Because the disease tends to be more severe in people over the age of 50-60, these people represent an important target group for immunization. Where pre-vaccination incidence is moderate or low (5-year average annual<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.

Patient monitoring:
At the outpatient level in a medical organization at the place of residence, a neuropathologist conducts dispensary observation of persons affected by a tick bite for twenty-one days with regular thermometry.

no treatment is provided on an outpatient basis.

Treatment (ambulance)

EMERGENCY STAGE TREATMENT

Drug treatment:
The provision of 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, repeated administration of the drug is possible
Psychomotor agitation	Diazepam 0.5% - 0.1 ml / kg, but not more than 2 ml	10-20 mg once, in the absence of effect after 15 minutes, the drug may 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 in / m, with unstable hemodynamics MgSO 5.0 in / by 10.0 physical. solution -0.9% - NaCL	In / m - 100 mg 1-2 times a day. In / in, drip - 100-200 mg in 100-500 ml of 0.9% NaCl solution. Lysine salt of ketoprofen: solution for injections: i / m or i / v 160 mg (2 ml) 1-3 times a day, Ksefokampo 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 intravenously, or Dexamethasone 8-12 mg intravenously per 10.0 ml 0.9% NaCL solution. Supply of humidified oxygen through the 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 simultaneously. 0.9% sodium chloride solution Start a rapid infusion - a bolus of at least 10 ml / kg / in 10-15 minutes (perhaps the introduction of saline with syringes).

Treatment (hospital)

STATIONARY TREATMENT

Treatment tactics:
At the stationary stage, temperature, hemodynamic parameters (blood pressure, pulse, heart rate) are recorded daily in the patient observation card (medical history), respiration and respiratory rate are assessed, 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 ongoing correction of drug therapy with justification.

Drug-free treatment
Strict bed rest- it is necessary to observe normal temperature up to 5-7 days and until the symptoms of intoxication disappear. In addition, bed rest should be observed for the next 1-2 weeks after the temperature has returned to normal. Almost complete restriction of movement, minimizing painful stimuli, prohibit balneotherapy, massive electrical procedures. Ensure the correct position of the patient: an elevated position of the head 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.
With focal form discharge not earlier than 21 days of illness after clinical recovery and normalization of cerebrospinal fluid.

Drug treatment
Etiotropic therapy

Standard treatment regimen for febrile TBE	Standard treatment regimen for meningeal TBE	Standard treatment regimen for focal forms of TBE	Alternatives treatment regimen for extremely severe TBE	Alternatives treatment regimen for the two-wave course of CE
Human serum immunoglobulin against tick-borne encephalitis virus [UD-B]
A single dose of 0.1 ml / kg of body weight IM, for 3-5 days (until the general condition improves, the fever disappears). Heading daily dose of at least 21 ml.	Single dose of 0.1 ml / kg of body weight x2 times a day with an interval of 10-12 hours, i / m, for at least 5 days (until the disappearance of fever, regression of general infectious symptoms, stabilization and reduction of meningeal symptoms). Heading dose from 70 ml to 130 ml.	A single dose of 0.1 ml / kg of body weight x 2-3 times a day with an interval of 8-12 hours, intramuscularly, for 5-6 days (until the temperature drops and the neurological symptoms stabilize). Heading dose from 80 ml to 130 ml.	A single dose can be increased to 0.15 ml / kg of body weight.	The drug is used repeatedly 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 TBE for any reason in the febrile stage of the disease did not receive specific therapy, 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 through 10-12 hours.
The decision on the introduction of immunoglobulin against tick-borne encephalitis of a pregnant woman is made by a council consisting of an obstetrician-gynecologist, infectious disease specialist, and a neurologist.

Pathogenetic therapy
Detoxification therapy

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

Dehydration therapy(with intracranial hypertension, prevention of cerebral edema):
· L-Lysine - escinate 5-10 ml 2p per day intravenous drip [UD - B]
MgSO4 5.0-10.0 ml i.v.

