Clinical mimics and diagnostic challenges in tick-borne borreliosis: a systematic review

Abstract

Background. Ixodes tick-borne borreliosis (TBB) is a clinically multifaceted disease posing a serious threat in most territories of the Russian Federation. New TBB outbreaks emerge and spread to the country’s south.Objectives. The review highlights the TBB clinical diversity to physicians in order to improve the diagnosis quality and opportune aid. It focuses on the early and late clinical presentation of localised and disseminated polysystemic TBB.Methods. Sources were mined in the MEDLINE, PubMed and national electronic databases (Сyberleninka, eLibrary, etc.) with keywords “tick-borne borreliosis” [клещевой боррелиоз], “Lyme disease” [болезнь Лайма], “Lyme arthritis” [Лайм-артриты], neuroborreliosis [нейроборрелиоз] for the period of 2014–2020. Selected impactive publications within 2007–2013 were also included. Research was considered eligible if borreliosis was diagnosed using specific techniques like immune-enzyme assays, immunoblotting or PCR.Results. TBB is a common and cross-disciplinary situation. The disease may progress occult or manifest in a variety of forms, from annular erythema to cardiac, peripheral and central nervous system involvement or arthritis. The polysystemic nature of lesions, often long-term of the tick bite, forces multiple specialist visits ending with misdiagnoses, late aetiotropic therapy and transition into a chronic phase through ignorance of the patient’s epidemiological record. Some patients may have the acute phase followed by irreversible neurological damage associated with memory loss, cognitive decline, arthrosis and sclerotic skin change reducing the quality of life.Conclusion. TBB can be mimicked by therapeutic, neurological, skin and ophthalmic illnesses, which warrants the physician’s attention to the epidemiological record and knowledge of specific diagnostic techniques. Further research is necessary into the pathogenesis and clinical presentation of chronic TBB and its residual manifestations.