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Mazori DR, Orme CM, Mir A, Meehan SA, Neimann AL. Vesicular erythema migrans: an atypical and easily misdiagnosed form of Lyme disease. Dermatol Online J 2015; 21:13030/qt9cs1x7r5. [PMID: 26437159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 08/14/2015] [Indexed: 06/05/2023] Open
Abstract
Erythema migrans is the initial sign in the majority of patients infected with Borrelia, the genus of spirochetes that causes Lyme disease. Early identification and treatment decrease the risk of progression to later stages of disease. Although a "bull's eye" appearance owing to lesional clearing is considered classic for erythema migrans, this feature is surprisingly often lacking among patients in the United States. Furthermore, cutaneous Lyme disease can exhibit a wide range of morphologic variability in a minority of patients. Herein, we describe the case of a patient with Lyme disease in which the presence of atypical vesicular features, in conjunction with the initial absence of clearing, resulted in multiple misdiagnoses and delayed treatment. We also review the literature on the epidemiology and management of erythema migrans for cases in which the diagnosis may pose a challenge.
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Petersen BB, Møller JK, Vilholm OJ. Season is an unreliable predictor of Lyme neuroborreliosis. DANISH MEDICAL JOURNAL 2015; 62:A5084. [PMID: 26036883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Lyme neuroborreliosis (LNB) is a tick-borne infection of the nervous system caused by the spirochete Borrelia burgdorferi sensu lato. The primary symptoms are usually painful radiculitis, facial palsy and lymphocytic meningitis. The aim of this study was to provide data on the seasonal variation, anamnesis, symptoms, laboratory data and course of the disease in adults (≥ 16 years). METHODS The medical records of 69 patients with confirmed LNB who attended the Department of Neurology, Lillebaelt Hospital, Vejle, Denmark, were analysed. The diagnosis was confirmed by the presence of leucocytosis in the cerebrospinal fluid and intrathecal production of immunoglobulin M and/or G anti-B. burgdorferi antibodies. RESULTS Onset of neurological symptoms in LNB occurred year round in the Region of Southern Denmark. Only half of the patients had a history of a tick bite or erythema migrans (EM). Half of the patients who observed a tick bite subsequently reported EM. The duration from the onset of neurological symptoms to referral to hospital was remarkably long for patients with radiculoneuritis, whereas the onset of facial palsy led to a swift referral. Patients who were ≥ 50 years old had a significantly lower age-related risk of facial palsy without radicular symptoms. CONCLUSION In this study, winter as a low-risk season was not a reliable factor in ruling out LNB. This finding may be relevant when investigating the cause of facial palsy and radicular symptoms.
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Landolt L, Kovari H. [CME. Larva migrans]. PRAXIS 2014; 103:1491-1498. [PMID: 25491049 DOI: 10.1024/1661-8157/a001859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Abstract
A 32-year-old pregnant woman from southeastern Connecticut presents to her physician in July at 26 weeks’ gestation because of a skin lesion. She reports she has had fatigue, arthralgia, and headache for 2 days and a rash in her left axilla for 1 day. She lives in a wooded area and works in her garden frequently. Six weeks earlier, she had removed a small tick that was attached behind her right knee. On physical examination, she is afebrile. She has an erythematous, oval macular lesion, 7 to 8 cm in diameter, in her left axilla, with enhanced central erythema; no other abnormalities are noted. How should her case be managed?
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Abstract
A 32-year-old pregnant woman from southeastern Connecticut presents to her physician in July at 26 weeks' gestation because of a skin lesion. She reports she has had fatigue, arthralgia, and headache for 2 days and a rash in her left axilla for 1 day. She lives in a wooded area and works in her garden frequently. Six weeks earlier, she had removed a small tick that was attached behind her right knee. On physical examination, she is afebrile. She has an erythematous, oval macular lesion, 7 to 8 cm in diameter, in her left axilla, with enhanced central erythema; no other abnormalities are noted. How should her case be managed?
