title: Brief communication: hematogenous dissemination in early Lyme disease.
abstract: BACKGROUND
  Bloodstream invasion in Lyme disease has been difficult to study because until recently blood culture methods were too insensitive to detect spirochetemia.
  
  
  OBJECTIVE
  To evaluate the clinical and laboratory features of spirochetemic patients.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Lyme Disease Diagnostic Center in Valhalla, New York, 1997 to 2002.
  
  
  METHODS
  213 untreated adults with erythema migrans.
  
  
  METHODS
  Blood culture for Borrelia burgdorferi.
  
  
  METHODS
  Symptom scores and selected laboratory measures.
  
  
  RESULTS
  Spirochetemia was found in 93 (43.7%) patients. Spirochetemic patients were more often symptomatic (89.2% vs. 74.2%; P = 0.006) and more often had multiple erythema migrans lesions (41.9% vs. 15.0%; P < 0.001) than patients without spirochetemia. However, 8 (22.9%) of the 35 asymptomatic patients with a single skin lesion nevertheless had a positive blood culture. Risk for spirochetemia was present the day the patient noticed the lesion and continued for more than 2 weeks.
  
  
  CONCLUSIONS
  Long-term outcome data were not available.
  
  
  CONCLUSIONS
  The high rate, early onset, and prolonged duration of risk for spirochetemia explain why untreated patients with erythema migrans are at risk for dissemination of B. burgdorferi to anatomic sites beyond the lesion site. Differences in the strain of the infecting spirochete, as well as host factors, may be important determinants of hematogenous dissemination.
authors.affiliation: Division of Infectious Diseases, New York Medical College, Valhalla, New York 10595, USA. gary_wormser@nymc.edu
authors.forename: Gary P
authors.initials: GP
authors.lastname: Wormser
authors.forename: Donna
authors.initials: D
authors.lastname: McKenna
authors.forename: Jennafer
authors.initials: J
authors.lastname: Carlin
authors.forename: Robert B
authors.initials: RB
authors.lastname: Nadelman
authors.forename: L Frank
authors.initials: LF
authors.lastname: Cavaliere
authors.forename: Diane
authors.initials: D
authors.lastname: Holmgren
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Byrne
authors.forename: John
authors.initials: J
authors.lastname: Nowakowski
mesh_terms: D000328:Adult; D016470:Bacteremia / Q000175:diagnosis / Q000382:microbiology*; D025065:Borrelia burgdorferi / Q000302:isolation & purification*; D003430:Cross-Sectional Studies; D006801:Humans; D008193:Lyme Disease / Q000175:diagnosis / Q000382:microbiology*