Solitary erythema migrans in Georgia and South Carolina

Michael W. Felz, Francis W. Chandler, James H. Oliver, Daniel W. Rahn, Martin E. Schriefer

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

Objective: To evaluate the incidence of Borrelia burgdorferi infection in humans with erythema migrans (EM) in 2 southeastern states. Design: Prospective case series. Setting: Family medicine practice at academic center. Patients: Twenty-three patients with solitary EM lesions meeting Centers for Disease Control and Prevention (CDC) criteria for Lyme disease. Interventions: 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. Main Outcome Measures: 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; 55 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.

Original languageEnglish (US)
Pages (from-to)1317-1326
Number of pages10
JournalArchives of Dermatology
Volume135
Issue number11
DOIs
StatePublished - Nov 1999

Fingerprint

Erythema
Spirochaetales
Infection
Borrelia burgdorferi
Lyme Disease
Centers for Disease Control and Prevention (U.S.)
Biopsy
Polymerase Chain Reaction
Coloring Agents
Borrelia Infections
Borrelia burgdorferi Group
Anti-Bacterial Agents
Flagellin
Family Practice
Doxycycline
Photography
Therapeutics
Medicine
Outcome Assessment (Health Care)
Antibodies

ASJC Scopus subject areas

  • Dermatology

Cite this

Felz, M. W., Chandler, F. W., Oliver, J. H., Rahn, D. W., & Schriefer, M. E. (1999). Solitary erythema migrans in Georgia and South Carolina. Archives of Dermatology, 135(11), 1317-1326. https://doi.org/10.1001/archderm.135.11.1317

Solitary erythema migrans in Georgia and South Carolina. / Felz, Michael W.; Chandler, Francis W.; Oliver, James H.; Rahn, Daniel W.; Schriefer, Martin E.

In: Archives of Dermatology, Vol. 135, No. 11, 11.1999, p. 1317-1326.

Research output: Contribution to journalArticle

Felz, MW, Chandler, FW, Oliver, JH, Rahn, DW & Schriefer, ME 1999, 'Solitary erythema migrans in Georgia and South Carolina', Archives of Dermatology, vol. 135, no. 11, pp. 1317-1326. https://doi.org/10.1001/archderm.135.11.1317
Felz, Michael W. ; Chandler, Francis W. ; Oliver, James H. ; Rahn, Daniel W. ; Schriefer, Martin E. / Solitary erythema migrans in Georgia and South Carolina. In: Archives of Dermatology. 1999 ; Vol. 135, No. 11. pp. 1317-1326.
@article{f030aa64fa6a4bc699d4639c0783f274,
title = "Solitary erythema migrans in Georgia and South Carolina",
abstract = "Objective: To evaluate the incidence of Borrelia burgdorferi infection in humans with erythema migrans (EM) in 2 southeastern states. Design: Prospective case series. Setting: Family medicine practice at academic center. Patients: Twenty-three patients with solitary EM lesions meeting Centers for Disease Control and Prevention (CDC) criteria for Lyme disease. Interventions: 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. Main Outcome Measures: 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; 55 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.",
author = "Felz, {Michael W.} and Chandler, {Francis W.} and Oliver, {James H.} and Rahn, {Daniel W.} and Schriefer, {Martin E.}",
year = "1999",
month = "11",
doi = "10.1001/archderm.135.11.1317",
language = "English (US)",
volume = "135",
pages = "1317--1326",
journal = "JAMA Dermatology",
issn = "2168-6068",
publisher = "American Medical Association",
number = "11",

}

TY - JOUR

T1 - Solitary erythema migrans in Georgia and South Carolina

AU - Felz, Michael W.

AU - Chandler, Francis W.

AU - Oliver, James H.

AU - Rahn, Daniel W.

AU - Schriefer, Martin E.

PY - 1999/11

Y1 - 1999/11

N2 - Objective: To evaluate the incidence of Borrelia burgdorferi infection in humans with erythema migrans (EM) in 2 southeastern states. Design: Prospective case series. Setting: Family medicine practice at academic center. Patients: Twenty-three patients with solitary EM lesions meeting Centers for Disease Control and Prevention (CDC) criteria for Lyme disease. Interventions: 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. Main Outcome Measures: 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; 55 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.

AB - Objective: To evaluate the incidence of Borrelia burgdorferi infection in humans with erythema migrans (EM) in 2 southeastern states. Design: Prospective case series. Setting: Family medicine practice at academic center. Patients: Twenty-three patients with solitary EM lesions meeting Centers for Disease Control and Prevention (CDC) criteria for Lyme disease. Interventions: 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. Main Outcome Measures: 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; 55 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.

UR - http://www.scopus.com/inward/record.url?scp=0032727483&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0032727483&partnerID=8YFLogxK

U2 - 10.1001/archderm.135.11.1317

DO - 10.1001/archderm.135.11.1317

M3 - Article

C2 - 10566829

AN - SCOPUS:0032727483

VL - 135

SP - 1317

EP - 1326

JO - JAMA Dermatology

JF - JAMA Dermatology

SN - 2168-6068

IS - 11

ER -