Primary and secondary erythema migrans in central Wisconsin

Prospective Clinical Evaluation of Patients from Missouri and New York with Erythema Migrans--Like Skin Lesions

“…EM-like lesions in Missouri patients were more circular in shape than were lesions in New York patients, and they often had a prominent punctum and raised, irregular borders ( figure 2). An oval appearance of EMlike lesions in patients with Lyme disease has been previously noted, with orientation of the long axis along presumptive lines of skin tension [36]. This configuration might be attributable to invasion of type I collagen matrices by B. burgdorferi [37], because type I collagen is believed to be oriented along lines of skin tension [36].…”

Antibody Response to IR6, a Conserved Immunodominant Region of the VlsE Lipoprotein, Wanes Rapidly after Antibiotic Treatment ofBorrelia burgdorferiInfection in Experimental Animals and in Humans

“…Patient MC2, in whom initial treatment failed, received iv ceftriaxone 1 year after treatment with azithromycin. This patient had intense migratory joint pain that started at 7 months and a small right knee effusion at 11 months that was positive for B. burgdorferi by PCR [23]. Except for patient MC2, whose anti-C 6 antibody level remained essentially unchanged for 1 year, the antibody levels of all patients either reached the cutoff line or likely would have done so shortly after the last time point we assessed (figure 4).…”

The Role of Culture and Nucleic Acid Amplification in Diagnosis of Lyme Borreliosis

“…Lyme borrelia can be recovered from various tissues and body fluids of patients with Lyme disease, including biopsy (Steere et al, 1983b;Asbrink and Hovmark, 1985;Berger et al, 1985;Neubert et al, 1986;Preac-Mursic et al, 1986;Berger et al, 1992a;Schwartz et al, 1992;Wormser et al, 1992;Melski et al, 1993;Mitchell et al, 1993;Nadelman et al, 1993;van Dam et al, 1993;Strle et al, 1996;Picken et al, 1997;Brettschneider et al, 1998;Jurca et al, 1998;Steere et al, 1998;Logar et al, 1999;Lebech et al, 2000;Nowakowski et al, 2001;Oksi et al, 2001;Ornstein et al, 2001;Zore et al, 2002;Carlsson et al, 2003) and lavage specimens of erythema migrans skin lesions (EM), biopsy specimens of acrodermatitis chronica atrophicans skin lesions (ACA) (Asbrink and Hovmark, 1985;Neubert et al, 1986;Preac-Mursic et al, 1986;van Dam et al, 1993;Picken et al, 1998), biopsy specimens of borrelial lymphocytoma skin lesions , cerebrospinal fluid specimens (Steere et al, 1983b;Preac-Mursic et al, 1986;Karlsson et al, 1990;van Dam et al, 1993;Cimperman et al, 1999;Ornstein et al, 2001) and blood specimens Steere et al, 1983aSteere et al, , 1984Neubert et al, 1986;…”

“…Lyme borrelia have only rarely been recovered from specimens of synovial fluid or synovial tissues in patients with Lyme arthritis, the most frequent late extracutaneous manifestation of this spirochetal infection in the United States (Steere et al, 1983a(Steere et al, , 1984Marques et al, 2000;Stanek and Strle, 2003). Berger et al, 1992;Schwartz et al, 1992;Wormser et al, ;Mitchell et al, 1993;Melski et al, 1993;Nadelman et al, 1993;Steere et al, 1998;Nowakowski et al, 2001 ! 40% b Asbrink and Hovmark, 1985;van Dam et al, 1993;Moter et al, 1994;Strle et al, 1996;Picken et al, 1997;Brettschneider et al, 1998;Jurca et al, 1998;Lebech et al, 2000;Ornstein et al, 2001;Zore et al, 2002;Carlsson et al, 2003 Acrodermatitis chronica atrophicans ND !…”

“…The highest reported success rates were 86% in a small United States study of 21 patients for whom 4-mm skin biopsy specimens were cultured (Berger et al, 1992a) and 88% in a study from the Netherlands of 57 patients who underwent a 4-mm skin biopsy (van Dam et al, 1993). Lyme borrelia can be recovered from both primary (site of tick bite) and secondary EM lesions (that arise by hematogenous dissemination) Melski et al, 1993). Despite the clinical tradition of biopsying the advancing border of an EM lesion, a recent systematic study of this practice conducted in Europe found comparable yields from biopsy specimens taken from the EM center (Jurca et al, 1998).…”