title: Clinical appearance of erythema migrans caused by Borrelia afzelii and Borrelia garinii--effect of the patient's sex.
abstract: OBJECTIVE
  The aim in this survey was to study the clinical characteristics of infections caused by Borrelia genospecies in patients with erythema migrans where borrelial origin was confirmed by polymerase chain reaction. The aim was also to study factors influencing the clinical appearance of erythema migrans.
  
  
  METHODS
  The study was conducted in southern Sweden from May 2001 to December 2003 on patients 18 years and older attending with erythema migrans at outpatient clinics. All erythema migrans were verified by polymerase chain reaction, photographed and categorized as "annular" or "non-annular" lesions. A logistic regression model was used to analyze relations between the appearance of the erythema migrans (i.e. annular or non-annular) and factors that influenced its clinical appearance.
  
  
  RESULTS
  A total of 118 patients, 54 women (45.8%) and 64 men (54.2%), fulfilled the inclusion criteria. Of these patients, 74% were infected by B. afzelii and 26% by B. garinii (p < 0.001). A total of 45% (38/85) of the erythema migrans were annular, 46% (39/85) were nonannular and 9.4% (8/85) were atypical. For men infected by B. afzelii, the odds ratio of developing non-annular erythema migrans was 0.09 (95% CI: 0.03-0.33) in comparison with women with the same infection.
  
  
  CONCLUSIONS
  In this prospective study of a large series of erythema migrans, where infecting genospecies were confirmed by polymerase chain reaction, the sex of patients infected with B. afzelii had a strong influence on the appearance of the rash. Patients infected by B. garinii more often had non-annular erythema migrans and a more virulent infection with more individuals presenting with fever, raised levels of C-reactive protein and seroreactivity in the convalescence sera.
authors.affiliation: Department of Clinical Sciences, University Hospital of Malmö, Lund University, Malmö, Sweden. louise.bennet@ltblekinge.se
authors.forename: Louise
authors.initials: L
authors.lastname: Bennet
authors.forename: Carl-Johan
authors.initials: CJ
authors.lastname: Fraenkel
authors.forename: Ulf
authors.initials: U
authors.lastname: Garpmo
authors.forename: Anders
authors.initials: A
authors.lastname: Halling
authors.forename: Mikael
authors.initials: M
authors.lastname: Ingman
authors.forename: Katharina
authors.initials: K
authors.lastname: Ornstein
authors.forename: Louise
authors.initials: L
authors.lastname: Stjernberg
authors.forename: Johan
authors.initials: J
authors.lastname: Berglund
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015748:Borrelia burgdorferi Group / Q000235:genetics; D004269:DNA, Bacterial / Q000032:analysis; D015787:Erythema Chronicum Migrans / Q000145:classification / Q000175:diagnosis* / Q000382:microbiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D012737:Sex Factors; D011795:Surveys and Questionnaires
chemical_list: D004269:DNA, Bacterial