Cerebral edema treatment:
· Mannitol 15% solution 1-1.5 g / kg / 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 level of the upper limit of the norm and above, the administration of mannitol is contraindicated in connection with a change in the osmolality of the blood and the threat of the development of swelling of brain cells. In these cases, the introduction of a concentrated glucose solution of 10%, 20% or 40% and a 0.45% NaCl solution is indicated.

Non-steroidal anti-inflammatory drugs ( with an increase in body temperature above 38.5 0 C, in the presence of TBI and a history of convulsive syndrome).
Duration 1-3 days:
· Diclofenac, 3 ml / m [UD - B]
or
· Ketoprofen 2 ml / m [UD - B]
· Paracetamol 500 mg, by mouth, at intervals of at least 4 hours [DD - B].
With severe pain syndrome (severe headache, muscle pain, bone aches, polyradiculoneuritis)
Tramadol 50-100 mg i / v, i / m, s / c. The maximum daily dose is 400 mg (in exceptional cases it can be increased to 600 mg). [LEO - B]
or
· Ksefokam 8 mg intravenously drip in 200 ml of saline or jet.

Glucocorticosteroids:
With meningoencephalitic, meningoencephalopoliomyelitic, polyradiculoneuritic forms and the development of ITS within 3-7 days, prednisolone 5-10 mg / kg, i.v.
or
dexamethasone 8-12 mg IV, jet [UD - V]

Antihistamines:
clemastine 1ml, i / m [UD - V]
or
diphenhydramine 1% -1.0 with analgin 50% -2.0, i / m

To improve microcirculation and rheological properties of blood, with an antiplatelet purpose(taking into account the indicators of the coagulogram):
· Pentoxifylline 2% solution 100 mg / 5 ml, 100 mg in 20-50 ml of 0.9% sodium chloride, intravenous drip, course from 10 days to 1 month [UD - B]
or
· Heparin subcutaneously (every 6 hours) 50-100 U / kg / day 5-7 days [LE - A]
or
Warfarin 2.5-5 mg / day, by mouth

Symptomatic therapy:
Relief of convulsive syndrome:
· Diazepam 2 ml per 10.0 ml of 0.9% sodium chloride, i.v. jet [UD - V]
or
· Carbamazepine 200 mg for seizures, as prescribed by a neurologist (from 200 mg-600 mg) [LEO - B]

Improving cerebral circulation:
In the acute period with depression of consciousness and fever, vascular drugs are contraindicated, after normalization of the temperature and clarification of consciousness, as well as in the presence of cognitive disorders, connect (if at the time of examination and in the anamnesis there are no epileptic seizures), antioxidants:
· Mexidol 5.0 intravenous drip on 200.0 ml of 0.9% sodium chloride [UD - B],
· Ceraxon 500mg-1000mg intravenous drip on 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 i.v. cap for 0.9% sodium chloride [UD - B]
· Thiamine chloride 1.0-2.0 / m [UD - B]
· 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 - 2.0 g x 2 times / day, i.m., i.v., 10 days;
or
Cefepime 1.0 g at intervals of 12 hours (i / m, i / v). [UD - V]
Ciprofloxacin 100ml x 2 times / day, i.v. 7-10 days

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

A combination of 2 or more antibacterial drugs according to indications:
Antifungal drugs ( according to indications ):
· Fluconazole 100 ml IV 1 time per day, every other day, 3-5 times [UD - B]

Other drugs for general anesthesia during EMS, intubation and other invasive procedures:
· Propofol at a rate of 0.3-4 mg / kg in 1 hour intravenous drip to provide a sedative effect during intensive therapy and during mechanical ventilation [LEO - B]
or
Lidocaine 1%, 2% 4-5 ml

With infectious toxic shock:
· Prednisolone 5-10 mg / kg IV [LE - V]
Dopamine 10-15 mcg / kg per minute i / v. The infusion is carried out continuously for 2-3 hours to 1-4 days or more. The daily dose reaches 400-800 mg. The introduction is carried out under the control of an ECG. [UD - V]

With the development of respiratory failure:
· Mechanical ventilation from the moment the first signs of respiratory failure and swelling of the brain appear, tracheostomy (according to indications).
· To combat hypoxia, the systematic introduction of humidified oxygen through nasal catheters (20-30 minutes every hour).
Carrying out hyperbaric oxygenation (10 sessions under pressure p 02-0.25 MPa)

For bulbar disorders:
· Mechanical ventilation;
Proserin 1.0 ml s / c.

