1/22. Serologically diagnosed lyme disease manifesting erythema migrans in korea.lyme disease is a vector-borne infection, primarily transmitted by ixodes ticks, and caused by borrelia burgdorferi. It has a wide distribution in the northern hemisphere. In korea, however, only one human case has been reported, although B. burgdorferi was isolated from the vector tick I. persulcatus in the region. A 60-year-old male and a 45-year-old female developed the clinical sign of erythema migrans. Each patients were bitten by a tick four weeks and five weeks, respectively, before entering the hospital. On serologic examination, significantly increased IgM and IgG antibody titers to B. burgdorferi were observed in consecutive tests performed at an interval of two weeks. They responded well to treatment with tetracycline.- - - - - - - - - - ranking = 1keywords = erythema (Clic here for more details about this article) |
2/22. Erythema migrans--influence of posture. Case report.Despite widespread awareness of the most classical clinical presentation with central clearing of erythema migrans, a pathognomonic sign of infection with borrelia burgdorferi, diagnosis of other forms of erythema migrans remains more difficult. We describe a case of a patient with secondary lesions of erythema migrans that within three months formed a complicated pattern and affected at last nearly the entire lower limb of the patient. In addition, the erythema appeared to be posture-dependent in the way that the lesion was with central clearing in the supine and with homogeneous appearance in the upright position. The borrelial infection was confirmed by PCR sequencing that detected dna of B. afzelii in the skin biopsy specimen. The lesions disappeared during antibiotic therapy. This case shows how posture can be important in the examination of patients with a suspected erythema migrans.- - - - - - - - - - ranking = 1keywords = erythema (Clic here for more details about this article) |
3/22. Borrelia lonestari infection after a bite by an Amblyomma americanum tick.Erythematous rashes that are suggestive of early lyme disease have been associated with the bite of Amblyomma americanum ticks, particularly in the southern united states. However, borrelia burgdorferi, the causative agent of lyme disease, has not been cultured from skin biopsy specimens from these patients, and diagnostic serum antibodies usually have not been found. Borrelia lonestari sp nov, an uncultured spirochete, has been detected in A. americanum ticks by dna amplification techniques, but its role in human illness is unknown. We observed erythema migrans in a patient with an attached A. americanum tick. dna amplification of the flagellin gene flaB produced B. lonestari sequences from the skin of the patient that were identical to those found in the attached tick. B. lonestari is a probable cause of erythema migrans in humans.- - - - - - - - - - ranking = 0.4keywords = erythema (Clic here for more details about this article) |
4/22. Erythema migrans and the differential diagnosis of annular erythema.The diagnosis of lyme disease (LD) or Lyme borreliosis is often based on the recognition of erythema migrans (EM) because its clinical appearance precedes systemic manifestations of the disease and the antibody response. The clinical basis and variable presentation of EM leave room for diagnostic error and, as a consequence, potential long-term repercussions such as rheumatic, cardiac, ophthalmic, or neurologic complications. Most cases are reported in the Northcentral and Northeastern states. In areas where LD is not endemic, the differential diagnosis of annular erythema may not list EM highly, although all the features of a lesion may fit the typical description of EM. Therefore, a complete understanding of LD and its clinical presentation are key in making a diagnosis, especially in areas with low incidence. We present a hypothetical case report of EM from oklahoma, a state with low incidence of LD, for the purposes of review of this entity and the differential diagnosis of annular erythema.- - - - - - - - - - ranking = 1.4keywords = erythema (Clic here for more details about this article) |
5/22. Nodular fasciitis, erythema migrans, and oligoarthritis: manifestations of Lyme borreliosis caused by Borrelia afzelii.We describe a 35-year old patient with nodular fasciitis, erythema migrans, and gonarthritis four months after a bite of a Borrelia afzelii infected tick. The Borrelia afzelii infection was identified by a polymerase chain reaction and direct sequencing of the amplification product. Borrelia-specific dna was also detectable in nodular fasciitis tissue. We therefore conclude that Borrelia afzelii can be a causative agent of nodular fasciitis and Lyme arthritis in a highly endemic region of Northern germany.- - - - - - - - - - ranking = 1keywords = erythema (Clic here for more details about this article) |