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Knoll JM, Ridgeway AC, Boogaerts CM, Burket GA. Appalachian Trail hikers' ability to recognize Lyme disease by visual stimulus photographs. Wilderness Environ Med 2014; 25:24-8. [PMID: 24433777 DOI: 10.1016/j.wem.2013.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 08/21/2013] [Accepted: 09/13/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Lyme disease is the most common vector-borne infectious disease in North America. With nearly 2,500 Appalachian Trail (AT) hikers entering the endemic area for as long as 6 months, exposure to the disease is likely. The characteristic exanthem of erythema migrans (EM) should be a trigger for seeking medical treatment, and its recognition in this relatively isolated environment is important. OBJECTIVE The purpose of this study was to determine the ability of AT hikers to identify EM, the exanthem of Lyme disease. METHODS Hikers were administered a photographic stimulus in this Internal Review Board-approved pilot study. Historical hiking data, basic demographics, and self-reported treatment and diagnosis were collected. RESULTS In all, 379 responses were collected by 4 researchers at 3 geographically separate locations at or proximate to the AT from June 2011 to May 2012. Fifty-four percent of respondents (206 of 379) were able to recognize the photographs of EM/Lyme disease; 46% could not. Of those who did recognize EM, 23 (6%) had seen it either on themselves or on another hiker while on the AT. A total of 37 hikers stated that they had been diagnosed with Lyme disease while hiking, and of these, 89% were treated with antibiotics. Thirteen of these 37 hikers (35%) diagnosed with Lyme disease had visualized an embedded tick. Nine percent of all respondents reported they had been diagnosed with Lyme disease by a healthcare practitioner, whether from EM, symptomatology, or by titer. CONCLUSIONS This study suggests that hikers are poorly able to recognize the characteristic exanthem of Lyme disease but have a high exposure risk.
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Eriksson P, Schröder MT, Niiranen K, Nevanlinna A, Panelius J, Ranki A. The many faces of solitary and multiple erythema migrans. Acta Derm Venereol 2013; 93:693-700. [PMID: 23450303 DOI: 10.2340/00015555-1549] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Case definitions for European Lyme disease have been published. However, multiple erythema migrans may pose a diagnostic challenge. Therefore, we retrospectively reviewed the clinical and serological findings and response to therapy in a cohort of consecutive 54 patients with PCR-confirmed erythema migrans, referred to a university dermatology clinic. The proportion of patients with multiple erythema migrans lesions (usually 2 or 3) was almost equal (46%) to the proportion of patients with single erythema migrans lesions (54%). All patients, except for 2 multiple erythema migrans patients with a concomitant autoimmune disease, completely responded to treatment. In conclusion, multiple erythema migrans may be more common than anticipated, and since only 50% of the patients were seropositive when seeking medi-cal help, PCR testing of skin lesions is helpful to confirm the diagnosis in clinically atypical cases.
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[Lyme borreliosis. A tick bite and its multiple sequelae]. MMW Fortschr Med 2013; 155:17. [PMID: 24006580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Spring P, Vernez M, Maniu CM, Hohl D. Localized interstitial granuloma annulare induced by subcutaneous injections for desensitization. Dermatol Online J 2013; 19:18572. [PMID: 24011321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Accepted: 06/15/2013] [Indexed: 06/02/2023] Open
Abstract
We describe a patient with interstitial granuloma annulare associated with subcutaneous injection therapy (SIT) for desensitization to a type I allergy. Asymptomatic, erythematous, violaceous annular patches were located at the injection sites on both her arms. Medical history revealed perennial rhinoconjonctivitis treated with SIT (Phostal Stallergen® cat 100% and D. pteronyssinus/D.farinae 50%:50%).
