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PubMedDate not supplied

European erythema migrans disease and related disorders.

European erythema migrans disease, lymphocytoma, and acrodermatitis chronica are a group of disorders associated with the bite of ixodid ticks. These disorders are now thought to be due to a single, or closely related, ixodid tick spirochetes. European erythema migrans disease closely resembles Lyme disease. Serological evaluation may help to separate spirochetal lymphocytoma from other pseudolymphomas of nonspirochetal origin and from lymphoma. Acrodermatitis chronica atrophicans, so far observed mainly in Europe, is presumably a late manifestation of this group of spirochetal disorders.

Acrodermatitis↗

PubMed2006

[Skin manifestations of Lyme borreliosis].

Lyme borreliosis is the most common tick-borne disease which is caused by Borrelia burgdorferi and transmitted in the Poland, as well as Europe, primarily by Ixodes ticks. After inoculation spirochetes spreads in the skin, activate locally immune response mechanisms and cause characteristic skin lesions like erythema migrans, lymphadenosis benigna cutis, erythema migrans multiplex and acrodermatitis chronica atrophicans. The correct clinical diagnosis of skin lesions and antibiotic treatment is most important for regression of symptoms and prevention of late manifestations of Lyme disease.

Acrodermatitis↗

PubMed1999

Scored antibody reactivity determined by immunoblotting shows an association between clinical manifestations and presence of Borrelia burgdorferi sensu stricto, B. garinii, B. afzelii, and B. Valaisiana in humans.

An immunoglobulin G immunoblot was developed with antigenic extracts of Borrelia burgdorferi sensu stricto, B. garinii, B. afzelii, and B. valaisiana genospecies and was reacted with sera from patients with neuroborreliosis, acrodermatitis, and Lyme arthritis. A detailed analysis of the reactivities of the protein bands was performed, and a two-step scoring procedure was selected to determine the preferential reactivity of sera to one particular genospecies. The discriminative potential of 5 proteins (12-kDa, 16-kDa, 18-kDa, OspA, and 66-kDa proteins) was used as a rapid first-step scoring method, followed by scoring of 14 additional protein bands if necessary. The advantage of this procedure is the low percentage of serum samples with inconclusive results for one of the four species (10% for patients with neuroborreliosis, 6% for patients with acrodermatitis chronica atrophicans, and 6% for patients with Lyme arthritis). Among 31 serum samples from patients with neuroborreliosis, 16 were more reactive to B. garinii, 7 were more reactive to B. afzelii, 3 were more reactive to B. valaisiana, and 2 were more reactive to B. burgdorferi sensu stricto. Of 31 serum samples from patients with acrodermatitis, 26 showed a higher level of reactivity to B. afzelii. Of 34 serum samples from patients with Lyme arthritis, 21 were more reactive to B. burgdorferi sensu stricto, 10 were more reactive to B. afzelii, and 1 was more reactive to B. valaisiana. Our results suggest an organotropism of Borrelia species and provide some evidence of a pathogenic potential of B. valaisiana in humans.

Antibodies, Bacterial↗

PubMed1987

Erythema chronicum migrans disease in the Federal Republic of Germany.

Epidemiology and clinical presentation of Erythema chronicum migrans disease are not well known yet. During a period of only 19 months, serological and clinical investigation of 2955 patients rendered 1106 cases of infection whose widespread incidence was remarkable: of the 328 administration districts of the FRG, 205 were affected. Accordingly, positive antibodies against Borrelia burgdorferi could be demonstrated in an average of 15.7% of the investigated rural population (2830 persons). Typical clinical signs were encountered in 817 of 1106 infected persons. Erythema (458 cases) and meningopolyneuritis (404 cases) were especially prominent. In comparison to Lyme disease the occurrence of arthritis (63 cases), carditis (13 cases) multiple erythema, recurrence, and central nervous symptoms in meningopolyneuritis (10%) were rare. On the other hand, progressive borrelia encephalomyelitis (45 cases) was surprisingly common. Acrodermatitis chronica atrophicans occurred in 72 cases; lymphadenosis benigna cutis in 5 patients. The variability of this disease is demonstrated by the combined syndromes occurring in only 27% of the cases.

Acrodermatitis↗

PubMed1997

Current aspects of Lyme disease and other Borrelia burgdorferi infections.

Lyme disease, acrodermatitis chronica atrophicans, and borrelial lymphocytoma are caused by species of the spirochete Borrelia burgdorferi. Lyme disease has emerged as the leading vector-borne infectious disease in the United States. This article presents a current review of these entities.

Acrodermatitis↗

PubMed1985

[Borreliosis--still a diagnostic labyrinth].

