Brief communication: hematogenous dissemination in early Lyme disease.
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.
Wormser
Gary P
GP
Division of Infectious Diseases, New York Medical College, Valhalla, New York 10595, USA. gary_wormser@nymc.edu
McKenna
Donna
D
Carlin
Jennafer
J
Nadelman
Robert B
RB
Cavaliere
L Frank
LF
Holmgren
Diane
D
Byrne
Daniel W
DW
Nowakowski
John
J
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*