Hautmanifestationen der Lyme-Borreliose

Abstract

The dermatological symptoms of Lyme borreliosis present with a typical clinical pattern and characteristic time of appearance. In contrast to other manifestations of Lyme borreliosis they are easily recognizable in most of the cases. In the first stage, erythema migrans arises at the tick bite site. With this symptom the diagnosis of Lyme borreliosis can be established. During all manifestations of Lyme borreliosis the history of erythema migrans is an important parameter to verify the diagnosis. In the early stage of disease a lymphocytic proliferation can appear at the tick bite site, at the ear lobe, or at the mamilla. Borrelia lymphocytoma can be diagnosed when antibodies against Borrelia burgdorferi are positive. Years after infection, acrodermatitis chronica atrophicans arises at distal body sites causing livid swelling and gradually skin atrophy. Skin lesions can be accompanied by neuropathies, mostly of the lower legs, which in contrast to the skin lesions, do not respond well to antibiotic therapy. There is evidence that some cases of Shulman syndrome, morphea and lichen sclerosus et atrophicus might be related to a borrelia infection as indicated by cultivation of B. burgdorferi from skin biopsies of morphea and response to antibiotic treatment in some cases. The classical dermatological symptoms of Lyme borreliosis, erythema migrans, borrelia lymphocytoma and acrodermatitis chronica atrophicans respond to oral antibiotic treatment. In acrodermatitis chronica atrophicans parenteral antibiotic therapy is sometimes necessary.

A Case of Generalized Morphea with a High Titer of Anti‐Borrelia burgdorferi Antibodies

“…These diseases have been thought to be chronic forms of borreliosis, because their histopathological findings such as fibrosis in the dermis were quite similar (4). Such observations have led several investigators to consider the possibility of Borrelia burgdorferi as a common etiologic factor among all of these diseases, because infection due to Borrelia burgdorferi is thought to play an important role in the development of sclerosis in the dermis (8). In our case, we have no further evidence that Borrelia burgdorferi infection can cause a disease such as generalized morphea other than the elevated titer of anti-Borrelia burgdotferi antibodies.…”

Ear presentation of Lyme borreliosis in a child

“…9 In Scotland, our laboratory uses local isolates for western blot analysis, rather than US or European isolates, and this improves the specificity of Lyme borreliosis testing. 9 In Scotland, our laboratory uses local isolates for western blot analysis, rather than US or European isolates, and this improves the specificity of Lyme borreliosis testing.…”

“…12 While this down-regulation may protect the autoantigen reaction, it may also lead to an impaired capacity of Langerhan's cells to eliminate the spirochaetes, resulting in chronicity of the infection. 9,15 Erythromycin is used if the patient is allergic to penicillin. 13 A case report has shown that borrelia spirochaetes may be cultured from skin biopsy material as long as 10 years after the onset of disease.…”

“…Insufficient elimination of borrelia spirochaetes by complement and antibodies has also been reported due to down-regulation of the immune response. 8,9 • Head and neck Lyme borreliosis can present without a classic history or recent tick bite • Specific laboratory testing aids the diagnosis of atypical skin lesions • This condition is a differential diagnosis of a persistent, inflamed earlobe in a well child 14 In a child younger than eight years of age with early localised or disseminated infection, evidence-based treatment recommendations specify treatment with amoxicillin, ceftriaxone or cefuroxime, for a duration of 14-21 days.…”

Physician Beliefs, Attitudes, and Approaches Toward Lyme Disease in an Endemic Area

“…This is curious because, while EM may take several forms, the classic expanding lesion with central clearing is considered by most authorities to be pathognomonic. 3, [15][16][17][18] Respondents varied in their choice of serologic tests, but almost half did not specify a particular assay when ordering Lyme serology. More pediatricians ordered the Western blot assay, a useful confirmatory test, perhaps owing to its ready availability at our children's hospital.…”