Use of a novel technique of cutaneous lavage for diagnosis of Lyme disease associated with erythema migrans.
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.
Wormser
G P
GP
Department of Medicine, Westchester County Medical Center, New York Medical College, Valhalla 10595.
Forseter
G
G
Cooper
D
D
Nowakowski
J
J
Nadelman
R B
RB
Horowitz
H
H
Schwartz
I
I
Bowen
S L
SL
Campbell
G L
GL
Goldberg
N S
NS
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*