title: Use of a novel technique of cutaneous lavage for diagnosis of Lyme disease associated with erythema migrans.
abstract: OBJECTIVE
  Determining the microbial cause of cellulitis is often difficult. In this study, a novel two-needle lavage technique was used to culture Borrelia burgdorferi from the skin of suspected erythema migrans lesions.
  
  
  METHODS
  The yield of lavage cultures for B burgdorferi was compared with that of a 2-mm skin biopsy sample.
  
  
  METHODS
  A Lyme disease diagnostic center located in an area in which Lyme disease is epidemic.
  
  
  METHODS
  Forty-five patients with suspected erythema migrans who had not been treated with antimicrobial agents.
  
  
  METHODS
  Cutaneous lavage of the advancing edge of a suspected primary erythema migrans lesion was done for all 45 participants, 33 of whom also had a skin biopsy of the same lesion at an identical (14) or an adjacent (19) site.
  
  
  METHODS
  Growth of B burgdorferi in in vitro culture.
  
  
  RESULTS
  Lavage fluid cultures grew B burgdorferi in 13 (29%) of the 45 cases (95% confidence interval [CI], 16% to 44%). Among the 33 cases in which both lavage and skin biopsy cultures were done, the yield of lavage culture was less than that of biopsy culture (P less than .09, 12/33 vs 20/33). If contaminated cultures are excluded, this difference is significant (P less than .05, 12/30 vs 20/27).
  
  
  CONCLUSIONS
  Cutaneous lavage is a new diagnostic technique for recovery of B burgdorferi from erythema migrans lesions that has potential applicability to other types of cutaneous infections.
authors.affiliation: Department of Medicine, Westchester County Medical Center, New York Medical College, Valhalla 10595.
authors.forename: G P
authors.initials: GP
authors.lastname: Wormser
authors.forename: G
authors.initials: G
authors.lastname: Forseter
authors.forename: D
authors.initials: D
authors.lastname: Cooper
authors.forename: J
authors.initials: J
authors.lastname: Nowakowski
authors.forename: R B
authors.initials: RB
authors.lastname: Nadelman
authors.forename: H
authors.initials: H
authors.lastname: Horowitz
authors.forename: I
authors.initials: I
authors.lastname: Schwartz
authors.forename: S L
authors.initials: SL
authors.lastname: Bowen
authors.forename: G L
authors.initials: GL
authors.lastname: Campbell
authors.forename: N S
authors.initials: NS
authors.lastname: Goldberg
mesh_terms: D001706:Biopsy; D015748:Borrelia burgdorferi Group / Q000302:isolation & purification*; D002481:Cellulitis / Q000382:microbiology; D015787:Erythema Chronicum Migrans / Q000382:microbiology*; D006801:Humans; D008193:Lyme Disease / Q000175:diagnosis*; D012867:Skin / Q000382:microbiology*; D013048:Specimen Handling; D007507:Therapeutic Irrigation / Q000379:methods*