Characteristics of spirochetemic patients with a solitary erythema migrans skin lesion in Europe

Maraspin, Vera; Ogrinc, Katarina; Rojko, Tereza; Bogovič, Petra; Ružić‐Sabljić, Eva; Kastrin, Andrej; Wormser, Gary P.; Strle, Franc

doi:10.1371/journal.pone.0250198

Cited by 6 publications

(1 citation statement)

References 37 publications

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“…We do not have a reliable explanation for the negative correlation between the Borrelia isolation rate from the skin and the presence of Borrelia IgM (but not IgG) antibodies in serum ( Table 4 ). However, low IgM seropositivity in EM patients with Borrelia isolation from skin and/or blood has been reported previously [ 21 ].…”

Section: Discussionmentioning

confidence: 96%

Microbiologic Findings in a Cohort of Patients with Erythema Migrans

Ružić-Sabljić,

Maraspin,

Bogovič

et al. 2024

Microorganisms

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Erythema migrans (EM) is the initial and the most frequent clinical manifestation of Lyme borreliosis (LB). Herein, we report on the capacity of culture and serology for the demonstration of Borrelia infection in a cohort of 292 patients diagnosed with typical EM at a single medical center. The median duration of EM at diagnosis was 12 days, and the largest diameter was 16 cm; 252 (86.3%) patients presented with solitary EM, whereas 40 (13.7%) had multiple EM. A total of 95/292 (32.5%) patients had positive IgM, and 169 (57.9%) had positive IgG serum antibodies; the Borrelia isolation rate was 182/292 (62.3%). The most frequent species by far was B. afzelii (142/148, 95.9%) while B. garinii (2.7%) and B. burgdorferi s.s. (1.4%) were rare. IgM seropositivity was associated with a younger age, multiple EM and the absence of underlying chronic illness; IgG seropositivity was associated with the duration of EM at diagnosis, the diameter of the EM, having had a previous episode of LB and the absence of symptoms at the site of the EM. Furthermore, the Borrelia isolation rate was statistically significantly lower in patients with positive Borrelia IgM antibodies. Although microbiologic analyses are not needed for the diagnosis of typical EM, they enable insights into the etiology and dynamics of the immune response in the course of early LB.

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Section: Discussionmentioning

confidence: 96%

Microbiologic Findings in a Cohort of Patients with Erythema Migrans

Ružić-Sabljić,

Maraspin,

Bogovič

et al. 2024

Microorganisms

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Early Lyme Disease (Erythema Migrans) and Its Mimics (Southern Tick-Associated Rash Illness and Tick-Associated Rash Illness)

Strle

Wormser

2022

Infectious Disease Clinics of North America

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Colocalization of Radicular Pain and Erythema Migrans in Patients With Bannwarth Syndrome Suggests a Direct Spread of Borrelia Into the Central Nervous System

Ogrinc

Kastrin

Lotrič‐Furlan

et al. 2021

Clinical Infectious Diseases

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Background There is a general assumption that after deposition into skin, Lyme borreliae disseminate hematogenously to other organs, resulting in extracutaneous manifestations of Lyme borreliosis, including Lyme neuroborreliosis. However, our experience over the past 40 years, along with several published case reports which observed colocalization of radicular pain and erythema migrans (EM) in patients with borrelial meningoradiculoneuritis (Bannwarth’s syndrome), argues against hematogenous dissemination in Lyme neuroborreliosis. Methods We compared the location of EM in 112 patients with Bannwarth’s syndrome to 12315 EM patients without neurological involvement. Moreover, we assessed the colocalization of EM and radicular pain in patients with Bannwarth’s syndrome. Results Compared to >12000 EM patients without neurological involvement, patients with Bannwarth’s syndrome had a significantly higher frequency of EM on head/neck (6% vs 1%; P=.0005) and trunk (47% vs 24%; P<.0001), similar frequency on arms (16% vs 16%; P=.91), but lower frequency on legs (30% vs 59%; P<.0001). Moreover, in 79% (89/112) of patients the site of EM matched the dermatomes of radicular pain. The odds for a congruent location of EM and radicular pain were highly significant with the highest odds ratios (OR) observed for head (OR=221), followed by neck (OR=159), legs (OR=69), arms (OR=48) and trunk (OR=33). Conclusions The greater frequency of EM on head/neck and trunk and the colocalization of EM with radicular pain in patients with Bannwarth’s syndrome suggest that central nervous system involvement in Lyme neuroborreliosis is due to a retrograde spread of borrelia from skin to the spinal cord via peripheral nerves.

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Characteristics of spirochetemic patients with a solitary erythema migrans skin lesion in Europe

Cited by 6 publications

References 37 publications

Microbiologic Findings in a Cohort of Patients with Erythema Migrans

Microbiologic Findings in a Cohort of Patients with Erythema Migrans

Early Lyme Disease (Erythema Migrans) and Its Mimics (Southern Tick-Associated Rash Illness and Tick-Associated Rash Illness)

Colocalization of Radicular Pain and Erythema Migrans in Patients With Bannwarth Syndrome Suggests a Direct Spread of Borrelia Into the Central Nervous System

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