Abstract
BackgroundLimited data are available regarding the relationship of Borrelia burden in skin of patients with erythema migrans (EM) and the disease course and post-treatment outcome.MethodsWe studied 121 adult patients with EM in whom skin biopsy specimens were cultured and analyzed by quantitative PCR for the presence of Borreliae. Evaluation of clinical and microbiological findings were conducted at the baseline visit, and 14 days, 2, 6, and 12 months after treatment with either amoxicillin or cefuroxime axetil.ResultsIn 94/121 (77.7%) patients Borrelia was detected in skin samples by PCR testing and 65/118 (55.1%) patients had positive skin culture result (96.8% B. afzelii, 3.2% B. garinii). Borrelia culture and PCR results correlated significantly with the presence of central clearing and EM size, while Borrelia burden correlated significantly with central clearing, EM size, and presence of newly developed or worsened symptoms since EM onset, with no other known medical explanation (new or increased symptoms, NOIS). In addition, the logistic regression model for repeated measurements adjusted for time from inclusion, indicated higher Borrelia burden was a risk factor for incomplete response (defined as NOIS and/or persistence of EM beyond 14 days and/or occurrence of new objective signs of Lyme borreliosis). The estimated association between PCR positivity and unfavorable outcome was large but not statistically significant, while no corresponding relationship was observed for culture positivity.ConclusionsHigher Borrelia burden in EM skin samples was associated with more frequent central clearing and larger EM lesions at presentation, and with a higher chance of incomplete response.
Highlights
Erythema migrans (EM) is the clinical hallmark of early Lyme borreliosis (LB), the most common tick-borne human disease in the Northern Hemisphere, caused by Borrelia burgdorferi s.l. [1,2,3]
In 94/121 (77.7%) patients Borrelia was detected in skin samples by PCR testing and 65/118 (55.1%) patients had positive skin culture result (96.8% B. afzelii, 3.2% B. garinii)
The logistic regression model for repeated measurements adjusted for time from inclusion, indicated higher Borrelia burden was a risk factor for incomplete response
Summary
Erythema migrans (EM) is the clinical hallmark of early Lyme borreliosis (LB), the most common tick-borne human disease in the Northern Hemisphere, caused by Borrelia burgdorferi s.l. [1,2,3]. In our previous study we suggested that Borrelia skin culture positivity may predict a less favorable treatment outcome in EM patients [5]. Skin culture positivity was found to be significantly associated with larger numbers of spirochetes in EM skin lesion specimens [6,7,8], suggesting that borrelial burden in the skin influences the course and post-treatment outcome of the disease. We hypothesized that a higher borrelial burden in the skin of EM patients might influence the pre-treatment course and post-treatment outcome of the disease. Limited data are available regarding the relationship of Borrelia burden in skin of patients with erythema migrans (EM) and the disease course and post-treatment outcome.
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