Morphoea and Borrelia burgdorferi: results from the Scottish Highlands in the context of the world literature

Abstract

Aims: Previous studies investigating the link between infection with Borrelia burgdorferi and morphoea have produced conflicting results. Often, these studies have been undertaken in patients from different regions or countries, and using methods of varying sensitivity for detecting Borrelia burgdorferi infection. This study aimed to establish whether a relation could be demonstrated in the Highlands of Scotland, an area with endemic Lyme disease, with the use of a sensitive method for detecting the organism. Methods: The study was performed on biopsies of lesional skin taken from 16 patients from the Highlands of Scotland with typical clinical features of morphoea. After histological confirmation of the diagnosis, a nested polymerase chain reaction (PCR) using primers to a unique conserved region of the Borrelia burgdorferi flagellin gene was performed on DNA extracts from each biopsy. A literature search was also performed for comparable studies. Results: None of the 16 patients had documented clinical evidence of previous infection with B burgdorferi. DNA was successfully extracted from 14 of the 16 cases but all of these were negative using PCR for B burgdorferi specific DNA, despite successful amplification of appropriate positive controls in every test. The results were compared with those of other documented studies. Conclusions: Examination of the literature suggests that there is a strong geographical relation between B burgdorferi and morphoea. These results, in which no such association was found, indicate that morphoea may not be associated with the subspecies of B burgdorferi found in the Highlands of Scotland. E rythema chronicum migrans, acrodermatitis chronica atrophicans (ACA), and lymphocytoma cutis are all cutaneous manifestations of Lyme disease, a multisystem disorder that follows infection with Borrelia burgdorferi.

“Borrelia-associated early-onset morphea”: A particular type of scleroderma in childhood and adolescence with high titer antinuclear antibodies?

“…11 After the first report by Aberer, Neumann, and Stanek 6 in 1985 on an association between morphea and B burgdorferi infection, the pathogenic role of Borrelia in triggering morphea onset has been an open matter of intense debate. [12][13][14][15][16][17] Intrigued by 3 young patients suffering from severe or disseminated morphea in association with Borrelia infection, we reevaluated the enigmatic relationship between these two conditions and examined retrospectively a cohort of 90 morphea patients, identifying a unique autoimmune type of scleroderma in which B burgdorferi seems to have an important role.…”

Presence of Borrelia burgdorferi“Sensu Lato” in patients with morphea from the Amazonic region in Brazil

“…3 However, subsequent reports with contradictory results were published. 4,5 Detection of Borrelia in morphea has been extensively reviewed by Weide et al 6 and Goodlad et al 7 These authors showed that an important challenge for the establishment of morphea and Borrelia association is the difficulty to detect the spirochete in tissue specimens. Most current borrelial detection methods lack sufficient sensitivity, so that even classical cutaneous borrelial infections rely on 1373 diagnosis based on circumstantial evidence combining clinicopathological, laboratorial information, and response to therapy.…”

Borreliose de Lyme

“…It can be triggered by physical trauma, infections or immunological changes. 55 In 1987 Aberer et al published the first study suggesting the association of scleroderma plaque and B. burgdorferi. 56 Subsequently, other authors also correlated sclerodermia and infection by B. burgdorferi.…”