{"id":33913,"date":"2020-03-12T13:30:22","date_gmt":"2020-03-12T12:30:22","guid":{"rendered":"http:\/\/www.invarena.cz\/?p=33913"},"modified":"2020-03-12T13:31:59","modified_gmt":"2020-03-12T12:31:59","slug":"mam-bolesti-zad-muze-to-byt-borrelioza","status":"publish","type":"post","link":"https:\/\/www.invarena.cz\/?p=33913","title":{"rendered":"M\u00e1m bolesti zad. M\u016f\u017ee to b\u00fdt borreli\u00f3za?"},"content":{"rendered":"\n

DOTAZ: Jak\u00fd je postup p\u0159i diagnoze lymsk\u00e1 borelioza? M\u00e1m n\u011bkolik let bolesti zad, tento rok na hranici snesitelnosti, 2x gynek.operace, 1x lumb. punkce, antibiotika 2x, 2x gastroskopie., 2x CT, rentgeny, ultrazvuky ..zat\u00edm v\u0161e bez efektu. <\/strong><\/p>\n\n\n\n

Odpov\u011b\u010f<\/strong>: <\/p>\n\n\n\n

Diagn\u00f3za lymsk\u00e9 borreli\u00f3zy (LB) se op\u00edr\u00e1 p\u0159edev\u0161\u00edm o v\u00e1\u0161 \u00fadaj o p\u0159is\u00e1t\u00ed kl\u00ed\u0161t\u011bte a o v\u00fdskyt typick\u00fdch p\u0159\u00edznak\u016f. Ve sv\u00e9m dotazu uv\u00e1d\u00edte pouze bolesti zad, kter\u00e9 mohou m\u00edt \u0159adu p\u0159\u00ed\u010din a samostatn\u011b nejsou pro LB typick\u00e9.

Projevy LB maj\u00ed t\u0159i stadia. Prvn\u00ed dv\u011b stadia se pozoruj\u00ed v\u00a0prvn\u00edch t\u00fddnech a m\u011bs\u00edc\u00edch po p\u0159is\u00e1t\u00ed kl\u00ed\u0161t\u011bte. T\u0159et\u00ed stadium prob\u00edh\u00e1 m\u011bs\u00edce a\u017e l\u00e9ta po infekci. Projevy jednotliv\u00fdch stadi\u00ed by m\u011bly b\u00fdt odd\u011bleny bezp\u0159\u00edznakov\u00fdm obdob\u00edm trvaj\u00edc\u00edm n\u011bkolik dn\u016f a\u017e let. V\u011bt\u0161ina nemocn\u00fdch m\u00e1 v\u0161ak pouze jedin\u00fd projev LB, obvykle nedoch\u00e1z\u00ed k\u00a0postupn\u00e9mu rozvoji onemocn\u011bn\u00ed ve t\u0159ech stadi\u00edch. <\/p>\n\n\n\n

Prvn\u00edm a nej\u010dast\u011bj\u0161\u00edm projevem je zarudnut\u00ed k\u016f\u017ee v\u00a0m\u00edst\u011b p\u0159is\u00e1t\u00ed kl\u00ed\u0161t\u011bte v\u011bt\u0161inou s\u00a0odstupem 7-14 dn\u016f. Tato \u010derven\u00e1 skvrna by m\u011bla b\u00fdt nejm\u00e9n\u011b 5\u00a0cm \u0161irok\u00e1 (b\u00fdv\u00e1 ale v\u011bt\u0161\u00ed) a m\u011bla by trvat aspo\u0148 3 dny. Je ost\u0159e ohrani\u010den\u00e1 a uprost\u0159ed vybledl\u00e1. Nebol\u00ed, n\u011bkdy lehce sv\u011bd\u00ed, k\u016f\u017ee nen\u00ed hork\u00e1 ani nep\u00e1l\u00ed. N\u011bkdy mohou b\u00fdt p\u0159itom i ch\u0159ipkov\u00e9 p\u0159\u00edznaky \u2013 \u00fanava, mal\u00e1tnost, bolesti sval\u016f a kloub\u016f, hlavy, zv\u00fd\u0161en\u00e1 teplota. <\/p>\n\n\n\n

