No detection of Borrelia burgdorferi-specific DNA in erythema migrans lesions after minocycline treatment

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).…”

Clinical Relevance of Different IgG and IgM Serum Antibody Responses to Borrelia burgdorferi After Antibiotic Therapy for Erythema Migrans

“…These patients were selected from a series of 1014 consecutive patients with suspected EM seen between June 1, 1994, and December 31, 2000, at the Department of Dermatology, Medical University of Graz. Selection of these 113 patients was based on the following inclusion criteria ( Figure 1): (1) a clinical diagnosis of definite EM, that is, a round to oval, sharply demarcated, red to bluish red, expanding erythema at least 5 cm in diameter with or without central clearing 3,4 made by a dermatologist; (2) treatment with a standard oral antibiotic agent 8,12,13,19,20 after the clinical diagnosis; (3) clinical follow-up for a minimum of 1 year after therapy; (4) at least 3 serum samples available for the analysis of anti-B burgdorferi antibodies, including a sample from directly before therapy and at least 2 posttreatment samples (the last sample had to be obtained Ն1 year after therapy); and (5) information on the following clinical variables was available: age and sex of the patient, duration of EM before therapy, size of EM, type of EM (solitary or multilocular), presence of associated extracutaneous signs and symptoms, type and duration of antibiotic therapy, and duration of EM and of associated extracutaneous signs and symptoms after initiation of therapy. Exclusion criteria for this study were (1) reinfection, that is, the patient had a previous EM episode or developed a second EM during follow-up; (2) antibiotic drug treatment before the first serum sampling; (3) any further antibiotic therapy during followup, irrespective of the indication; and (4) concurrent conditions or therapies with potential influence on the development of anti-B burgdorferi antibodies (eg, autoimmune disease, malignancy, and corticosteroid medications).…”

“…35 It could be speculated that persistent seropositivity indicates a continuing specific immune stimulation by noneradicated spirochetes with the potential consequence of ongoing symptoms or sequelae of Lyme disease. However, molecular and cultural proof of B burgdorferi elimination from the skin after antibiotic therapy 19,42 make survival of B burgdorferi in antibiotically treated patients with EM unlikely. In the present study, PP was not correlated with a worse disease outcome, which contradicts such earlier theories.…”

Methodological Aspects

“…Four PCR-and culture-positive patients, two of whom had skin rashes only and one of whom had systemic symptoms, responded to a 21-day regimen of oral antimicrobial therapy, and plasma samples tested 70 and 100 days after therapy were negative in a PCR assay (51). In another study, formalin-fixed, paraffin-embedded specimens taken from the affected skin of 8 of 14 patients with EM (57%) were PCR positive before therapy; however, after treatment with minocyclin (14 days), all specimens were PCR negative (118).…”

“…Two patients have been reported with PCR reactivity in CSF 14 days after onset of therapy (88). In patients with EM, treatment is generally effective (51,118), although treatment failures with minocycline have been detected by PCR (99).…”