Primary and Secondary Erythema Migrans in Central Wisconsin

Melski, John W.; Reed, Kurt D.; Mitchell, Paul D.; Barth, Garin D

doi:10.1001/archderm.1993.01680270047005

Cited by 47 publications

(9 citation statements)

References 22 publications

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“…Patients with objective evidence of therapy failure (by culture or PCR) are extremely rare, and we have been unsuccessful thus far in acquiring serum specimens from such patients. One serum sample that we were able to obtain (15,17) was already analyzed by us in a previous study (19).…”

Section: Discussionmentioning

confidence: 99%

C ₆ Test as an Indicator of Therapy Outcome for Patients with Localized or Disseminated Lyme Borreliosis

et al. 2003

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Management of Lyme disease would benefit from a test to assess therapy outcome. Such a test could be employed to ascertain if treatment of early Lyme disease was successful and would be helpful to clinicians assessing patients with lingering posttreatment symptoms. We reported recently that levels of the antibody to C 6 , a Borrelia burgdorferi-derived peptide that is used as an antigen in the C 6 -Lyme diagnostic test, declined after successful antibiotic treatment of Lyme borreliosis patients. We assessed retrospectively the change in anti-C 6 antibody titers in 131 patients with either early localized disease (erythema migrans) or disseminated disease. All of these patients were treated with antibiotics and were free of the clinical signs shown at presentation within 12 weeks after the initiation of treatment. Decreases in reciprocal geometric mean titers (rGMT) of the anti-C 6 antibody were quantified for the subpopulation of 45 patients whose baseline rGMT were >80 and whose second serum specimens were obtained at least 6 months after the baseline specimen. Eighty percent of this patient group (36 of 45) experienced a >4-fold decrease in their rGMT (P < 0.0003). These results suggest that a change in the anti-C 6 antibody titer may serve as an indicator of therapy outcome for patients with localized or disseminated Lyme borreliosis.

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Section: Discussionmentioning

confidence: 99%

C ₆ Test as an Indicator of Therapy Outcome for Patients with Localized or Disseminated Lyme Borreliosis

et al. 2003

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“…B. burgdorferi sensu lato can be recovered from various tissues and body fluids of patients with LB, including biopsy (14,25,31,140,165,178,200,204,209,214,221,227,237,256,267,303,327,333,342,369) and lavage (369) specimens of EM skin lesions, biopsy specimens of ACA skin lesions (14,258,267,342), biopsy specimens of borrelial lymphocytoma skin lesions (188), cerebrospinal fluid specimens (60,147,237,267,342), and blood specimens (13,22,189,216,221,322,367,368,374). Anecdotally, recovery of B. burgdorferi sensu lato from other tissue or fluid specimens (189), such as synovial fluid (289), cardiac tissue (312), and iris (265), has also been reported.…”

Section: Laboratory Diagnosismentioning

confidence: 99%

Diagnosis of Lyme Borreliosis

et al. 2005

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A large amount of knowledge has been acquired since the original descriptions of Lyme borreliosis (LB) and of its causative agent, Borrelia burgdorferi sensu stricto. The complexity of the organism and the variations in the clinical manifestations of LB caused by the different B. burgdorferi sensu lato species were not then anticipated. Considerable improvement has been achieved in detection of B. burgdorferi sensu lato by culture, particularly of blood specimens during early stages of disease. Culturing plasma and increasing the volume of material cultured have accomplished this. Further improvements might be obtained if molecular methods are used for detection of growth in culture and if culture methods are automated. Unfortunately, culture is insensitive in extracutaneous manifestations of LB. PCR and culture have high sensitivity on skin samples of patients with EM whose diagnosis is based mostly on clinical recognition of the lesion. PCR on material obtained from extracutaneous sites is in general of low sensitivity, with the exception of synovial fluid. PCR on synovial fluid has shown a sensitivity of up to >90% (when using four different primer sets) in patients with untreated or partially treated Lyme arthritis, making it a helpful confirmatory test in these patients. Currently, the best use of PCR is for confirmation of the clinical diagnosis of suspected Lyme arthritis in patients who are IgG immunoblot positive. PCR should not be used as the sole laboratory modality to support a clinical diagnosis of extracutaneous LB. PCR positivity in seronegative patients suspected of having late manifestations of LB most likely represents a false-positive result. Because of difficulties in direct methods of detection, laboratory tests currently in use are mainly those detecting antibodies to B. burgdorferi sensu lato. Tests used to detect antibodies to B. burgdorferi sensu lato have evolved from the initial formats as more knowledge on the immunodominant antigens has been collected. The recommendation for two-tier testing was an attempt to standardize testing and improve specificity in the United States. First-tier assays using whole-cell sonicates of B. burgdorferi sensu lato need to be standardized in terms of antigen composition and detection threshold of specific immunoglobulin classes. The search for improved serologic tests has stimulated the development of recombinant protein antigens and the synthesis of specific peptides from immunodominant antigens. The use of these materials alone or in combination as the source of antigen in a single-tier immunoassay may someday replace the currently recommended two-tier testing strategy. Evaluation of these assays is currently being done, and there is evidence that certain of these antigens may be broadly cross-reactive with the B. burgdorferi sensu lato species causing LB in Europe

