title: Comparison of culture-confirmed erythema migrans caused by Borrelia burgdorferi sensu stricto in New York State and by Borrelia afzelii in Slovenia.
abstract: BACKGROUND
  The clinical manifestations of Lyme borreliosis in North America and Europe seem to differ, but a systematic comparison has never been done.
  
  
  OBJECTIVE
  To compare European and U.S. patients with culture-confirmed erythema migrans.
  
  
  METHODS
  Prospective, clinical cohort study.
  
  
  METHODS
  University medical centers in Westchester County, New York, and Ljubljana, Slovenia.
  
  
  METHODS
  119 U.S. patients with Borrelia burgdorferi sensu stricto infection and 85 Slovenian patients with B. afzelii infection.
  
  
  METHODS
  Interview, physical examination, and laboratory assays.
  
  
  RESULTS
  Compared with Slovenian patients, U.S. patients had erythema migrans for a briefer duration (median duration, 4 days compared with 14 days; P < 0.001) but were more likely to have systemic symptoms (P = 0.01), abnormal findings on physical examination (P < 0.001), and seroreactivity (P < 0.001). Central clearing of erythema migrans lesions was more likely in Slovenian patients (P < 0.001).
  
  
  CONCLUSIONS
  Erythema migrans caused by B. afzelii in Slovenia and erythema migrans caused by B. burgdorferi in New York have distinct clinical presentations. Caution should be used when clinical and laboratory experience from one side of the Atlantic is applied to patients on the other.
authors.affiliation: University of Ljubljana, Slovenia.
authors.forename: F
authors.initials: F
authors.lastname: Strle
authors.forename: R B
authors.initials: RB
authors.lastname: Nadelman
authors.forename: J
authors.initials: J
authors.lastname: Cimperman
authors.forename: J
authors.initials: J
authors.lastname: Nowakowski
authors.forename: R N
authors.initials: RN
authors.lastname: Picken
authors.forename: I
authors.initials: I
authors.lastname: Schwartz
authors.forename: V
authors.initials: V
authors.lastname: Maraspin
authors.forename: M E
authors.initials: ME
authors.lastname: Aguero-Rosenfeld
authors.forename: S
authors.initials: S
authors.lastname: Varde
authors.forename: S
authors.initials: S
authors.lastname: Lotric-Furlan
authors.forename: G P
authors.initials: GP
authors.lastname: Wormser
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001898:Borrelia / Q000302:isolation & purification; D025065:Borrelia burgdorferi; D015748:Borrelia burgdorferi Group / Q000302:isolation & purification; D015787:Erythema Chronicum Migrans / Q000175:diagnosis / Q000382:microbiology*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D011446:Prospective Studies