Polymerase chain reaction control of antibiotic treatment in dermatoborreliosis

Abstract

Assessment of the efficacy of an antibiotic drug used in patients with various manifestations of dermatoborreliosis is crucial. Clinical judgement alone (resolution of the present dermatologic lesion, prevention of later major or minor sequelae) is not sufficient in erythema migrans and acrodermatitis chronica atrophicans. Thus, laboratory tests are desirable to prove the benefit of an antimicrobial agent. It was intended to establish a constant parameter--besides the clinical picture--for assessing the efficacy of antibiotic treatment in patients with dermatoborreliosis in terms of eradication of Borrelia burgdorferi from the site of infection. Polymerase chain reaction (PCR) was therefore performed from pretreatment biopsy specimens from lesional skin of 36 erythema migrans patients (m:f = 15:21, mean age 49 years) and seven acrodermatitis chronica atrophicans patients (m:f = 0:7, mean age 59 years), respectively. After antibiotic therapy with minocycline (100 mg, orally twice daily, 14 days) for erythema migrans, and ceftriaxone (2 g, intravenously once daily, 14 days) for acrodermatitis chronica atrophicans another punch biopsy was obtained and analysed by PCR. In pretreatment specimens, B. burgdorferi-specific DNA was amplified by PCR in 23/36 erythema migrans patients (69%), and in 5/7 acrodermatitis chronica atrophicans patients (71%). After antibiotic therapy, PCR yielded negative results in all of these cases. Clinically, all patients showed complete recovery or at least marked improvement of lesions at this time. PCR appears to be a reliable parameter for the assessment of the efficacy of antibiotic treatment in dermatoborreliosis.

Diagnosis of Lyme Borreliosis

“…PCR targets that have been employed for detection of B. burgdorferi sensu lato DNA in skin biopsy specimens include p66 (31,210,211,344,358,359), the 16S rRNA gene (296,303), fla (177,234,256), the 23S rRNA gene (31), the 5S rRNA-23S rRNA gene spacer (279), recA (177), and ospA (209,279,327).…”

Differenzialdiagnose der Acrodermatitis chronica atrophicans unter besonderer Berücksichtigung der chronisch-venösen Insuffizienz

“…Es gibt nur sehr wenige Studien über die Häufigkeit von Fehldiagnosen in der Dermatologie. Beispielsweise haben Weenig et al (32) Es gibt aktuell keine allgemein anerkannte Empfehlung für die Behandlung der ACA, zumal bislang nur wenige Therapiestudien mit kleinen Patientenzahlen durchgeführt wurden (1,2,4,17,21,22,31). Aus diesen Studie kann abgeleitet werden, dass Doxycyclin, Minocyclin, Cefuroxim, Cefotaxim, Ceftriaxon und orales wie auch parenterales Penizillin effektiv sind.…”

The Role of Culture and Nucleic Acid Amplification in Diagnosis of Lyme Borreliosis

“…Of these, skin biopsy samples taken from patients with EM were the most frequently tested specimens Wienecke et al, 1993;Muellegger et al, 1995Muellegger et al, , 1996von Stedingk et al, 1995;Picken et al, 1997;Rijpkema et al, 1997;Brettschneider et al, 1998;Oksi et al, 2001;Liveris et al, 2002;Wang, 2002). Other commonly used clinical specimens for PCR analysis include whole blood (Liebling et al, 1993), serum (Wallach et al, 1993;Demaerschalck et al, 1995) or plasma specimens (Goodman et al, 1995;Oksi et al, 2001), cerebrospinal fluid from patients with neuroborreliosis (Debue et al, 1991;Keller et al, 1992;Luft et al, 1992;Liebling et al, 1993;Pachner and Delaney, 1993;Zbinden et al, 1994;Christen et al, 1995;Nocton et al, 1996;Priem et al, 1997;Schwaiger et al, 2001;Ornstein et al, 2002), and synovial fluid/tissue from patients with Lyme arthritis (Debue et al, 1991;Liebling et al, 1993;Bradley et al, 1994;Persing et al, 1994;Jaulhac et al, 1996;Nocton et al, 1996;Priem et al, 1997;Eiffert et al, 1998;van der Heijden et al, 1999;Schwaiger et al, 2001;Schnarr et al, 2001).…”

“…The PCR targets that have been employed for detection of Lyme borrelia DNA in skin biopsy specimens include p66 (Wienecke et al, 1993;von Stedingk et al, 1995;Muellegger et al, 1995Muellegger et al, , 1996Brettschneider et al, 1998), rrs Schwaiger et al, 2001), fla (Picken et al, 1997;Oksi et al, 2001;Liveris et al, 2002), rrl (Brettschneider et al, 1998), rrf-rrl spacer (Rijpkema et al, 1997), recA (Liveris et al, 2002), and ospA (Moter et al, 1994;Rijpkema et al, 1997;Steere et al, 1998).…”