In case of violation of hemostasis:
· SZP - 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 - a concentrate for the preparation of an injection solution in ampoules of 25 mg (5 ml), 50 mg (5 ml), 100 mg (5 ml), 200 mg (5 ml);
0.9% NaCl solution - 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;
· Chlosalt - 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 escinat - 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, pills 25 mg, 50 mg, 75 mg, 100 mg, 150 mg; ointment, gel; solution for injection 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 U, ampoules 1.0 ml, 5.0 ml, vials 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 preparation of solution for injection for intramuscular and intravenous administration in a 1 g bottle;
Cefepime - powder for preparation of solution for injection 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 10 ml ampoules (concentrate to be diluted); coated tablets 250 mg, 500 mg, 750 mg;
Meropenem - powder for preparation of solution for infusion, 1000 mg in 100 ml vials;
Vancomycin - powder, lyophilisate for preparation of solution for infusion 500 mg, 1000 mg;
· Amikacin - powder for preparation of solution for injection, 0.5 g; solution for injection 100 mg / 2 ml, 500 mg / 2 ml;
Fluconazole - solution for infusion 200 mg / 100 ml; solution for intravenous administration 2 mg / ml;
Tramadol - solution for injection 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 infusion 1%;
Ascorbic acid - injection solution 5%;
· Thiamine chloride - solution for injection 5%;
· Pyridoxine hydrochloride - solution for injection 5%;
Mexidol - injection solution 2 ml;
Diazepam - solution for injection 10 mg / 2 ml;
· Carbamazepine - 200 mg film-coated tablets;
Ceraxon injection solution 4 ml;
· Gliatillin - injection solution 2 ml;
Lidocaine - injection solution 1%, 2%, 10%; aerosol 10%;
· Clemastine - solution for injection 1 mg / ml.

Surgery: no.

Other treatments: no.

Indications for specialist consultation:
· Consultation with a neuropathologist: in an infectious 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 and spinal cord and pia mater;
· Consultation of a resuscitator: determination of indications for transfer to the ICU;
Ophthalmologist consultation: fundus examination to determine signs of intracranial hypertension, dynamics of hyperemia, stagnation of the optic nerve discs, correction of dehydration therapy, determination of indications for radiation diagnostics (CT / MRI) of the brain;
· Consultation with a neurosurgeon: establishment or exclusion of a volumetric formation of the brain (intracerebral hematoma, hemorrhage into a brain tumor, abscess);
· Consultation with an oncologist: to exclude a brain tumor (if indicated);
· Consultation of a cardiologist in the development of cardiovascular disorders;
· Consultation of an endocrinologist in case of concomitant diseases - diabetes mellitus, obesity.
· Consultation of an ENT doctor for diseases of the ENT organs;
· Consultation with an allergist;
· Consultation of a psychiatrist in case of mental and behavioral changes.

Indications for transfer to the intensive care unit and intensive care unit:
With the development of complications:
Bulbar disorders;
• impairment of consciousness;
Edema - swelling of the brain;
· Infectious toxic shock;
· Severe and extremely severe neurological disorders;
· Instability of hemodynamics;
• impaired respiratory function;
· Pneumonia, sepsis;
· Anaphylactic shock (risk of possible complications of treatment).

Treatment effectiveness indicators:
Tick-borne encephalitis after a person's recovery leaves a long and lasting immunity. Virus neutralizing antibodies accumulate in the blood rather slowly, reaching a maximum in 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 foci of encephalitis.

Clinical indicators:
· Stable temperature normalization;
· Lack of intoxication;
· Regression of neurological symptoms.

Laboratory indicators:
· Normalization of UAC indicators;
· Rehabilitation of cerebrospinal fluid.

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

Hospitalization

Indications for planned hospitalization: No.

