title: Detection of Borrelia burgdorferi sensu lato in lesional skin of patients with erythema migrans and acrodermatitis chronica atrophicans by ospA-specific PCR.
abstract: The aim of this study was to develop a sensitive and specific PCR for the detection of Borrelia burgdorferi DNA. The plasmid-located gene coding for the outer surface protein A (OspA [31-kDa protein]) was used as a target. Nucleotide sequence information from different B. burgdorferi ospA genotypes was used to design primers homologous to different genotypes. The sensitivity of the nested PCR differed from 1 fg to 1 pg of borrelial DNA, depending on the strain analyzed. No cross-reactions with DNA from spirochetes other than B. burgdorferi or with human DNA were observed. A total of 22 skin biopsy samples from patients with erythema migrans (EM [n = 10]) or acrodermatitis chronica atrophicans (ACA [n = 12]) were examined for the presence of B. burgdorferi by nested PCR. Of 22 biopsies, 80% from EM patients and 92% from ACA patients were positive by PCR amplification. By comparison, 50% of the EM patients had elevated B. burgdorferi-specific immunoglobulin M (IgM) and/or IgG antibody levels as tested by enzyme-linked immunosorbent assay (ELISA) using purified B. burgdorferi flagella as antigen. A total of 33% of ACA patients had elevated IgM titers, and all had high IgG titers in their sera. Only 30% of specimens from patients with EM and none from patients with ACA were positive by culture. All culture-positive specimens were also positive by PCR. Thus, the sensitivities of the PCR were 80 and 92%, respectively, for patients with EM and ACA on the basis of the clinical and histopathological diagnoses of Lyme disease. From these results, we conclude that PCR is a suitable method to detect B. burdorferi sensu lato DNA in skin biopsy samples and could be applied as an additional diagnostic tool.
authors.affiliation: Institute of Immunology, University of Heidelberg, Germany.
authors.forename: S E
authors.initials: SE
authors.lastname: Moter
authors.forename: H
authors.initials: H
authors.lastname: Hofmann
authors.forename: R
authors.initials: R
authors.lastname: Wallich
authors.forename: M M
authors.initials: MM
authors.lastname: Simon
authors.forename: M D
authors.initials: MD
authors.lastname: Kramer
mesh_terms: D000169:Acrodermatitis / Q000175:diagnosis* / Q000382:microbiology; D000954:Antigens, Surface / Q000235:genetics*; D001425:Bacterial Outer Membrane Proteins / Q000235:genetics*; D001428:Bacterial Vaccines; D015748:Borrelia burgdorferi Group / Q000235:genetics / Q000302:isolation & purification*; D004269:DNA, Bacterial / Q000032:analysis; D015787:Erythema Chronicum Migrans / Q000175:diagnosis* / Q000382:microbiology; D005260:Female; D006801:Humans; D008074:Lipoproteins; D008297:Male; D016133:Polymerase Chain Reaction / Q000379:methods; D012680:Sensitivity and Specificity; D012867:Skin / Q000382:microbiology*
chemical_list: D000954:Antigens, Surface; D001425:Bacterial Outer Membrane Proteins; D001428:Bacterial Vaccines; D004269:DNA, Bacterial; D008074:Lipoproteins; C072045:OspA protein