Solitary erythema migrans in Georgia and South Carolina.
OBJECTIVE
To evaluate the incidence of Borrelia burgdorferi infection in humans with erythema migrans (EM) in 2 southeastern states.


METHODS
Prospective case series.


METHODS
Family medicine practice at academic center.


METHODS
Twenty-three patients with solitary EM lesions meeting Centers for Disease Control and Prevention (CDC) criteria for Lyme disease.


METHODS
Patients underwent clinical and serologic evaluation for evidence of B burgdorferi infection. All lesions underwent photography, biopsy, culture and histopathologic and polymerase chain reaction analysis for B burgdorferi infection. Patients were treated with doxycycline hyclate and followed up clinically and serologically.


METHODS
Disappearance of EM lesions and associated clinical symptoms in response to antibiotic therapy; short-term and follow-up serologic assays for diagnostic antibody; growth of spirochetes from tissue biopsy specimens in Barbour-Stoenner-Kelly II media; special histopathologic stains of tissue for spirochetes; and polymerase chain reaction assays of tissue biopsy specimens for established DNA sequences of B burgdorferi.


RESULTS
The EM lesions ranged from 5 to 20 cm (average, 9.6 cm). Five patients (22%) had mild systemic symptoms. All lesions and associated symptoms resolved with antibiotic therapy. Overall, 7 patients (30%) had some evidence of B burgdorferi infection. Cultures from 1 patient (4%) yielded spirochetes, characterized as Borrelia garinii, a European strain not known to occur in the United States; 3 patients (13%) demonstrated spirochetallike forms on special histologic stains; 5 patients (22%) had positive polymerase chain reaction findings with primers for flagellin DNA sequences; and 2 patients (9%) were seropositive for B burgdorferi infection using recommended 2-step CDC methods. No late clinical sequelae were observed after treatment.


CONCLUSIONS
The EM lesions we observed are consistent with early Lyme disease occurring elsewhere, but laboratory confirmation of B burgdorferi infection is lacking in at least 16 cases (70%) analyzed using available methods. Genetically variable strains of B burgdorferi, alternative Borrelia species, or novel, uncharacterized infectious agents may account for most of the observed EM lesions.
Felz
M W
MW
Department of Family Medicine, Medical College of Georgia, Augusta 30912-3500, USA. mfelz@mail.mcg.edu
Chandler
F W
FW
Oliver
J H
JH
Rahn
D W
DW
Schriefer
M E
ME
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000907:Antibodies, Bacterial / Q000097:blood; D001706:Biopsy; D001898:Borrelia / Q000145:classification; D015748:Borrelia burgdorferi Group / Q000235:genetics / Q000254:growth & development / Q000276:immunology; D004396:Coloring Agents; D004269:DNA, Bacterial / Q000032:analysis / Q000235:genetics; D004318:Doxycycline / Q000627:therapeutic use; D015787:Erythema Chronicum Migrans / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D005408:Flagellin / Q000032:analysis / Q000235:genetics; D005500:Follow-Up Studies; D005845:Georgia; D006801:Humans; D015994:Incidence; D008193:Lyme Disease / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D010781:Photography; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D013022:South Carolina
D000900:Anti-Bacterial Agents; D000907:Antibodies, Bacterial; D004396:Coloring Agents; D004269:DNA, Bacterial; D005408:Flagellin; D004318:Doxycycline