Pokud jste nezaregistrovala p\u0159is\u00e1t\u00e9 kl\u00ed\u0161t\u011b a ani nem\u011bla tuto velkou \u010dervenou skvrnu s centr\u00e1ln\u00edm v\u00fdbledem, je diagn\u00f3za LB pom\u011brn\u011b m\u00e1lo pravd\u011bpodobn\u00e1. Je v\u0161ak mo\u017en\u00e9, \u017ee jste si kl\u00ed\u0161t\u011bte ani skvrny nev\u0161imla. <\/p>\n\n\n\n

Druh\u00fdm stadiem jsou neurologick\u00e9 projevy. <\/strong>kter\u00e9 za\u010d\u00ednaj\u00ed 2 a\u017e 12 t\u00fddn\u016f po n\u00e1kaze. Projev\u00ed se nej\u010dast\u011bji aseptickou meningitidou a\/nebo krani\u00e1ln\u00ed neuritidou. M\u016f\u017ee b\u00fdt i vz\u00e1cn\u00e1 meningopolyradikuloneuritida s\u00a0kompletn\u00edm v\u00fdskytem t\u0159\u00ed p\u0159\u00edznak\u016f (ko\u0159enov\u00e1 bolest + asymetrick\u00e9 chab\u00e9 par\u00e9zy (ochrnut\u00ed) + lymfocyt\u00e1rn\u00ed pleocyt\u00f3za v\u00a0moku). Abychom mohli \u0159\u00edci, \u017ee tyto neurologick\u00e9 projevy souvis\u00ed s boreli\u00f3zou, mus\u00ed b\u00fdt spln\u011bna t\u0159i krit\u00e9ria: klinick\u00fd neurologick\u00fd n\u00e1lez (meninge\u00e1ln\u00ed dr\u00e1\u017ed\u011bn\u00ed a\/nebo lo\u017eiskov\u00fd neurologick\u00fd n\u00e1lez), biochemick\u00e9 a cytologick\u00e9 vy\u0161et\u0159en\u00ed mozkom\u00ed\u0161n\u00edho moku s\u00a0p\u0159\u00edtomnost\u00ed lymfocyt\u00e1rn\u00ed pleocyt\u00f3zy a pr\u016fkaz vytv\u00e1\u0159en\u00ed se borreliov\u00fdch protil\u00e1tek v\u00a0moku. <\/p>\n\n\n\n

Pokud v\u00e1\u0161 neurolog nezjistil p\u0159\u00edtomnost t\u011bchto t\u0159\u00ed p\u0159\u00edznak\u016f, je diagn\u00f3za LB nepravd\u011bpodobn\u00e1. <\/p>\n\n\n\n

M\u016f\u017ee b\u00fdt i posti\u017een\u00ed srdce, kter\u00fdm je u LB nej\u010dast\u011bji zpomalen\u00ed p\u0159evodu vzruchu ze s\u00edn\u00ed na komory srdce (tedy zpomalen\u00ed pr\u00e1ce srdce) s\u00a0\u00fanavou, du\u0161nost\u00ed, z\u00e1vrat\u011bmi, bu\u0161en\u00edm srdce, v n\u011bkter\u00fdch p\u0159\u00edpadech i s mdlobami. Tyto obt\u00ed\u017ee neuv\u00e1d\u00edte. <\/p>\n\n\n\n

O diagn\u00f3ze LB m\u016f\u017ee napov\u011bd\u011bt v\u00fdskyt \u010derven\u00e9 tuh\u00e9 papulky \u010di uzl\u00edku zejm\u00e9na na boltci, prsn\u00ed bradavce, nosu. Krom\u011b toho m\u016f\u017ee b\u00fdt r\u016fzn\u011b na t\u011ble n\u011bkolik \u010derven\u00fdch skvrn, kter\u00e9 u\u017e b\u00fdvaj\u00ed men\u0161\u00ed jak 5 cm, a mohou se st\u011bhovat. Tyto obt\u00ed\u017ee rovn\u011b\u017e neuv\u00e1d\u00edte.<\/p>\n\n\n\n