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Huppertz HI. [Lyme borreliosis in children and adolescents]. KINDERKRANKENSCHWESTER : ORGAN DER SEKTION KINDERKRANKENPFLEGE 2013; 32:108-113. [PMID: 23600115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Maurin O, de Régloix S, Babouraj N, Bon O, Jost D, Domanski L. [Erythema chronicum migrans]. LA REVUE DU PRATICIEN 2013; 63:178. [PMID: 23513773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Schatorjé EJH, van der Steeg H, Stelma F, Hebeda K, Warris A. [Borrelial lymphocytoma]. NEDERLANDS TIJDSCHRIFT VOOR GENEESKUNDE 2013; 157:A6605. [PMID: 24382037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Borrelial lymphocytoma is a relatively rare but typical presentation of Lyme disease. Predilection sites are the ears in children and chest/nipples in adults. It is treated like an erythema migrans and has a good prognosis. CASE DESCRIPTION A 16-year-old boy presented with a swollen, red and painful right nipple since several months. An ultrasound showed normal breast tissue. The patient was referred to the pediatric surgeon who performed an incision biopsy. Histopathological examination revealed follicular hyperplasia without signs of malignancy. An infectious cause, most likely Lyme disease, was suspected. Serological analysis and PCR of the tissue confirmed the diagnosis of a borrelial lymphocytoma, and the patient was treated with doxycycline with good result. CONCLUSION Early recognition of the characteristic clinical presentation of borrelial lymphocytoma, supported by positive results from serologic testing for Lyme disease, avoids the need for additional and invasive diagnostic tests.
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Atiq N, van Meurs T. [A boy with nail abnormalities]. NEDERLANDS TIJDSCHRIFT VOOR GENEESKUNDE 2013; 157:A6429. [PMID: 23838405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A 12-year-old boy consulted the dermatologist for nail abnormalities. Three weeks earlier, he was treated with doxycycline 100 mg BID for 10 days because of erythema chronicum migrans. Following sun exposure, the patient had developed distal onycholysis surrounded by a hyperpigmented zone. He was diagnosed with doxycycline-induced photo-onycholysis.
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Krbková L, Náterová Z. [Erythema migrans]. KLINICKA MIKROBIOLOGIE A INFEKCNI LEKARSTVI 2012; 18:172-179. [PMID: 23386506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The article summarizes the latest knowledge about the etiology, epidemiology, pathogenesis, clinical signs, diagnostic procedures and therapy of erythema migrans (EM), a cutaneous form of Borrelia infection. The sole focus on this clinical entity is intentional since EM is the most common clinical involvement in Lyme borreliosis (LB) in the Czech Republic (CR). New genospecies from the Borrelia burgdorferi sensu lato complex, B. lusitaniae and B. spielmanii, as etiologic agents are reported. Although there are no commercial tests available yet for their detection, ticks are demonstrably infected with them in Europe and probably even in the CR. Six pathogenic genospecies circulate among vertebrates and Ixodes ricinus ticks in Europe. The transmission cycle in nature, hosts identified as reservoirs and distribution of borreliae in Europe are presented. Clinical forms of EM are described in detail including accompanying features. Types of erythema in the USA and Europe are compared. In the part on differential diagnosis, allergies, skin and infectious diseases with similar appearance on the skin as EM are mentioned. Although the diagnosis of EM is exclusively clinical and serology is not indicated, methods of direct detection and two-tier testing of antibodies are discussed. There are therapeutic recommendations concerning the choice of antibiotics available in the CR.
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Ghayad Z, Hou C. Erythema migrans in early disseminated lyme disease. THE JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION 2012; 112:748. [PMID: 23139346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Chappell DH, Jacobson NA, Jacobsen VL. Erythema chronicum migrans. THE JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION 2012; 112:308. [PMID: 22582201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Filipiuk J, Nowicka-Ciełuszecka A, Tarasiuk J, Pancewicz S. [Occurrence of erythema migrans in Hajnowka district in years 2004-2009]. PRZEGLAD EPIDEMIOLOGICZNY 2012; 66:19-23. [PMID: 22708293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The aim of the study was the analysis of epidemiology and clinical picture of early Lyme disease-erythema migrans (EM). There was analysed the medical documentation of 307 (126 men and 181 women) patients, who came to Outpatient Clinic of Infectious Diseases with EM in Hajn6wka in years 2004-2009. Most people (54%) lived in Hajnówka district. 51,8% of patients remembered the contact with a tick. The highest incidence of EM cases was observed in July. The average size of erythema was 10,5 cm2. In 59 cases skin lesion was accompanied by such symptoms as: itching, pain and inflammatory infiltration in the skin lesion, pain in muscles and joints, headaches, fever and cold syndroms. The most common localisation of EM were lower limbs (135 people), trunk (68) and upper limbs (29). Time of patients' visit in our Outpatient Clinic from EM notice lasted about 2 months. 6 people from analysed group were reinfected. There was used the month treatment by doxycycline in prevailing cases.
