Abstract
To assess whether differences in presentation between US and European patients with early Lyme borreliosis are due to the lower rate of spirochetemia in Europe, we compared multiple variables for patients with erythema migrans (EM), restricting the analysis to subjects with a positive blood culture at the time of presentation: 93 US patients infected with Borrelia burgdorferi versus 183 European patients infected with Borrelia afzelii (No = 144) or Borrelia garinii (No = 39). Compared to spirochetemic Slovenian EM patients infected with B. afzelii, US patients with a positive blood culture significantly less often recalled a preceding tick bite at the site of the EM skin lesion, had a shorter duration of EM prior to diagnosis and more often had multiple EM lesions, regional lymphadenopathy, constitutional symptoms, an increased ESR value, a low blood lymphocyte count and detectable borrelia antibodies in acute and convalescent phase blood samples. Similar differences were observed when US patients were compared to Slovenian patients with B. garinii infection, but not all reached statistical significance. The findings are comparable to those previously reported for the corresponding skin culture positive patients and do not support the hypothesis that a higher frequency of spirochetemia at the time of presentation in US patients with EM, compared with European EM patients, is the reason for the observed differences.
Highlights
Given the much higher rate of spirochetemia documented in patients with erythema migrans (EM) in the US compared to Europe [8,9,10,11], the question arises whether the observed differences in the clinical manifestations and laboratory test results are a reflection of the lower rate of spirochetemia associated with infection caused by European borrelial species
Data from European patients are derived from a recent review of blood culture positive Slovenian patients >15 years old with a solitary EM and B. afzelii or B. garinii isolated from blood [13], and on unpublished data from patients with multiple EM with isolation of B
In comparing patients with a positive blood culture for B. garinii to patients who had a positive blood culture for B. burgdorferi, the only variable that differed from the same comparisons with B. afzelii infected patients was that those infected with B. garinii had a larger diameter of the EM skin lesion than patients with
Summary
In North America, LB is nearly exclusively caused by Borrelia burgdorferi sensu stricto (hereafter referred to as B. burgdorferi), while in Europe it is predominantly caused by Borrelia afzelii and Borrelia garinii and the closely related species Borrelia bavariensis [1,2,3]. All of these species of Lyme borrelia cause EM, notable clinical and laboratory differences have been reported between EM patients who acquire the infection in the United States versus in Europe. Given the much higher rate of spirochetemia documented in patients with EM in the US compared to Europe [8,9,10,11], the question arises whether the observed differences in the clinical manifestations and laboratory test results are a reflection of the lower rate of spirochetemia associated with infection caused by European borrelial species
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