Acrodermatitis chronica atrophicans and meningo-polyneuritis Garin-Bujadoux-Bannwarth following initial erythema migrans represent infectious diseases and may lead to diagnostic misinterpretation. Three case reports illustrate the spirochetal nature of these entities usually transmitted by ticks (Ixodes ricinus).

Acrodermatitis↗

PubMed1991

Periarticular fibrous nodules in Lyme borreliosis.

Periarticular fibrous nodules have been described in patients with late-phase acrodermatitis chronica atrophicans (ACA) in the setting of Lyme borreliosis. We report the clinical and histopathological study of two patients with periarticular fibrous nodules and with Lyme borreliosis and discuss the relationship between these nodules and ACA.

Acrodermatitis↗

PubMed1992

Neurological complications of Lyme borreliosis.

Lyme disease, like syphilis, a spirochetal infection, can appear with exacerbations and remissions in different stages. The clinical picture is marked by dermatological, neurological, rheumatic and cardiological complications. PNS complications appear in the second and third stage. Tick bite meningoradiculoneuritis neuritis (Garin-Bujadoux-Bannwarth-Syndrome), characterized by painful asymmetrical sensory and motor dysfunctions and inflamed CSF, is a typical manifestation of the second stage. Mononeuritis multiplex appearing in conjunction with acrodermatitis chronica atrophicans is a typical PNS manifestation of the third stage. CNS involvement may also occur in early and late stages of Lyme-Borreliosis, presenting as myelitis or progressive encephalomyelitis. Lyme-Borreliosis is a treatable condition, which should not be missed in the differential diagnosis of PNS and CNS disorders.

Acrodermatitis↗

PubMed2007

Focus floating microscopy: "gold standard" for cutaneous borreliosis?

Borrelia burgdorferi is difficult to detect in routine biopsy material from patients with skin lesions of borreliosis. In this study, a new immunohistochemical method, focus floating microscopy (FFM), was developed to detect B burgdorferi in tissue sections and was compared with polymerase chain reaction (PCR). By using standard histologic equipment, tissue sections stained with a polyclonal B burgdorferi antibody were simultaneously scanned through 2 planes: horizontally in serpentines and vertically by focusing through the thickness of the section. Borrelia were detected in 47 of 71 ticks, 34 of 66 tick bites, 30 of 32 erythema chronicum migrans cases, 41 of 43 borrelial lymphocytomas, and 50 of 51 acrodermatitis chronica atrophicans cases. FFM proved to be more sensitive than PCR (96.0% vs 45.2%) and nearly equally specific (99.4% vs 100%). All 169 control cases, except 1 false-positive case of secondary syphilis, were negative with FFM. FFM is an easy, quick, and inexpensive method to reliably detect Borrelia in cutaneous tissue sections.

Acrodermatitis↗

PubMed1995

[Lyme borreliosis--diagnosis, clinical aspects and therapy of the cutaneous form].

Occurrence of Lyme borreliosis and namely its skin forms have a rising tendency. Thick population of ticks and their relatively high contamination with borrelia (app. 9% in Slovakia), increased presence of man in nature and frequent professional exposition create good conditions for the spreading of the disease. During the period of 20 months in 1993-1994 19 cases of borreliosis were recorded among 2,187 patients hospitalized at the Bratislava Dermatologic Clinic--17 cases of erythema chronicum migrans and two cases of acrodermatitis chronica atrophicans. All patients stated that they came into contact with ticks 24 hours--12 months prior to the origin of dermatologic alterations. 14 cases of erythema chronicum migrans being IFT examined by means of B. burgdorferi antigen included 10 patients who yielded the titre of antibodies higher than 1:256; 6 patients being examined by means of ELISA test included 2 positive findings. The IFT values varied also in cases of classical clinical picture of erythema chronicum migrans and a discrepancy was observed between IFT and ELISA results. Two cases of acrodermatitis chronica atrophica had positive serologic test. The serologic tests were performed also in 4 cases of scleroderma with positive results. Into their analysis the authors included also other studies on the basis of which they present schemes of diagnostic examination and therapeutic interventions in Lyme borreliosis. (Tab. 2, Ref. 4.)

Adolescent↗

PubMed1994

Evidence for the involvement of different genospecies of Borrelia in the clinical outcome of Lyme disease in Belgium.

In addition ot Borrelia burgdorferi, recognized as the aetiological agent of Lyme disease, at least two separate genospecies have recently been described. A relationship between infection by strains belonging to different genospecies and clinical outcome has been suspected. In this paper, 9 cases of Lyme arthritis were attributed to infection by B. burgdorferi sensu stricto, 18 cases of neuroborreliosis to B. garinii and one case of acrodermatitis chronica atrophicans to a strain of B. afzelii. These conclusions were based on the preferential reactivity of sera with antigens of given strains in Western blots and on residual reactivity after absorption of sera with antigens of representative strains. No conclusion could be reached concerning sera of 10 patients with erythema migrans.