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“…Secondary lesions, which usually appear 3-5 weeks after the tick bite, are lighter, smaller, less edematous, and have less frequent central clearing compared with primary EM (22). During this period, some patients develop malar rash, diffuse erythema or rarely urticaria.…”

Section: Cutaneous Manifestations Of Lyme Diseasementioning

confidence: 99%

Ticks, Borrelia Burgdorferi and Lyme Disease

Bağcı¹,

Ruzicka²

2016

tdd

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Lyme disease, which is caused by spirochete Borrelia burgdorferi sensu lato, is a ticktransmitted, multisystem infectious disease. It occurs in stages, with different clinical manifestations at each stage. Erythema migrans is the most frequent manifestation which occurs at the site of the tick bite. Borrelial lymphocytoma and acrodermatitis chronica atrophicans are late-stage cutaneous manifestations. Extracutaneous signs of infection most often involve the musculoskeletal, cardiovascular, and nervous systems. Serologic assays remain the mainstay of diagnosis. All stages of the disease are curable with appropriate antibiotic therapy. Keywords: Lyme disease, Borrelia burgdorferi, erythema migrans, acrodermatitis chronica atrophicans, ticks, Ixodes Işın Sinem Bağcı, Thomas Ruzicka* Ticks, Borrelia Burgdorferi and Lyme DiseaseKeneler, Borrelia Burgdorferi ve Lyme Hastalığı Öz AbstractLyme hastalığı Borrelia burgdorferi sensu lato grubu spiroketlerin sebep olduğu multisistemik bir enfeksiyon hastalığıdır. Her hastalık evresi değişik klinik bulgularla kendini gösterir. En sık klinik bulgusu kene ısırık yerinde gelişen eritema migranstır. Borrelial lenfositoma ve akrodermatitis kronika atrofikans geç dönemde gelişen deri bulgularıdır. Deri bulguları dışında kas-iskelet, kardiyovasküler ve sinir sistemi tutulumu da görülebilir. Tanı serolojik testler ile konulur. Hastalığın her evresi uygun antibiyotiklerle tedavi edilebilir.

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Primary and Secondary Erythema Migrans in Central Wisconsin

Cited by 47 publications

References 22 publications

C ₆ Test as an Indicator of Therapy Outcome for Patients with Localized or Disseminated Lyme Borreliosis

C ₆ Test as an Indicator of Therapy Outcome for Patients with Localized or Disseminated Lyme Borreliosis

Diagnosis of Lyme Borreliosis

Ticks, Borrelia Burgdorferi and Lyme Disease

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Primary and Secondary Erythema Migrans in Central Wisconsin

Cited by 47 publications

References 22 publications

C 6 Test as an Indicator of Therapy Outcome for Patients with Localized or Disseminated Lyme Borreliosis

C 6 Test as an Indicator of Therapy Outcome for Patients with Localized or Disseminated Lyme Borreliosis

Diagnosis of Lyme Borreliosis

Ticks, Borrelia Burgdorferi and Lyme Disease

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Product

Resources

About

C ₆ Test as an Indicator of Therapy Outcome for Patients with Localized or Disseminated Lyme Borreliosis

C ₆ Test as an Indicator of Therapy Outcome for Patients with Localized or Disseminated Lyme Borreliosis