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Ninety-three Borrelia burgdorferi isolates obtained from erythema migrans lesions or blood of Lyme disease patients in Westchester County, N.Y., between 1991 and 1994 were characterized by PCR-restriction fragment length polymorphism (PCR-RFLP) analysis of the 16S-23S rRNA gene spacer. All isolates could be classified into three distinct RFLP types. Among the 82 skin biopsy isolates studied, 21 (25.6%) were type 1, 37 (45.1%) were type 2, and 21 (25.6%) were type 3. Three (3.7%) cultures contained a mixture of two isolates with distinct RFLP types. The 11 isolates cultured from blood showed a similar predominance of RFLP type 2 (6 of 11; 54.5%) relative to types 1 (2 of 11; 18.2%) and 3 (3 of 11; 27.3%). For one patient both skin and blood isolates were cultured, and RFLP analysis revealed that these isolates differed from one another. This study demonstrates that there is genotypic heterogeneity in B. burgdorferi strains infecting Lyme disease patients, and this typing approach may allow differentiation of isolates with various degrees of pathogenic potential.

To evaluate the frequency, pattern, and severity of Lyme disease is a multisystemic infection caused by liver function test abnormalities in patients with Lyme the tick-borne spirochete, Borrelia burgdorferi. A great disease associated with erythema migrans (EM), 115 in-deal of attention has been paid to the dermatologic, dividuals with no other identifiable cause for liver func-musculoskeletal, cardiovascular, and neurological tion test abnormalities who presented with EM between manifestations of Lyme disease. 1,2 Acute hepatitis has July 1990 and September 1993 were prospectively evalu-been reported in the early stages of Lyme disease, 3-6 ated. For individuals with abnormal liver function tests, and hepatic enzyme elevations have been reported in common causes of hepatitis, including hepatitis A, B, 20% to 50% of patients with the characteristic rash of and C, were excluded. A local control group was used early Lyme disease, erythema migrans (EM). 2,7-10 Howfor comparison. Forty-six (40%) patients had at least one ever, there have been no prospective evaluations of heliver test abnormality, and 31 (27%) had more than 1 abnormality compared with 19 (19%) and 4 (4%) of con-patic dysfunction in treated patients for whom other trols, respectively (P õ .01 for each comparison). g-Gluta-major causes for liver disease were excluded. Moreover, myl transpeptidase (28%) and alanine transaminase there have been few prospective evaluations of liver (ALT) (27%) were the most frequently elevated liver function tests in a large group of patients in whom the function tests among Lyme disease patients. Anorexia, diagnosis of Lyme disease was confirmed by culture of nausea, or vomiting was reported by 30% of patients, but B. burgdorferi. To determine the frequency, severity, did not occur more frequently in patients with elevated and response to therapy of hepatitis associated with liver function tests compared with those with normal Lyme disease, we prospectively evaluated patients pre- Liver function test abnormalities are common in pa-The study population consisted of 124 consecutive untients with EM but were mild, most often not associated treated patients ¢16 years of age with a clinical diagnosis of with symptoms, and improved or resolved by 3 weeks EM who were enrolled in one of two ongoing treatment trials after the onset of antibiotic therapy in most patients. at the Lyme Disease Diagnostic Center of the Westchester

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