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

Information

Information

ABBREVIATIONS USED IN THE PROTOCOL

IgM, IgG	Immunoglobulins of classes M, G
WQE	Tick-borne encephalitis virus
WHO	World health organization
ITSH	Infectious toxic shock
ELISA	Linked immunosorbent assay
CT scan	CT scan
KSC	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	Lumbar puncture
ESR	Erythrocyte sedimentation rate
Ultrasound	Ultrasound procedure
CNS	central nervous system
ChMN	Cranial nerves
ECG	Electrocardiogram
EEG	Electroencephalography

List of protocol developers:
1) Kosherova Bakhyt Nurgalievna - Doctor of Medical Sciences, Professor, Republican State Enterprise at the Karaganda State Medical University, Vice-Rector for Clinical Work and Continuous Professional Development, Chief Freelance Adult Infectionist of the Ministry of Health and Social Development of the Republic of Kazakhstan.
2) Egemberdieva Ravilya Aitmagambetovna - Doctor of Medical Sciences, Republican State Enterprise at the REM “Kazakh National Medical University named after S.D. Asfendiyarov ", Professor of the Department of Infectious and Tropical Diseases.
3) Duisenova Amangul Kuandykovna - Doctor of Medical Sciences, Professor, RSE at the REM “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 - GKP "City Clinical Hospital No. 7" of the Health Department of Almaty, head of the neurology department, neuropathologist of the highest category.
6) Mazhitov Talgat Mansurovich - Doctor of Medical Sciences, JSC "Astana Medical University" Professor of the Department of Clinical Pharmacology.

Conflict of interests: absent.

List of reviewers:
-Baesheva Dinagul Ayapbekovna - Doctor of Medical Sciences, Professor, RSE at REM Medical University "Astana", Head of the Department of Children's Infections, Chairman of the Republican Public Association "Society of Infectious Diseases".
-Kulzhanova Sholpan Adlgazyevna - Doctor of Medical Sciences, JSC "Astana Medical University", Head of the Department of Infectious Diseases and Epidemiology.

Terms of revision of the protocol: revision of the protocol 3 years after its publication and from the date of its entry into force or in the presence of new methods with a level of evidence.

Attached files

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

ICD-10 code

A84 Tick-borne viral encephalitis

A69.2 Lyme disease

The incubation period after a tick bite in humans

Infection occurs directly through the bite of an arthropod. It is the tick that is the carrier of many dangerous diseases for humans. There have been cases when the infection occurred through the gastrointestinal tract. No, you don't need to eat a tick for this. But cases of tick ingestion, thus, in the body were 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 is delayed for 2 months.

Most often, the first symptoms begin to manifest themselves 7-24 days after the bite. There were cases when a sharp deterioration was observed after 2 months. Therefore, the state of health must be monitored. The incubation period is completely dependent on the blood-brain barrier. The weaker it is, the faster the disease will manifest itself, if any. You need to pay attention to all the 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 diseases. One of them is tick-borne encephalitis. With its rapid development, it leads to damage to the nervous system and can lead to brain inflammation. Disability and death are not excluded. The main symptoms after a tick bite begin to pester a person after a week.

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

Vomiting, migraine, chills can act as auxiliary symptoms. The human condition is deteriorating sharply. On the fourth day after the onset of the onset of the disease, sluggish paralysis may develop. Sometimes it affects the larynx and pharynx, which makes it difficult for a person to swallow. There were cases when the reaction was so strong that there were disturbances in the work of the respiratory system and heart. Epileptic seizures are possible.

What does a tick bite look like in humans?

The attachment of a tick to the human body occurs through an organ - a hypostome. It is an unpaired outgrowth capable of performing the functions of the sense organs. With the help of it, the tick is attached and sucks blood. Most often, a tick bite in humans is observed in places with delicate skin, and looks like a red speck, with a dark dot in the middle. It is necessary to look for it on the abdomen, lower back, groin, armpits, chest and ears.

