Granuloma Annulare and Morphea: Correlation with Borrelia burgdorferi Infections and Chlamydia-related Bacteria

Abstract

A retrospective study of 109 skin biopsies with granuloma annulare (GA) or morphea histology from patients with suspected tick bite was performed. Biopsies were tested for cutaneous Borrelia burgdorferi DNA using PCR. The same biopsies were analysed for tick-borne novel agents, Chlamydia-related bacteria (members of the Chlamydiales order), using a PCR-based method. Borrelia DNA was detected in 7/73 (9.6%) biopsies with GA and in 1/36 (2.8 %) biopsies with morphea, while Chlamydiales DNA was found in 53/73 (72.6%) biopsies with GA and 25/34 (73.4%) biopsies with morphea. All Borrelia DNA-positive GA samples were also positive for Chlamydiales DNA. The Chlamydiales sequences detected in GA were heterogeneous and contained Waddliaceae and Rhabdochlamydiaceae bacteria, which are also present in Ixodes ricinus ticks, while the Chlamydiales sequences detected in morphea closely resembled those found in healthy skin. In conclusion, tick-mediated infections can trigger GA in some cases, while correlation of either Borrelia or Chlamydiales with morphea is unlikely.

Chlamydiales Bacterial Sequences in Lesional and Healthy Skin of Patients with Parapsoriasis

“…No significant differences in the occurrence of Chlamydiales DNA or in the sequence heterogeneity were observed between the swabs taken from skin lesions and those from healthy skin, whereas in skin biopsies from the lesions (77%) Chlamydiales were more often detected than in biopsies of healthy skin (54%). Similarly, in our earlier studies, the prevalence of Chlamydiales DNA was >70% in biopsies from various skin lesions (tick-bitten skin, granuloma annulare and morphea), whereas approximately half of the biopsies of healthy skin harboured Chlamydiales sequences (7,8). The slightly higher prevalence seen in the current study might be due to differences in storage conditions of the samples.…”

“…The diversity of Chlamydiales sequences in skin swabs and biopsies of parapsoriasis resembled that of healthy skin and morphea described in our earlier studies (7,8): in all these groups, the majority of classified sequences belonged to Parachlamydiaceae, Criblamydiaceae and Simkaniaceae families. Consequently, these Chlamydiales are not likely to play a significant role in the pathogenesis of parapsoriasis.…”

“…We recently demonstrated the presence of Chlamydiales DNA in human skin (7). Chlamydiales DNA could be detected in > 50% of all the skin biopsies studied, but the prevalence was higher and the type range was wider in biopsies from individuals with a suspected tick-related skin condition, compared with biopsies from healthy skin (8).…”

Borrelia and Chlamydia can form mixed biofilms in infected human skin tissues

“…Furthermore, the presence of Chlamydia DNAs in 68% of the skin biopsies obtained from patients with a suspected tick bite history was found [52]. The follow up study from the same research group reported that all Borrelia positive granuloma annulare skin conditions were also positive for Chlamydia related bacteria [53]. Furthermore, a recent Australian study also confirmed that DNA from ticks contains DNA belonging to the chlamydial order genotype [54] suggesting that Chlamydia can be a very frequent co-infection in Borrelia infected tissues.…”

Interstitial granuloma annulare triggered by Lyme disease

“…A retrospective study of 73 skin biopsies of GA from patients with a suspected tick bite detected Borrelia DNA by PCR in 9.6% (7/73) of biopsies. Chlamydiales DNA, which is also known to be present in Ixodes ticks, was isolated in 72.6% (53/73) in the same study, thereby suggesting tick exposure in these patients with GA [7]. Additionally, another study investigating a total of 157 biopsies of GA using a stain containing polyclonal Borrelia antibodies and focus-floating microscopy detected Borrelia in 80.9% (127/157) of biopsies of GA [8].…”