title: Clinical characteristics associated with Borrelia burgdorferi sensu lato skin culture results in patients with erythema migrans.
abstract: Clinical characteristics associated with isolation of Borrelia burgdorferi sensu lato from skin have not been fully evaluated. To gain insight into predictors for a positive EM skin culture, we compared basic demographic, epidemiologic, and clinical data in 608 culture-proven and 501 culture-negative adult patients with solitary EM. A positive Borrelia spp. skin culture was associated with older age, a time interval of >2 days between tick bite and onset of the skin lesion, EM ≥ 5 cm in diameter, and location of the lesion on the extremities, whereas several other characteristics used as clinical case definition criteria for the diagnosis of EM (such as tick bite at the site of later EM, information on expansion of the skin lesion, central clearing) were not. A patient with a 15-cm EM lesion had almost 3-fold greater odds for a positive skin culture than patients with a 5-cm lesion. Patients with a free time interval between the tick bite and onset of EM had the same probability of a positive skin culture as those who did not recall a tick bite (OR=1.02); however, the two groups had >3-fold greater odds for EM positivity than patients who reported a tick bite with no interval between the bite and onset of the lesion. In conclusion, several yet not all clinical characteristics used in EM case definitions were associated with positive Borrelia spp. skin culture. The findings are limited to European patients with solitary EM caused predominantly by B. afzelii but may not be valid for other situations.
authors.affiliation: Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia.
authors.forename: Franc
authors.initials: F
authors.lastname: Strle
authors.affiliation: Institute for Biostatistics and Medical Informatics, Faculty of Medicine Ljubljana, Ljubljana, Slovenia.
authors.forename: Lara
authors.initials: L
authors.lastname: Lusa
authors.affiliation: Institute of Microbiology and Immunology, Faculty of Medicine Ljubljana, Ljubljana, Slovenia.
authors.forename: Eva
authors.initials: E
authors.lastname: Ružić-Sabljić
authors.affiliation: Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia.
authors.forename: Vera
authors.initials: V
authors.lastname: Maraspin
authors.affiliation: Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia.
authors.forename: Stanka
authors.initials: S
authors.lastname: Lotrič Furlan
authors.affiliation: Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia.
authors.forename: Jože
authors.initials: J
authors.lastname: Cimperman
authors.affiliation: Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia.
authors.forename: Katarina
authors.initials: K
authors.lastname: Ogrinc
authors.affiliation: Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia.
authors.forename: Tereza
authors.initials: T
authors.lastname: Rojko
authors.affiliation: Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia.
authors.forename: Jerneja
authors.initials: J
authors.lastname: Videčnik Zorman
authors.affiliation: Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia.
authors.forename: Daša
authors.initials: D
authors.lastname: Stupica
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001898:Borrelia / Q000145:classification / Q000302:isolation & purification*; D005260:Female; D005929:Glossitis, Benign Migratory / Q000382:microbiology / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012621:Seasons; D012867:Skin / Q000473:pathology; D064927:Tick Bites / Q000382:microbiology / Q000473:pathology*