Abstract

Lyme disease (Lyme borreliosis) is a complex multisystem illness with varying clinical manifestations. This tick-borne zoonosis is caused by the spirochetal bacterium, Borrelia burgdorferi sensu lato (Bbsl) and, worldwide, presents with at least 20 different types of rashes. Certain cutaneous rashes are inherently interconnected to various stages of Lyme disease. In this study, five Canadian Lyme disease patients from a multi-age range presented various phases of the acrodermatitis chronica atrophicans (ACA) rash. In each case of ACA, the underlying etiological pathogen was the Lyme disease spirochete. Although ACA rashes are normally found on the lower extremities, this study illustrates that ACA rashes are not directly correlated with a tick bite, geographic area, age, Bbsl genospecies, exercise, or any given surface area of the body. Case 4 provides confirmation for an ACA rash and gestational Lyme disease. One patient (Case 5) puts forth a Bbsl and Bartonella sp. co-infection with a complex ACA rash. This study documents ACA rashes on Lyme disease patients for the first time in Canada.

Highlights

  • Lyme disease (Lyme borreliosis) is a multisystem, zoonotic infection caused by the bacterium, Borrelia burgdorferi sensu lato (Bbsl) [1]

  • This study reports ACA rashes on Lyme disease patients for the first time in Canada

  • ACA has a predilection for sites on the lower extremities, where collagenous tissue is prolific, ACA has no direct correlation with a tick bite, geographic location, age, exercise, Bbsl genospecies, and location on the skin surface

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Summary

Introduction

Lyme disease (Lyme borreliosis) is a multisystem, zoonotic infection caused by the bacterium, Borrelia burgdorferi sensu lato (Bbsl) [1]. There are at least 24 genospecies in the Bbsl complex. Several of these Bbsl genospecies are known to be pathogenic to humans. Lyme disease has been recognized in 85 countries [25], and evidence abounds on the wide dispersal of Lyme disease vector ticks by songbirds [25]. Most significantly, this tick-borne zoonosis can have a broad spectrum of clinical manifestations that often involve varied, cutaneous rashes

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