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Lyme disease with facial nerve palsy: rapid diagnosis using a nested polymerase chain reaction–restriction fragment length polymorphism analysis
Author(s) -
Yuichi Hashimoto,
Hidetoshi Takahashi,
Kazunori Kishiyama,
Yukita Sato,
Minoru Nakao,
Kenji Miyamoto,
Hajime Iizuka
Publication year - 1998
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1046/j.1365-2133.1998.02080.x
Subject(s) - neuroborreliosis , forehead , restriction fragment length polymorphism , nested polymerase chain reaction , medicine , lyme disease , borrelia garinii , pathology , polymerase chain reaction , borrelia burgdorferi , biology , spirochaetaceae , anatomy , virology , immunology , antibody , genetics , gene
A 64‐year‐old woman with Lyme disease and manifesting facial nerve palsy had been bitten by a tick on the left frontal scalp 4 weeks previously. Erythema migrans appeared on the left forehead, accompanied by left facial paralysis. Nested polymerase chain reaction–restriction fragment length polymorphism analysis (nested PCR–RFLP) was performed on DNA extracted from a skin biopsy of the erythema on the left forehead. Borrelia flagellin gene DNA was detected and its RFLP pattern indicated that the organism was B. garinii . Five weeks later, B. garinii was isolated by conventional culture from the erythematous skin lesion, but not from the cerebrospinal fluid. After treatment with ceftriaxone intravenously for 10 days and oral administration of minocycline for 7 days, both the erythema and facial nerve palsy improved significantly. Nested PCR and culture taken after the lesion subsided, using skin samples obtained from a site adjacent to the original biopsy, were both negative. We suggest that nested PCR–RFLP analysis might be useful for the rapid diagnosis of Lyme disease and for evaluating therapy.