Early dissemination of Borrelia burgdorferi without generalized symptoms in patients with erythema migrans^Note

Abstract

The diagnosis of erythema migrans (EM) is not always easy, and reports of culture- or PCR-confirmed diagnosis as well as reports of EM with simultaneous disseminated disease are few. Characteristics and incidence of EM in addition to frequency of early dissemination of B. burgdorferi were studied in the archipelago of South-Western Finland prospectively using questionnaires, skin biopsies and blood samples. Clinical EM was recognized in 82 patients (incidence 148/100,000 inhabitants/year). Of skin biopsy samples, 35.5% were positive by PCR (the majority B. garinii), and 21.5% by cultivation (all B. garinii). Of blood samples, 3.8% were positive by PCR, and 7.7% by cultivation. Of the patients, 30.9% were seropositive at the first visit, and 52.9% 3 weeks later. Of the patients with laboratory confirmed diagnosis, the EM lesion was ring-like in 31.8% and homogeneous in 65.9%. Dissemination of B. burgdorferi, based on culture or PCR positivity of blood samples, was detected in 11.0% of the patients. The frequency of generalized symptoms was nearly the same in patients with as in those without dissemination (22.2% vs 27.4%). Only 21.4% of the patients with culture-positive EM recalled a previous tick bite at the site of the EM lesion. We conclude that EM lesions are more often homogeneous than ring-like. B. burgdorferi may disseminate early without generalized symptoms.

Cloning of the gene encoding the decorin-binding protein B (DbpB) in Borrelia burgdorferi sensu lato and characterisation of the antibody responses to DbpB in Lyme borreliosis

“…As an ELISA antigen, recombinant DbpB from B. garinii predominated. This is in line with European studies, in which either B. garinii or B. afzelii has been observed to be the most prevalent strain causing human LB [26][27][28]. In patients with LA from Germany, the DbpB from B. burgdorferi sensu stricto also performed well as an ELISA antigen.…”

Improved serodiagnosis of erythema migrans using novel recombinant borrelial BBK32 antigens

“…Recent reports from the USA and Europe (Oksi et al, 2001;Smith et al, 2002) have shown that the diagnosis of EM solely on clinical grounds may be difficult. During the first few days of infection, the pathognomonic expanding peripheral erythema with a central clearing appears to be far less common than lesions with homogeneous redness (Oksi et al, 2001;Smith et al, 2002).…”

“…During the first few days of infection, the pathognomonic expanding peripheral erythema with a central clearing appears to be far less common than lesions with homogeneous redness (Oksi et al, 2001;Smith et al, 2002). This implies that EM may be confused with other similar rashes, e.g.…”

“…The classical appearance of EM is an enlarging, ringlike erythema with a central clearing. However, early in the course of LB, atypical lesions may occur and cause diagnostic problems (Oksi et al, 2001;Smith et al, 2002). The gold standard for the diagnosis of early LB is microbiological confirmation of LB by culture from biopsies taken from EM lesions and/or from blood.…”

Antibody responses to borrelia IR6 peptide variants and the C6 peptide in Swedish patients with erythema migrans

“…In addition, the relative distribution of different Borrelia genospecies in different geographical locations may explain the somewhat discrepant serological responses. Such differences have previously been documented: In a Finnish study, the majority of culture or PCR verified EM patients were positive for B. garinii (Oksi et al, 2001) while a recent Swedish study from Blekinge County showed a predominance of B. afzelii in a comparable patient material (Bennet et al, 2006).…”