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

The bite of a tick, a carrier of the disease of borreliosis, looks more pronounced. It is characterized by the appearance of a specific spotted erythema. The speck can change size and reach up to 10-20 cm in diameter. In some cases, all 60 cm were recorded. The spot has a rounded shape, sometimes it takes the form of an irregular oval. Over time, an elevated outer border begins to form, it acquires a bright red hue. In the center of the speck, the skin becomes cyanotic or whitish. The stain is somewhat reminiscent of a bagel. A crust and scar is gradually formed. After a couple of weeks, the scar disappears on its own.

Signs of an encephalitis tick bite in humans

It must be understood that a small tick bite can lead to serious health problems. So, encephalitis can cause paralysis of the limbs and lead to death. You shouldn't panic ahead of time. You should be able to distinguish between symptoms and, if they appear, immediately consult a doctor. The likelihood of a favorable outcome is high if the person showed signs of an encephalitis tick bite at an early stage.

Chills appear first. A person thinks that he is getting ARVI or flu. Therefore, he begins treatment according to his own standard scheme, but it does not help. An increase in temperature is added to the chill, sometimes its indicator is 40 degrees. At the next stage, headache and nausea appear, sometimes all this is complemented by vomiting. The person is still convinced that this is the flu. Severe headaches are replaced by body aches. Breathing gradually begins to become difficult, the person is not able to move normally. His face and skin blush rapidly. This indicates that the virus has begun its pernicious activity. After that, irreversible processes begin in the body. Paralysis or death is possible.

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. In the meantime, 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 you do not start it, the person will die. Ehrlichiosis is caused by bacteria, which are transmitted by a tick bite into the body. The likelihood of getting such a disease increases if a person is often located in areas where ticks are spread. 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 Borrelia spirochetes. The phenomenon is common on all continents, so it is not so easy to avoid infection. A person who has Lyme disease is not dangerous to others. Bacteria, along with saliva, enter the skin of a person, after a few days they begin to actively multiply. The danger is that from a tick bite a person can develop borreliosis, with further damage to the heart, joints and brain. The bacteria can live in the human body for years and gradually lead to the 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 vary in size and change. Ultimately, the bite will become crusty and the skin may remain pale or cyanotic. A red hill appears around the lesion site, all this visually resembles a donut. After a couple of weeks, everything disappears. But the danger has not passed, after a month and a half the nervous system and heart may be damaged.

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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 provoke tick-borne encephalitis. People who like to spend a lot of time in nature are subject to this influence. They need to be extra careful and constantly examine their bodies for ticks.

The first signs after a bite can manifest themselves after a week. Sometimes it takes a whole month. The first step is chills, accompanied by an increase in body temperature and a fever. The person sweats intensely, he is pestered by a severe headache and body aches. If symptoms do not manifest themselves for a long time, even mild muscle weakness can serve as a cause for panic.

It is necessary to seek help with a sharp increase in body temperature, severe head pain, sleep disturbance. Often, the disease can cause hallucinations and seizures. All these symptoms should be the reason for going to the hospital.

The 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 from a tick bite, a person can develop irreparable consequences. They arise due to untimely treatment of encephalitis, borreliosis, acarodermatitis and dermatobiasis.

• Encephalitis can lead to serious consequences. It often affects the central nervous system and heart. A person may develop shortness of breath, and over time, paralysis develops. If treatment is not started on time, the victim may remain disabled or die.
• Borreliosis. The danger of defeat lies in the fact that the disease can be "silent" for six months. During this period, irreparable changes can occur in the body. So, borreliosis manifests itself in the form of erythema. Redness can appear at the site of the bite, progress over time and eventually disappear. The worst thing begins later, a month later, serious disorders of the central nervous system and heart develop. Lethal outcome is not excluded.
• Acarodermatitis. There are no consequences after such a defeat. A person can be pestered 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 belly of the tick begin to hatch in the body, it can be fatal. The child's body is not able to cope with this problem, even with quality treatment.

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Complications after a tick bite in humans

After a tick bite, various complications can develop. First of all, the central nervous system suffers. Development of epilepsy, headaches, paralysis is possible. The cardiovascular system also lends itself to particular influence. The appearance of arrhythmias, constant surges in blood pressure is not excluded. The lungs also suffer, pneumonia can develop and, as a result, pulmonary bleeding. 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 up with chronic weakness. The body is able to renew itself on its own after a couple of months. In severe cases, the process can take six months. In the worst case, the person will develop defects that will interfere with his normal life. Persistent changes in the body lead to the appearance of epilepsy and disability.

