Characteristics of spirochetemic patients with a solitary erythema migrans skin lesion in Europe.

Vera Maraspin,Gary P Wormser,Andrej Kastrin,Katarina Ogrinc,Eva Ružić-Sabljić,Petra Bogovič,Tereza Rojko,Franc Strle,Catherine A Brissette

doi:10.1371/journal.pone.0250198

Vera Maraspin, Gary P Wormser + Show 7 more

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https://doi.org/10.1371/journal.pone.0250198

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Abstract

Neither pre-treatment characteristics, nor the outcome after antibiotic therapy, have been reported for spirochetemic European patients with Lyme borreliosis. In the present study, patients with a solitary erythema migrans (EM) who had a positive blood culture for either Borrelia afzelii (n = 116) or Borrelia garinii (n = 37) were compared with age- and sex-matched patients who had a negative blood culture, but were culture positive for the corresponding Borrelia species from skin. Collectively, spirochetemic patients significantly more often recalled a tick bite at the site of the EM skin lesion, had a shorter time interval from the bite to the onset of EM, had a shorter duration of the skin lesion prior to diagnosis, and had a smaller EM skin lesion that was more often homogeneous in appearance. Similar results were found for the subset of spirochetemic patients infected with B. afzelii but not for those infected with B. garinii. However, patients with B. garinii bacteremia had faster-spreading and larger EM skin lesions, and more often reported itching at the site of the lesion than patients with B. afzelii bacteremia. Treatment failures were rare (7/306 patients, 2.3%) and were not associated with having spirochetemia or with which Borrelia species was causing the infection.

Highlights

Lyme borreliosis (LB) is the most common tick-transmitted disease in the Northern hemisphere
In the period from 1995 to 2018, borreliae had been isolated from the blood of 219 adult patients with LB; 170 of them had a solitary erythema migrans (EM) and 153 fulfilled all of the other inclusion criteria and qualified for the present study
Controls consisted of 153 patients with a solitary EM, who had a negative borrelia blood culture, but for whom B. afzelii (n = 116) or B. garinii (n = 37) had been isolated from a skin culture

Summary

Introduction

Lyme borreliosis (LB) is the most common tick-transmitted disease in the Northern hemisphere. In North America it is nearly exclusively caused by Borrelia burgdorferi sensu stricto (hereafter referred to as B. burgdorferi), while in both Europe and Asia the majority of patients with LB are infected with Borrelia afzelii, Borrelia garinii or Borrelia bavariensis. Differences in the clinical features of LB between North America and Europe are believed to be attributable to the different species causing the infections [1,2,3]. Irrespective of the causative agent, LB usually presents with a characteristic skin lesion called erythema migrans (EM). This lesion, which is the result of introduction of Lyme borrelia

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