Clinical Spectrum of Skin Manifestations of Lyme Borreliosis in 204 Children in Austria

Glatz, Martin; Resinger, Astrid; Semmelweis, Kristina; Ambros-Rudolph, Christina M.; Müllegger, Robert R.

doi:10.2340/00015555-2000

Cited by 36 publications

(27 citation statements)

References 46 publications

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“…In the present study there was a median time interval of 21 days from the tick bite to the occurrence of BL; thus, the incubation period is longer than 14-17 days as reported for European EM [35,36]. However, BL may also appear before EM [9,33]. In the present study, EM was noticed before BL in 24 of 91 patients (26.4%) and simultaneously with BL in 38 (41.8%), and 29 patients (31.9%) stated that the EM appeared after the onset of BL.…”

Section: Treatment Resultsmentioning

confidence: 76%

“…All patients with treatment failure had uneventful outcome after retreatment. [18][19][20][21][22][23][24][25] than in adults [26][27][28][29][30][31][32], and 6 reports consisting of ≥20 cases of BL, 2 of which included only children [33,34], 3 included children and adults [2,7,8], and 1 included only adult patients [9]. Our results in 144 consecutive adult patients with BL diagnosed in a single center during a period of 29 years showed that most of the pretreatment clinical characteristics were similar to those in previous reports.…”

Section: Treatment Resultsmentioning

confidence: 99%

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Borrelial Lymphocytoma in Adult Patients

et al. 2016

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Background. Information on the course and outcome of borrelial lymphocytoma (BL) is limited. Methods. The study comprised 144 adult patients (75 female, 69 male; median age, 49 years) who had BL diagnosed at a single center between 1986 and 2014 and were followed up for 1 year.Results. BL was located on the breast in 106 patients (73.6%), on the ear lobe in 27 (18.8%), and elsewhere in 11 (7.6%). The median duration of BL before diagnosis was 27 days (interquartile range [IQR], 9-68 days). Concomitant erythema migrans was registered in 104 of 144 patients (72.2%); other objective manifestations of Lyme borreliosis (LB) were present in 11 (7.6%). Immunoglobulin M and/or G borrelial serum antibodies were present in 72 patients (50%). Borreliae were isolated from BL lesions in 14 of 42 patients (33.3%) who had not received antibiotics before skin biopsy. Of 13 typed Borrelia strains, 11 were B. afzelii, 1 was B. garinii, and 1 was B. bissettii. The median duration of BL after starting antibiotic treatment was 21 days ([IQR], 10-30 days); the average duration was longer in patients who were older, had longer BL duration before treatment, or had signs of disseminated LB. Treatment failure occurred in 14 of 144 patients (9.7%). Patients with signs or symptoms of disseminated LB before treatment had nearly 4 times higher odds of treatment failure (95% confidence interval, 1.22-13.07) than those without such symptoms. All patients with treatment failure had uneventful outcome after retreatment.Conclusions. BL is a rare manifestation of early localized LB. Fourteen-day antibiotic treatment, as used for erythema migrans, is effective.

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Section: Treatment Resultsmentioning

confidence: 76%

Section: Treatment Resultsmentioning

confidence: 99%

Borrelial Lymphocytoma in Adult Patients

et al. 2016

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“…In the adult European population 1-2% of Borreliosis develop ACA [2], among children ACA was observed in about 1% [6]. The clinical presentation may vary.…”

Section: Discussionmentioning

confidence: 99%

Atypical Acrodermatitis Chronica Atrophicans Herxheimer

Wollina¹

2015

CRDOA

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Acrodermatitis Chronica Atrophicans Herxheimer (ACA) is a tick-born disease due to infection by Borrelia afzelii, the major vector organism is Ixodes rhicinus. We report on a 48-year-old male patient who developed extensive livid-erythematous fibrosclerotic symmetric plaques associated with hyperpigmented widely distributed lesions within the tension lines, and acrocyanosis. The diagnosis of ACA has been confirmed by histopathologic examination of a skin biopsy and laboratory investigations with positive IgG and IgM immunoblots. The patient was treated by intravenous ceftriaxone resulting in partial remission of cutaneous and extracutaneous symptoms.Keywords: Acrodermatitis chronic atrophicans Herxheimer; Borreliosis; Cutaneous manifestations; Treatment Sensitivity and specificity of enzyme immuno assay and immune blot are 95% and 80-95% for ACA [4]. Polymerase chain reaction (PCR) of skin biopsies was positive in up to 88% on fresh-frozen tissue but only in 44-52% using paraffin-embedded tissue [5]. Case ReportA 48-year-old male patient was referred to our hospital because of large livid-erythematous fibrosclerotic plaques on his trunk and extremities which developed within half a year. He suffered from arterial hypertension and had a penicillin allergy. He had no memory of any tick bite.On examination we observed symmetric large lividerythematous fibrosclerotic plaques on his upper back. Erythematous to brownish lesions along the tension lines of skin were found on the lower back, abdominal, on the shoulders and proximal extremities. On this hands, a livid erythema was noted. During inspiration the lower thoracic aperture had a decreased elongation. On the hands there was an incomplete fist circuit notable. No other clinical symptoms were noted.We performed a skin biopsy. Histologic evaluation disclosed dermal changes including broadened and homogenized collagen bundles, perivascular and periadnexal lymphocytic infiltrate with some mast cells and plasma cells intermingled. PCR for Borrelia remained negative. Laboratory investigationsLeukocytes 12.4 (normal range: 3.8-11.0 Gpt/l); neutrophils 9.4 (1.8-7.6 Gpt/l); C-reactive protein 17.6 (< 5 mg/dl); total IgE 269 (0-100kU/l); rheumatoid factor 38 (< 14 IU/ml); Borrelia IgG-antibodies [Enzyme immune assay] >200 (<16 RE/ml), IgM-antibodies 19.2 (<16 RE/ml), IgG-immunoblot: positive; IgM-immunoblot positive; serum albumin 47.6 (60,3-71,4 %), γ-globulin 30.0 (8.7-16.0 %). Antinuclear antibodies (ANA) and antibodies against extractable nuclear antigens (ENA): negative. Imaging diagnosticsUltrasound -neck, axillaries, groins, abdomen -unremarkable. Thoracic X-ray and body plethysmography-unremarkable.

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“…In our case, BL was the only clinical presentation of Borrelia infection, as the former rash was not diagnosed as EM. The appearance of BL is usually a painless, bluishred, soft nodule or plaque (5). The diagnosis is based on patient's history and clinical findings, but serological tests are recommended to confirm the diagnosis, especially in atypical cases (2).…”

Section: Diagnosis: Borrelia Lymphocytomamentioning

confidence: 99%