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Tick ​​bite temperature in humans

A sharp increase in body temperature a few hours after the bite indicates that the body has responded to such an intrusion with an allergic reaction. This happens due to the ingestion of saliva under the skin of a sterile or infected tick. Therefore, when a tick bites, a person needs to constantly record the temperature, moreover, it is necessary to monitor the victim for 10 days. Body temperature must be constantly measured. Fever can 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 normalizes on its own. The 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 increased for 20 days. Therefore, the temperature indicators must be monitored without fail.

Redness after a bite

This symptom is characteristic of Lyme disease. The tick suction site is redder and resembles a ring. This can happen 3-10 days after the defeat. In some cases, a skin rash is noted. 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 not excluded. Swelling of the tonsils is often observed.

Over the next 3-4 weeks, the rash begins to gradually disappear and the stain may completely disappear. 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, in general, tick bites!

A bump 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, in some cases a seal appears. Where does all this come from and is there any danger in this? It should be understood that an ordinary allergic reaction can cause a bump 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 the saliva be infected, even in a sterile form, it can provoke an allergic reaction. Itching, redness, and light induration are normal body reactions. But, it’s not worth it to relax.

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

The bump can 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 in the form of fever and headache appear, you should immediately go to the hospital.

Diarrhea after a tick bite

Bowel upset is not common, but it can be one of the signs of serious damage to the body. Each person is individual and even the bite of an uninfected tick can lead to a number of negative reactions. The site of the lesion may turn red, over time, itching and rash appear. The intestines can also react negatively after a tick bite, causing diarrhea.

This symptomatology is twofold. In one case, it may indicate the weakness of the body, in the other, it can talk about its infection. Therefore, if negative symptoms appear, including an intestinal disorder, you need to go to the hospital. Even if a person becomes easier after a while. Many diseases carried by ticks begin to manifest themselves 2 weeks after the bite. During this period, the infection can develop in the body and lead to irreversible processes.

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Compaction 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 see a doctor. This can be either incorrect removal of the tick or the development of a serious disease. Often, after a bite, a seal forms, its development provokes an allergic reaction. Perhaps this is the most harmless thing that can happen.

Piercing the skin with its proboscis, the tick begins to stick. This process is capable of causing itching, redness and even rawness. Often, after removal, a seal appears. True, this symptom is not so harmless. It is likely that an infection has begun to develop in the human body. It can be encephalitis or borreliosis. It is worth immediately seeking help from the hospital.

Often people remove the tick itself incorrectly. This leads to the fact that his proboscis remains in the skin. In this regard, the inflammatory process begins, severe irritation and induration appear. Doctors will help to cope with this problem.

Treatment after a tick bite in humans

The first step is to remove the tick. This can be done both independently and by contacting the hospital. A live tick must be preserved and taken for examination. If, when removed, it was killed, 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 is correctly diagnosed with a disease and an effective treatment is prescribed.

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

• Tick-borne encephalitis. First of all, a person needs to ensure bed rest. It is desirable that it be at least a week. In 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 are also suitable, these are Reopolyglyukin, Polyglyukin and Gemodez. If meningitis is observed, 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 erythema manifestation, he should use Tetracycline. Bacteriostatics play a special role in treatment. It can be Lincomycin and Levomycetin. If a neurological syndrome is observed, then it is stopped by intravenous injections of bactericidal antibiotics. It can be Azlocillin and Piperatsilin. The water balance is restored by means of blood substitutes, such as Reopolyglyukin and Polyglyukin

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

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

Where can you take the tick and how to check it. It is necessary to find a hospital that does such research. The address of the laboratories and telephone numbers can be found on the Internet. It is enough to visit the website of the Ukrainian Consumer Supervision Service. In fact, ticks should be taken in every hospital where there is a laboratory. Most importantly, the research is completely free! It is recommended to clarify this information. The results are provided on the day the tick is delivered or the next day.

How to treat a tick bite in humans?

