ZNAČAJ HIRURŠKOG TRETMANA U PACIJENATA S UBODOM KRPELJA
Mehmedagić I. 1, Stojić V. 2 , Bojanić V. 1, Rifatbegović A. 1, Mešić D. 1, Hasukić Š. 1, Kadrić N. 1
1 Hirurška klinika UKC Tuzla
2 Klinika za infektivne bolesti Tuzla

Lyme Borreliosis (LB) ili lajmska bolest, danas najčešća krpeljna prenosiva bolest u Evropi i Sjevernoj Americi je multisistemska bolest uzrokovana spirohetom Borrelia burgdoferi. Za ovu bolest je specifično da se manefestuje širokim spektrom različitih kliničkih slika i trajno je kompleksan klinički i laboratorijski problem. Prirodan rezervoar borelije predstavljaju mnoge divlje i domaće životinje, a s jednog domaćina na drugog prenose ih različiti krpelji roda Ixodes spp.

CILJ: Ukazati na značaj hirurškog tretmana uboda krpelja, kao nespecifične metode u sprečavanju infekcije Borreliom burgdoferi.

ISPITANICI I METODE: U hirurškoj ambulanti Doma zdravlja Tuzla tokom 2002. godine hirurški smo obradili 52 pacijenta sa ubodom krpelja u dobi od 8-72 godine. Pacijenti su bili uposleni kao šumski radnici (najčešća frekventnost), poljoprivrednici, studenti, penzioneri i domaćice. U svih pacijenata smo uspješno otklonili krpelja tankom pincetom, pazeći pri tom da manipulacijom vađenja ne prouzrokujemo dublje pomjeranje krpelja, te izbacivanje crijevnog sadržaja i endolimfe u tkivo pacijenta. Nakon što smo provjerili da smo insekta u cijelosti odstranili, dezinficirali smo kožu na mjestu uboda, kako bi prevenirali bakterijsku infekciju. Sve pacijente smo liječili antibioticima "Citeral ", i ambulantno pratili 3 mjeseca.

REZULTATI: U 8 (15%) pacijenata javio se blagi eritem na mjestu uboda. Ubrzanu sedimentaciju imalo je 27(52%) pacijenata, leukociti su bili u granicama normalnih vrijednosti, kao i nalaz aminotransferaza. Serološke reakcije bile su negativne. Tretman je bio nastavljen od strane infektologa.

ZAKLJUČAK: Veoma je značajan stručni i blagovremen pristup hirurga u uklanjanju krpelja sa kože. Učešće specijaliste medicine rada je značajno u ocjeni: da li se radi o profesionalnom oboljenju (osobito za šumske radnike). Značaj multidiscipliniranog pristupa hirurga, infektologa i mikrobiologa je u profilaksi LB, kao i sprečavanja daljih stadija infekcije: I erytema migrans, II Borrelia limfocitom na koži, opšti simptomi, specifični od pojedinih organa (meningitis, radikuloneuritis, ispadi senzibiliteta, pareza facijalisa, AV blok, perikarditis, myokarditis, lymfadenopathia, hepatosplenomegalija), III akrodermatitis chr atrophikans, polyneuropathia chr, encephalomyelitis progresiva.

THE IMPORTANCE OF THE SURGICAL TREATMENT IN THE PATIENT WITH TICK BITE

Mehmedagić I 1, Stojić V 2 , Bojanić V 1, Rifatbegović A 1, Mešić D 1, Hasukić Š 1, Kadrić N 1
1 Surgical Clinic - University Clinical Center Tuzla
2 Infective disease Clinic - University Clinical Center Tuzla

Lyme borreliosis (LB) is widespread disease in Europe and North America. It caused by Borrelia Burgdoferi and the vector is tick. This disease has wide spectrum of clinical presentation. It is difficult to treat clinically, and to prove laboratory. The Borrelia reservoirs are many domestic and wild animals, and Ixodes spp. is a vector for this disease.

AIM: The aim of this report is to underline the importance of the surgical treatment after the Ixodes bite. The way to remove the insect or part of it with special forceps.

SUBJECTS AND METHODS: In surgical department - admission area, during 2002 we treated 52 patients with Ixodes bite, aged from 8-72 years. This patients employee as following occupations: forestry workers (the most frequent), farmers workers, students, retired persons and housewife. By using special forceps we successfully removed the head of Ixodes , or the Ixodes itself without spilling of contents of Ixodes or endolymph in the tissue of the patient. After removing procedure we disinfected the skin to prevent infection. The patients treated by antibiotic "Citeral ", and were followed during 3 months.

RESULTS: There were in 8 patients (15%) erythema at the removal point. The clinical status had followed signs: elevated sedimentation rates 27 patients (52%), WBC was in referent values, and also the amino-transferase level. Serologic examination was negative. After, that infective disease consultant was performing the physical exams, and treatment.

CONCLUSION: We want to underline the importance of the Ixodes removal from the skin as a non-specific method. Multidisciplinary approach-surgeon should be include necessary, infect disease consultant, and microbiologic consultant in the diagnosis and treatment of infection with borrelia burgdoferi. The participation of Occupational Health doctor is in assessment: Is this disease occupational disease (particularly in forestry workers). The purpose of this intervention is in stopping the development of other stages of this disease: I erythema migrans, II Borrelia lymphocitoma in skin lesion, general symptoms, (meningitis, radiculo-neuritis, AV block, pericacarditis, myocarditis, lymphadenopathy, hepatosplenomegaly), III chronic acrodermatitis atrophicans, chronic polyneuropathy, encephalomyelitis progressive.