Kloubn\u00ed pot\u00ed\u017ee se mohou objevit ji\u017e kr\u00e1tce po n\u00e1kaze. Zpo\u010d\u00e1tku si pacient jen st\u011b\u017euje na st\u011bhovav\u00e9 bolesti kloub\u016f, fyzik\u00e1ln\u00ed n\u00e1lez je na kloubech ale norm\u00e1ln\u00ed. Objektivn\u011b zjistiteln\u00fd kloubn\u00ed z\u00e1n\u011bt \u2013 lymsk\u00e1 artritida \u2013 vznik\u00e1 a\u017e za \u0159adu t\u00fddn\u016f a\u017e m\u011bs\u00edc\u016f po infekci. <\/p>\n\n\n\n

Ve t\u0159et\u00edm posledn\u00edm stadiu LB jsou kloubn\u00ed z\u00e1n\u011bty trvaj\u00edc\u00ed n\u011bkolik dn\u00ed a typick\u00e9 je samovoln\u00e9 odezn\u011bn\u00ed i bez l\u00e9\u010dby. Nen\u00ed-li kloubn\u00ed z\u00e1n\u011bt l\u00e9\u010den, doba trv\u00e1n\u00ed artritidy se prodlu\u017euje a m\u016f\u017ee doj\u00edt k\u00a0p\u0159echodu do chronick\u00e9 formy kloubn\u00edho z\u00e1n\u011btu trvaj\u00edc\u00edho v\u00edce jak rok. V p\u0159\u00edpad\u011b artritidy kolenn\u00edho kloubu, kter\u00e1 je u LB nej\u010dast\u011bj\u0161\u00ed, je charakteristick\u00e9 v\u00fdznamn\u00e9 zmno\u017een\u00ed tekutiny v\u00a0kloubu projevuj\u00edc\u00ed se otokem kolena. Krom\u011b kolenn\u00edho kloubu mohou b\u00fdt zasa\u017eeny i dal\u0161\u00ed zejm\u00e9na velk\u00e9 klouby. B\u00fdv\u00e1 posti\u017een jen jeden kloub nebo n\u011bkolik m\u00e1lo kloub\u016f. Uv\u00e1d\u00edte, \u017ee m\u00e1te bolesti zad. Tato lokalizace je pro LB netypick\u00e1, p\u00e1te\u0159 nepat\u0159\u00ed mezi velk\u00e9 klouby a tuto diagn\u00f3zu nepodporuje ani skute\u010dnost, \u017ee p\u0159i vy\u0161et\u0159en\u00ed z lumb\u00e1ln\u00ed punkce nebyly z\u0159ejm\u011b zji\u0161t\u011bny protil\u00e1tky proti borreliov\u00fdm antigen\u016fm nebo borreliov\u00e9 DNA. Pokud nebyly nalezeny tyto protil\u00e1tky ani v s\u00e9ru, lze diagn\u00f3zu LB prakticky vylou\u010dit. <\/p>\n\n\n\n

Bolesti zad teoreticky mohou souviset s chronickou polyradikulitidou a polyneuritidou, je\u017e u LB m\u016f\u017ee po letech nastat. Obvykle jsou p\u0159itom p\u0159\u00edtomny asymetrick\u00e9 parest\u00e9zie (pocity mraven\u010den\u00ed, sv\u011bd\u011bn\u00ed apod.), bolesti, ochrnut\u00ed a poruchy \u010dit\u00ed v\u00a0ko\u0159enov\u00fdch oblastech a na koncov\u00fdch \u010d\u00e1stech kon\u010detin, p\u0159\u00edpadn\u011b v\u00a0m\u00edstech d\u0159\u00edve p\u0159\u00edtomn\u00e9 \u010derven\u00e9 skvrny \u010di p\u0159is\u00e1t\u00ed kl\u00ed\u0161t\u011bte. \u010casto b\u00fdv\u00e1 dermatitida (posti\u017een\u00ed k\u016f\u017ee) na koncov\u00fdch \u010d\u00e1stech kon\u010detin. Pokud v\u00e1\u0161 neurolog tyto p\u0159\u00edznaky nezjistil, bolesti zad z\u0159ejm\u011b nebudou souviset s borreli\u00f3zou. <\/p>\n\n\n\n

