Microbiological findings in erythema (chronicum) migrans and related disorders

Neubert, U.; Krampitz, H. E.; Engl, Hildegard

doi:10.1016/s0176-6724(86)80127-4

Cited by 23 publications

(31 citation statements)

References 20 publications

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“…B. burgdorferi sensu lato can be recovered from various tissues and body fluids of patients with LB, including biopsy (14,25,31,140,165,178,200,204,209,214,221,227,237,256,267,303,327,333,342,369) and lavage (369) specimens of EM skin lesions, biopsy specimens of ACA skin lesions (14,258,267,342), biopsy specimens of borrelial lymphocytoma skin lesions (188), cerebrospinal fluid specimens (60,147,237,267,342), and blood specimens (13,22,189,216,221,322,367,368,374). Anecdotally, recovery of B. burgdorferi sensu lato from other tissue or fluid specimens (189), such as synovial fluid (289), cardiac tissue (312), and iris (265), has also been reported.…”

Section: Laboratory Diagnosismentioning

confidence: 99%

Diagnosis of Lyme Borreliosis

et al. 2005

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A large amount of knowledge has been acquired since the original descriptions of Lyme borreliosis (LB) and of its causative agent, Borrelia burgdorferi sensu stricto. The complexity of the organism and the variations in the clinical manifestations of LB caused by the different B. burgdorferi sensu lato species were not then anticipated. Considerable improvement has been achieved in detection of B. burgdorferi sensu lato by culture, particularly of blood specimens during early stages of disease. Culturing plasma and increasing the volume of material cultured have accomplished this. Further improvements might be obtained if molecular methods are used for detection of growth in culture and if culture methods are automated. Unfortunately, culture is insensitive in extracutaneous manifestations of LB. PCR and culture have high sensitivity on skin samples of patients with EM whose diagnosis is based mostly on clinical recognition of the lesion. PCR on material obtained from extracutaneous sites is in general of low sensitivity, with the exception of synovial fluid. PCR on synovial fluid has shown a sensitivity of up to >90% (when using four different primer sets) in patients with untreated or partially treated Lyme arthritis, making it a helpful confirmatory test in these patients. Currently, the best use of PCR is for confirmation of the clinical diagnosis of suspected Lyme arthritis in patients who are IgG immunoblot positive. PCR should not be used as the sole laboratory modality to support a clinical diagnosis of extracutaneous LB. PCR positivity in seronegative patients suspected of having late manifestations of LB most likely represents a false-positive result. Because of difficulties in direct methods of detection, laboratory tests currently in use are mainly those detecting antibodies to B. burgdorferi sensu lato. Tests used to detect antibodies to B. burgdorferi sensu lato have evolved from the initial formats as more knowledge on the immunodominant antigens has been collected. The recommendation for two-tier testing was an attempt to standardize testing and improve specificity in the United States. First-tier assays using whole-cell sonicates of B. burgdorferi sensu lato need to be standardized in terms of antigen composition and detection threshold of specific immunoglobulin classes. The search for improved serologic tests has stimulated the development of recombinant protein antigens and the synthesis of specific peptides from immunodominant antigens. The use of these materials alone or in combination as the source of antigen in a single-tier immunoassay may someday replace the currently recommended two-tier testing strategy. Evaluation of these assays is currently being done, and there is evidence that certain of these antigens may be broadly cross-reactive with the B. burgdorferi sensu lato species causing LB in Europe

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Section: Laboratory Diagnosismentioning

confidence: 99%

Diagnosis of Lyme Borreliosis

et al. 2005

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“…Warthin-Starry and modified Dieterle silver stains have been used to reveal the spirochetes in a variety of biopsy and autopsy materials that have been Formalin fixed and embedded in paraffin (31,61,62,67,99,123,130,146). According to Duray and Johnson, a modified Dieterle stain is easier to perform than the Warthin-Starry stain (61).…”

Section: Differential Diagnosismentioning

confidence: 99%

“…According to Duray and Johnson, a modified Dieterle stain is easier to perform than the Warthin-Starry stain (61). In various reports, silver stains have been used successfully to detect spirochetes in <1 to 100% of ECM lesion biopsies (31,32,63,67,130); for most investigators the success has been about 40 to 50%. The spirochetes are most easily found if the biopsy is taken from the advancing edge of the ECM lesion and the papillary dermis is examined.…”

Section: Differential Diagnosismentioning

confidence: 99%

“…Most biopsies yielding positive cultures have been taken from the expanding edge of the ECM lesion where histologic stains have shown that the spirochetes are in highest numbers. B. burgdorferi has also been isolated from skin biopsies of patients with acrodermatitis chronica atrophicans of several years duration (9,130) and patients with lymphocytoma (86). A skin biopsy was stored frozen at -80'C for 2 years before successful recovery of borreliae in culture medium (130).…”

Section: Differential Diagnosismentioning

confidence: 99%

“…B. burgdorferi has also been isolated from skin biopsies of patients with acrodermatitis chronica atrophicans of several years duration (9,130) and patients with lymphocytoma (86). A skin biopsy was stored frozen at -80'C for 2 years before successful recovery of borreliae in culture medium (130). The etiologic agent has been isolated only infrequently from affected joints (140,153); synovial fluid cultures of humans and dogs with Lyme arthritis have usually been negative (83,104,160).…”

Section: Differential Diagnosismentioning

confidence: 99%

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Laboratory aspects of Lyme borreliosis

Barbour

1988

Clin Microbiol Rev

130

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Lyme borreliosis (Lyme disease), a common tick-borne disorder of people and domestic animals in North America and Europe, is caused by the spirochete Borrelia burgdorferi. Following the discovery and initial propagation of this agent in 1981 came revelations that other tick-associated infectious disorders are but different forms of Lyme borreliosis. A challenge for the clinician and microbiology laboratory is confirmation that a skin rash, a chronic meningitis, an episode of myocarditis, or an arthritic joint is the consequence of B. burgdorferi infection. The diagnosis of Lyme borreliosis may be established by (i) directly observing the spirochete in host fluid or tissue, (ii) recovering the etiologic spirochete from the patient in culture medium or indirectly through inoculation of laboratory animals, or (iii) carrying out serologic tests with the patient's serum or cerebrospinal fluid. The last method, while lacking in discriminatory power, is the most efficacious diagnostic assay for most laboratories at present.

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