6/22. Vesicular erythema migrans.BACKGROUND--lyme disease is the most common vector-borne disease in the united states. The characteristic rash, erythema migrans, is an early sign of the disease. Clinical criteria remain the "gold standard" for diagnosis at this stage of illness. OBSERVATIONS--Five (8%) of 65 patients with erythema migrans seen in a lyme disease diagnostic center in Westchester County, new york, had a lesion with vesicles. borrelia burgdorferi was cultured from two of five. In one case the positive culture came from a swab of the blister fluid. CONCLUSIONS--Recognition of erythema migrans and its variants is important, since early treatment of lyme disease may prevent late complications. Vesicular erythema migrans should be added to the differential diagnosis of inflammatory vesicular rashes in the appropriate clinical setting.- - - - - - - - - - ranking = 1.6keywords = erythema (Clic here for more details about this article) |
7/22. Lyme borreliosis in portugal caused by Borrelia lusitaniae? Clinical report on the first patient with a positive skin isolate.BACKGROUND: Borrelia lusitaniae was isolated from an ixodes ricinus tick in portugal in 1993 for the first time. Further, this borrelia genospecies has been found in ixodid ticks collected around the coasts of southern portugal and North africa. Its reservoir has not been defined yet. B. lusitaniae was isolated once until now from a patient with a long standing and expanding skin disorder. PATIENT AND methods: A 46-year-old Portuguese woman presented with a skin lesion on the left thigh which had evolved slowly over ten years. The patient reported limb paraesthesias, cramps, chronic headaches, and cardiac rhythm disturbances. history of tick bites was negative nor had the patient ever noticed a skin lesion comparable with erythema chronicum migrans. skin biopsies were taken for histological evaluation, culture and dna detection. antibodies to borrelia were searched by indirect immunofluorescence assay and Western-blot. RESULTS: A bilateral carpal tunnel syndrome and local synovitis was diagnosed. Dermato-histology was normal, serology was negative. Spirochaetal organisms were cultured from a skin biopsy and identified as B. lusitaniae. The patient improved after a 2-week course of intravenous ceftriaxone; the skin lesions did not expand further. CONCLUSIONS: This culture confirmed skin infection by B. lusitaniae in a patient from portugal suggests an additional human pathogen out of the B. burgdorferi sensu lato complex in europe, particularly in portugal.- - - - - - - - - - ranking = 0.2keywords = erythema (Clic here for more details about this article) |
8/22. lyme disease during pregnancy.lyme disease, caused by infection with borrelia burgdorferi, can affect those exposed to a vector tick. pregnant women are no exception, and such infection places the fetus at risk. It is particularly important to recognize the disease early so that effective therapy may be instituted. Although the present patient had a favorable outcome, not all do. Clinical diagnosis is especially important since conventional laboratory tests may be inadequate or require lengthy periods of time before a positive result occurs. The dermatologic sign of lyme disease, erythema migrans, although occurring in only 50 percent of cases, is likely to be the most important diagnostic sign.- - - - - - - - - - ranking = 0.2keywords = erythema (Clic here for more details about this article) |
9/22. Persistent atrioventricular block in Lyme borreliosis.Cardiac manifestations are reported in 0.3%-4.0% of European patients with borrelia burgdorferi (B.b.) infection. Usually symptoms disappear within 6 weeks. We report a case with persistent impairment of atrioventricular (AV) conduction. diagnosis was confirmed by demonstration of IgM antibodies and increase of IgG antibody titers against B.b. in serum, by isolation of the spirochete from skin biopsy material and by the typical clinical combination of erythema migrans, Bannwarth syndrome (meningoradiculitis), and complete heart block. Despite immediate antibiotic therapy with ceftriaxone, first degree AV block and second degree block Wenckebach with atrial pacing at 100 beats/minute persisted for 2 years. We conclude, that Lyme carditis can cause long-standing or irreversible AV conduction defects despite adequate and early antimicrobial therapy.- - - - - - - - - - ranking = 0.2keywords = erythema (Clic here for more details about this article) |
10/22. Borrelia infection in children.All children (less than or equal to 15 years) admitted during 1986 to Sachs Children's Hospital and presenting signs of facial palsy and/or meningitis, or with a history of known tick bite followed by headache, fatigue and muscle pain, were investigated for antibodies to Borrelia in serum and cerebrospinal fluid. (The hospital's catchment area has a high incidence of tick-borne borrelia infections.) Significantly elevated antibody titre was found in 15 of the 33 patients, in three cases only in cerebrospinal fluid. Eight of the 15 children had facial palsy, which was concomitant with meningitis in six cases. Intravenous penicillin was given to all 15 patients with positive antibody titre, and additionally to three severely ill small children with facial palsy and meningitis. Furthermore, two cases of erythema chronicum migrans, which is considered pathognomonic for Borrelia infection, were treated with penicillin perorally. Cases of Borrelia infection occurred throughout the year, but with a peak in August. To emphasize the variety of symptoms, three cases are presented in some detail.- - - - - - - - - - ranking = 0.2keywords = erythema (Clic here for more details about this article) |
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