title: Infection with multiple strains of Borrelia burgdorferi sensu stricto in patients with Lyme disease.
abstract: OBJECTIVE
  To assess human skin biopsy specimens from erythema migrans lesions for the presence of infection with multiple strains of the Lyme disease spirochete, Borrelia burgdorferi.
  
  
  METHODS
  Skin biopsy specimens were obtained prospectively from patients with erythema migrans. To determine allelic differences and strain identification of B burgdorferi, the biopsy specimens were analyzed by cold single-strand conformation polymorphism of an amplified fragment of the outer surface protein C (ospC) gene. Further single-strand conformation polymorphism patterns of amplified ospC genes from culture isolates were compared with polymerase chain reaction products obtained directly from erythema migrans biopsy specimens.
  
  
  METHODS
  A private dermatology office and a university medical center outpatient department.
  
  
  METHODS
  Sixteen patients presenting with erythema migrans.
  
  
  RESULTS
  Two of the 16 patients in this cohort were infected with 2 B burgdorferi sensu stricto strains, as evidenced by 2 ospC alleles in their skin biopsy results.
  
  
  CONCLUSIONS
  This is the first documented description of the existence of more than a single strain of B burgdorferi sensu stricto in a human specimen.
authors.affiliation: Department of Medicine, State University of New York at Stony Brook, 11794-8161, USA.
authors.forename: G
authors.initials: G
authors.lastname: Seinost
authors.forename: W T
authors.initials: WT
authors.lastname: Golde
authors.forename: B W
authors.initials: BW
authors.lastname: Berger
authors.forename: J J
authors.initials: JJ
authors.lastname: Dunn
authors.forename: D
authors.initials: D
authors.lastname: Qiu
authors.forename: D S
authors.initials: DS
authors.lastname: Dunkin
authors.forename: D E
authors.initials: DE
authors.lastname: Dykhuizen
authors.forename: B J
authors.initials: BJ
authors.lastname: Luft
authors.forename: R J
authors.initials: RJ
authors.lastname: Dattwyler
mesh_terms: D000328:Adult; D000483:Alleles; D000942:Antigens, Bacterial; D001425:Bacterial Outer Membrane Proteins / Q000235:genetics; D001706:Biopsy; D025065:Borrelia burgdorferi; D015748:Borrelia burgdorferi Group / Q000145:classification* / Q000235:genetics; D015331:Cohort Studies; D004269:DNA, Bacterial / Q000032:analysis / Q000235:genetics; D015787:Erythema Chronicum Migrans / Q000382:microbiology*; D015964:Gene Expression Regulation, Bacterial; D006801:Humans; D008193:Lyme Disease / Q000382:microbiology*; D016133:Polymerase Chain Reaction; D018807:Polymorphism, Single-Stranded Conformational; D011446:Prospective Studies; D017422:Sequence Analysis, DNA; D012867:Skin / Q000382:microbiology
chemical_list: D000942:Antigens, Bacterial; D001425:Bacterial Outer Membrane Proteins; D004269:DNA, Bacterial; C079616:OspC protein