Je samoz\u0159ejm\u011b mo\u017en\u00e9 prov\u00e9st laboratorn\u00ed vy\u0161et\u0159en\u00ed. S\u00e9rologick\u00e9 vy\u0161et\u0159en\u00ed anti-borreliov\u00fdch protil\u00e1tek metodou ELISA je vyhled\u00e1vac\u00edm testem, kter\u00fd by m\u011bl b\u00fdt v\u017edy prov\u00e1d\u011bn jako prvn\u00ed. <\/p>\n\n\n\n

Pozitivn\u00ed v\u00fdsledky s\u00e9rologick\u00fdch test\u016f podporuj\u00ed diagn\u00f3zu, ale nejsou rozhoduj\u00edc\u00ed pro jej\u00ed stanoven\u00ed. I v\u00a0p\u0159\u00edpad\u011b pr\u016fkazu anti-borreliov\u00fdch protil\u00e1tek je t\u0159eba vylou\u010dit ostatn\u00ed mo\u017en\u00e9 diagn\u00f3zy. S\u00e9rologick\u00e9 testy nemohou poskytnout informace o d\u00e9lce trv\u00e1n\u00ed n\u00e1kazy, aktivit\u011b a z\u00e1va\u017enosti infekce, \u00fa\u010dinku l\u00e9\u010dby ani o progn\u00f3ze onemocn\u011bn\u00ed. Jejich opakov\u00e1n\u00ed po l\u00e9\u010db\u011b a p\u0159i n\u00e1sledn\u00e9 dispenzarizaci je v\u011bt\u0161inou ne\u00fa\u010deln\u00e9, posuzov\u00e1n\u00ed zm\u011bny titr\u016f protil\u00e1tek v\u00a0r\u016fzn\u00fdch odb\u011brech je bezcenn\u00e9. <\/p>\n\n\n\n

\u00a0\u00a0\u00a0\u00a0\u00a0 Polymer\u00e1zov\u00e1 \u0159et\u011bzov\u00e1 reakce zji\u0161\u0165uje ve vy\u0161et\u0159ovan\u00e9m materi\u00e1lu borreliovou DNA \u2013 nejvy\u0161\u0161\u00ed z\u00e1chyt b\u00fdv\u00e1 v\u00a0nitrokloubn\u00ed tekutin\u011b p\u0159\u00edpadn\u011b ve vzorku z\u00a0k\u016f\u017ee, vy\u0161et\u0159en\u00ed moku b\u00fdv\u00e1 \u010dasto negativn\u00ed. Vy\u0161et\u0159ov\u00e1n\u00ed mo\u010de \u010di krve je nevhodn\u00e9. Metoda je pova\u017eov\u00e1na pouze za dopl\u0148kovou a komer\u010dn\u00ed sety jsou ur\u010deny pouze pro v\u00fdzkumn\u00e9 \u00fa\u010dely.

Na z\u00e1klad\u011b shora uveden\u00e9ho je nepravd\u011bpodobn\u00e9, aby izolovan\u00e9 chronick\u00e9 bolesti zad bez ostatn\u00edch shora uveden\u00fdch p\u0159\u00edznak\u016f souvisely s boreli\u00f3zou.

MUDr. Jan \u010cin\u010dura <\/p>\n\n\n\n

<\/p>\n\n\n\n

<\/p>\n\n\n\n

<\/p>\n\n\n\n

<\/p>\n","protected":false},"excerpt":{"rendered":"

DOTAZ: Jak\u00fd je postup p\u0159i diagnoze lymsk\u00e1 borelioza? M\u00e1m n\u011bkolik let bolesti zad, tento rok na hranici snesitelnosti, 2x gynek.operace, 1x lumb. punkce, antibiotika 2x, […]<\/a><\/p>\n<\/div>","protected":false},"author":1,"featured_media":15661,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11,9],"tags":[],"class_list":["post-33913","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-zdravi","category-zpravy"],"_links":{"self":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/33913","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=33913"}],"version-history":[{"count":0,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/33913\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/media\/15661"}],"wp:attachment":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=33913"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=33913"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=33913"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}