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Füssle HS. [Erythema migrans. Can borrelia be transmitted other than by ticks?]. MMW Fortschr Med 2011; 153:22. [PMID: 21991831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Füessl HS. [From tick bite to borreliosis: the dreaded small blood sucker]. MMW Fortschr Med 2011; 153:14-17. [PMID: 21688404 DOI: 10.1007/bf03368461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Andersen CL. [Picture of the month: erythema migrans]. Ugeskr Laeger 2011; 173:590. [PMID: 21333263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Pfister HW. [Clinical aspects of neuroborreliosis]. MMW Fortschr Med 2010; 152:31-35. [PMID: 20672660 DOI: 10.1007/bf03366785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Benedix F, Geyer A, Röcken M, Biedermann T. Butterfly rash in a young boy: a quiz. Acta Derm Venereol 2010; 90:109-11. [PMID: 20107747 DOI: 10.2340/00015555-0756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Kaminsky A. Erythema figuratum. ACTAS DERMO-SIFILIOGRAFICAS 2009; 100 Suppl 2:88-109. [PMID: 20096167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
The term erythema figuratum is used to refer to erythematous lesions-with or without desquamation-that spread centrifugally in annular, arcuate, or polycyclic forms. Most of these conditions are reactions to unknown factors (immune, infectious, tumoral, and other processes), follow a chronic course with exacerbations and remissions, and are recurrent. They may disappear if the underlying cause is eradicated, but in general there are no specific treatments. They may appear at any time in life; some are more common in adults whereas others only present during childhood.
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Werner U. [Apparent and real sequelae of a tick bite. Unbelievable what is on this "market"]. MMW Fortschr Med 2009; 151:7. [PMID: 19927907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Moravcová L, Pícha D, Vanousová D, Hercogová J. [Detection of borrelia DNA from patients with neuroborreliosis and erythema migrans]. KLINICKA MIKROBIOLOGIE A INFEKCNI LEKARSTVI 2009; 15:160-165. [PMID: 19916154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
AIM Assessment of PCR procedure for proving of the Borrelia burgdorferi sensu lato DNA in nerve and skin forms of Lyme borreliosis. METHODS DNA from plasma, urine and CSF was isolated by QIAamp DNA mini kit. PCR was designed as two-step amplification (nested-PCR). Each sample was tested in PCR for five target sequences: two were specific for plasmide genes encoding OspA and OspC proteins and three correlated with genes for 16SrDNA, flagellin and p66 protein. RESULTS Borrelial DNA was proved in 41 patients suffering from neuroborreliosis out of 56 (77.4 %), among 48 patients with erythema migrans (EM) were found 26 positive (54.2 %). After treatment the specific DNA was detected in 22 patients with neuroborreliosis (41.5 %) and 16 patients with EM (38.1 %). Three months after the treatment 23 patients were positive in both of groups (28.7 %) and next 3 months later the specific DNA was found in 6 (9.5 %). The highest rate of positive results was manifested by 16SrDNA target, lower and comparable results were obtained by OspA, C and flagellin primers, the lowest rate was in p66 system. CONCLUSION The tested PCR proved specific DNA in all tested biological fluids in both of the clinical forms of Lyme borreliosis with a relatively high sensitivity. The proving of DNA can not be used for the assessment of the effect of treatment due to the long persistence of PCR positivity after antibiotic treatment. To achieve a sufficient diagnostic sensitivity of PCR it is desirable to use minimally two amplification systems in parallel.
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