Heterogeneity of Borrelia burgdorferi in the Skin

Abstract

The reliability of various in vitro techniques to identify Borrelia burgdorferi infection is still unsatisfactory. Using a high-power resolution videomicroscope and staining with the borrelia genus-specific monoclonal flagellar antibody H9724, we identified borrelial structures in skin biopsies of erythema chronicum migrans (from which borrelia later was cultured), of acrodermatitis chronica atrophicans, and of morphea. In addition to typical borreliae, we noted stained structures of varying shapes identical to borreliae found in a "borrelia-injected skin" model; identical to agar-embedded borreliae; and identical to cultured borreliae following exposure to hyperimmune sera and/or antibiotics. We conclude that the H9724-reactive structures represent various forms of B. burgdorferi rather than staining artifacts. These "atypical" forms of B. burgdorferi may represent in vivo morphologic variants of this bacterium.

Possible Role of Borreliaburgdorferi Sensu Lato Infection in Lichen Sclerosus

“…All forms of B burgdorferi, as described in detail by Aberer et al, 26 were seen: mostly single and paired spirochetes and, rarely, clusters and colonies. Forms varied from very long and undulated to comma-and dot-shaped forms, with their appearance ranging from delicate to plump or granular (Figure 2).…”

“…[21][22][23] Histological, histochemical, and immunohistochemical detection of microorganisms has turned out to be difficult, frequently unreliable, and almost always extremely time consuming. [23][24][25][26] Cultures with specific media can detect Borrelia species in all clinical forms, but these techniques are not generally available and are unreliable, with less than 50% sensitivity for classic borreliosis. Therefore, negative culture findings may be attributable to the fastidiousness of the organism in the culture.…”

“…Therefore, negative culture findings may be attributable to the fastidiousness of the organism in the culture. 26,27 The initial enthusiasm with molecular techniques gave way to a more realistic evaluation of these methods as it became clear that sensitivity varies (30%-90%) according to Borrelia strains, the material (fresh, frozen, or paraffin material), and the primers applied. 26,[28][29][30][31][32][33] In summary, all current detection methods seem to bear an inadequate sensitivity for the detection of Borrelia species, so even the classic cutaneous Borrelia infections remain a diagnosis based on circumstantial evidence combining clinicopathologic and laboratory information and response to therapy.…”

Experimental Infection of Ponies with Borrelia burgdorferi by Exposure to Ixodid Ticks

“…B. burgdorferi may assume a variety of morphologic forms in vivo and the plane of section rarely coincides with the long axis of the organism. 1 Thus, determination of whether a small irregular stained structure truly represents a B. burgdorferi organism becomes virtually impossible. Studies utilizing in situ hybridization to study the distribution of B. burgdorferi organisms are planned.…”

In Vitro Susceptibility Testing ofBorrelia burgdorferiSensu Lato Isolates Cultured from Patients with Erythema Migrans before and after Antimicrobial Chemotherapy

“…However, relatively few cases of culture-proven treatment failure have been published (19,22,28,29,37,38,39), and the underlying mechanisms of antimicrobial resistance in B. burgdorferi sensu lato remain unresolved. The overall culture detection rate of the pathogen in clinical specimens obtained from cutaneous lesions does not usually exceed 40 to 70% of cases under routine laboratory conditions (1,19,32,38,44). The culture-positive rate falls to Ͻ1 and 20% in cases with Lyme arthritis and neuroborreliosis, respectively.…”