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Early dissemination of Borrelia burgdorferi without generalized symptoms in patients with erythema migrans Note
Author(s) -
OKSI JARMO,
MARTTILA HARRI,
SOINI HANNA,
AHO HEIKKI,
UKSILA JAAKKO,
VILJANEN MATTI K.
Publication year - 2001
Publication title -
apmis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.909
H-Index - 88
eISSN - 1600-0463
pISSN - 0903-4641
DOI - 10.1034/j.1600-0463.2001.d01-178.x
Subject(s) - borrelia burgdorferi , erythema migrans , erythema , dermatology , borrelia , erythema chronicum migrans , lyme disease , medicine , virology , microbiology and biotechnology , immunology , biology , antibody , lyme borreliosis
The diagnosis of erythema migrans (EM) is not always easy, and reports of culture‐ or PCR‐confirmed diagnosis as well as reports of EM with simultaneous disseminated disease are few. Characteristics and incidence of EM in addition to frequency of early dissemination of B. burgdorferi were studied in the archipelago of South‐Western Finland prospectively using questionnaires, skin biopsies and blood samples. Clinical EM was recognized in 82 patients (incidence 148/1 inhabitants/year). Of skin biopsy samples, 35.5% were positive by PCR (the majority B. garinii ), and 21.5% by cultivation (all B. garinii ). Of blood samples, 3.8% were positive by PCR, and 7.7% by cultivation. Of the patients, 30.9% were seropositive at the first visit, and 52.9% 3 weeks later. Of the patients with laboratory confirmed diagnosis, the EM lesion was ring‐like in 31.8% and homogenous in 65.9%. Dissemination of B. burgdorferi , based on culture or PCR positivity of blood samples, was detected in 11.0% of the patients. The frequency of generalized symptoms was nearly the same in patients with as in those without dissemination (22.2% vs 27.4%). Only 21.4% of the patients with culture‐positive EM recalled a previous tick bite at the site of the EM lesion. We conclude that EM lesions are more often homogenous than ring‐like. B. burgdorferi may disseminate early without generalized symptoms.