Clinical manifestations of skin borreliosis - our experience

Abstract

Purpose: Lyme borreliosis is a multisystem infection caused by the spirochete Borrelia burgdorferi. A disease can affect every organ, and it is characterized by a wide range of clinical manifestations. Erythema migrans is the basic clinical marker of Lyme disease in acute or subacute form. Recurrences occur in 9–30% of inadequately treated patients. The aim of this paper was to investigate the frequency and clinical forms of skin borreliosis on our material, with the presentation of four atypical cases and to draw attention to the importance of clinical recognition of the disease. Methods & Materials: A retrospective study was carried out on monitored and outpatient patient's data, seen in the infectologist office during five-year period from 15.03.2013–15.03.2018. Results: During investigated period, 958 patients were examined in infectologist office. Of this number, 7.6% were with symptoms of borreliosis. 62 patients were presented with multi-organ chronic symptomatology. 21.7% of the patients had skin changes and 39.7% of the patients with multi-organ changes had skin affected. The diagnosis of the disease was based on anamnestic-epidemiological data, clinical picture, disease flow, serological findings and on the basis of the response to ex juvantibus therapy. The average age of affected patients, only with skin borreliosis was 35.42 g. The youngest patient was 2.3 years old, while oldest was 72 years old. 12 patients had subacute course. The average time from the onset of the disease manifestation to the establishment of the diagnosis and the onset of therapy was 6.8 weeks. The chronic flow of skin borreliosis was found in 5 patients. Conclusion: Erythema migrans was diagnosed at 23% patients, most often in atypical form. Average diagnosis time is 6,4 weeks. In the multi-organic symptomatology of chronic flow, atypical skin changes were represented in 54% of cases. Diagnosis of chronic forms of skin borreliosis is severe in the absence of positive epidemiological data. Inadequate length of therapy for first stage illness, re-bite ticks, and stress are the main causes of recurrence of borreliosis.