If a tick has been 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 an outpatient setting, a person is recommended to use immunoglobulins. The most commonly prescribed remedy is Rimantadine. It is taken for 3 days, one tablet in the morning and in the evening.

At home, the tick is removed with oil. It is necessary to drop a lot of it on the head of the tick. For these purposes, alcohol is also used. Removal can begin after 15 minutes. In most cases, the tick crawls out on its own. It is much easier to remove it 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 site of the lesion is not treated with anything else.

Tick ​​bite pills 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. It can be Prednisolone and Ribonuclease. Blood substitutes are actively used, such as Reopolyglyukin, Polyglyukin. All these pills from a tick bite do not give infection, spread throughout the human body and lead to serious damage in the body.

• Prednisone. The dosage regimen is individual. Usually the remedy is applied once a day. It is actively used to eliminate the effects of a tick bite. It is not recommended to take the drug in the presence of fungal infections and intolerance. Possible development of hypokalemia, flatulence, sleep disturbances and negative nitrogen balance.
• Ribonuclease. For the treatment of tick-borne encephalitis, the agent is injected intramuscularly 6 times a day. The dose can be adjusted. It is not worth using the remedy in case of respiratory failure, bleeding and tuberculosis. Development of allergic reactions is possible.
• Reopoliglyukin and Polyglyukin. The funds are administered intravenously at a rate of 60 drops per minute. The maximum amount is 2.5 liters. They cannot be used for cranial injuries and diabetes mellitus. May lead to the development of allergic reactions. It rarely causes arterial hypotension.
• With borreliosis, slightly different drugs are used. Reopolyglyukin and Polyglyukin are also used as medicines for hematopoiesis. 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 tool can be used both in the form of tablets and ointments. The ointment is applied to the affected area every 6 hours. As for the tablets, they are used 250-500 mg with the same frequency. Do not use the product for children under the age of eight, as well as for pregnant women. Development of diarrhea, constipation, allergic reactions is possible.
• Levomycetin and Lincomycin. When taken internally, the dose is up to 500 mg. In this amount, funds are used up to 4 times a day. The duration of treatment is usually 10 days. It is impossible to use drugs in case of violations of the functionality of the liver and kidneys. A similar requirement is made for children and pregnant women. Possible development: leukopenia, depression and skin rash.
• Azlocillin. The agent is administered intravenously. The maximum dosage is 8 grams. That is, 2 grams 4 times a day. People with allergic reactions should not take it. Able to provoke nausea, vomiting, anaphylactic shock.
• Piperacillin. The agent 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 and lactation. It can lead to headaches, skin flushing and dysbiosis.

Prevention of a tick bite 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 inappropriate to carry out it. The second criterion for prevention is specific immunotherapy. It is a therapeutic measure in which immunoglobulin is injected into the human body. Prevention of a tick bite should be more carefully carried out in people whose activities are directly related to work in nature.

It is important to dress properly when hiking in the forest or outdoors. Special clothing will help prevent ticks from entering underneath. You can use special deterrents. It can be both sprays and creams that are applied to the skin. All this will avoid a bite and further infection. Compliance with 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 shown and did not go to the doctor, the prognosis is extremely poor. The fact is that tick bites can manifest themselves only after a while. This is the main danger. The first symptomatology may appear within a week and subside after a few days. Then it flares up with renewed vigor, but already entails serious damage to the central nervous system and the 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 noticed a tick in himself in time, removed it and handed it over for examination, the likelihood of a good outcome is high. After all, even if the tick is infected, according to the results of the examination, the person will be prescribed high-quality treatment. This will prevent all serious consequences. The favorableness of the forecast depends entirely on the person himself.

Death from a tick bite in humans Death from a tick 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 shown and are in no hurry to see a doctor. In the meantime, the disease begins to actively progress. Encephalitis is especially dangerous; death from such a tick bite in humans can occur.

The disease can 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 the brain. This is often fatal. Borreliosis is also dangerous. He can show himself six months after infection. And everything happens instantly. Animals can die instantly. Finally, dermatobiasis. This disease is fatal in children. The body of adults is more adapted to this infection.