Acrodermatitis↗

PubMed1993

Monoclonal antibodies for identification of Borrelia afzelii sp. nov. associated with late cutaneous manifestations of Lyme borreliosis.

Borrelia isolates associated with Lyme borreliosis were previously divided into 3 genospecies, B. burgdorferi sensu stricto, B. garinii and group VS461, on the basis of DNA homology. B. burgdorferi sensu stricto and B. garinii were identified by monoclonal antibodies (MAbs), H3TS and D6 respectively, but no MAbs were available to identify group VS461. Two MAbs were produced, I 17.3 and J 8.3 which reacted with OspB and OspA proteins, respectively, of strains belonging to group VS461, which should be named B. afzelii sp. nov. 24 strains were assigned to B. afzelii sp. nov., 11 of them being isolated from skin lesions, 6 from acrodermatitis chronica atrophicans (ACA) and 5 from erythema chronicum migrans (ECM). Although quite unknown in the USA, ACA has frequently been reported in northern Europe where B. afzelii sp. nov. is commonly isolated. This study documents the involvement of B. afzelii sp. nov. as a specific aetiological agent of ACA.

Acrodermatitis↗

PubMed1999

[Clinical picture of Lyme boreliosis].

Prevalence of Lyme borreliosis in Europe has been well esablished during the last decade. The highest morbidity in Poland, exceeding 100 cases (100.000) year, was demonstrated in north-estern part of the country. Additional small endemic areas were also described in south-western and central part of the country. Clinical picture of the disease do not differ significantly from observed in other parts of Europe. Lyme borreliosis is characterized with a wide variety of manifestations recognized as typical: erythema migrans, borrelial lymphocytoma, acrodermatitis chronica atrophicans, arthritis, facial palsy, lymphocytic meningitis and cardiac transduction disturbances. However there are also controversial syndroms, that have confirmed etiology of Borrelia burgdorferi but only in some cases, such as: morphea sclerodermatous lesions, cardiomyopathy and some neurologic disorders. Diagnosis of Lyme borreliosis is still based on typical signs of the disease and laboratory techniques can not solve clinical doubts.

Acrodermatitis↗

PubMed2004

Borrelia-specific interferon-gamma and interleukin-4 secretion in cerebrospinal fluid and blood during Lyme borreliosis in humans: association with clinical outcome.

The Borrelia-specific interferon (IFN)- gamma and interleukin (IL)-4 responses of 113 patients and control subjects were analyzed using the sensitive enzyme-linked immunospot method. Cerebrospinal fluid (CSF) and blood samples were obtained, during the course of disease, from patients with chronic or nonchronic neuroborreliosis (NB) and from control subjects without NB. Blood samples were obtained from patients with Lyme skin manifestations and from healthy blood donors. Early increased secretion of Borrelia-specific IFN- gamma (P<.05) and subsequent up-regulation of IL-4 (P<.05) were detected in the CSF cells of patients with nonchronic NB. In contrast, persistent Borrelia-specific IFN- gamma responses were observed in the CSF cells of patients with chronic NB (P<.05). In patients with erythema migrans, increased IFN- gamma (P<.001) was observed in blood samples obtained early during the course of disease, whereas increased IL-4 (P<.05) was observed after clearance. On the contrary, patients with acrodermatitis chronica atrophicans had Borrelia-specific IFN- gamma (P<.001), but not IL-4, detected in blood samples. The present data suggest that an initial IFN- gamma response, followed by up-regulation of IL-4, is associated with nonchronic manifestations, whereas a persistent IFN- gamma response may lead to chronic Lyme borreliosis.

Acrodermatitis↗

PubMed1995

Association between different clinical manifestations of Lyme disease and different species of Borrelia burgdorferi sensu lato.

Borrelia burgdorferi sensu lato, the aetiological agent of Lyme disease, has been subdivided into three species: B. burgdorferi sensu stricto, B. garinii and B. afzelii. We and other authors have hypothesized an association between the three species of B. burgdorferi sensu lato and some of the different clinical manifestations of Lyme disease. In order to demonstrate this hypothesis, we analysed twenty-nine isolates cultured from patients with different symptoms. The method used was multilocus enzyme electrophoresis: twelve genetic loci were characterized on the basis of the electrophoretic mobility of their products, and twenty-eight distinctive allele profiles (electrophoretic types) were distinguished, among which mean genetic diversity per locus was 0.649. Cluster analysis of a matrix of genetic distances between paired electrophoretic types revealed three primary divisions separated at genetic distances greater than 0.7 and corresponding to the three species of B. burgdorferi sensu lato. Ten strains obtained from skin of patients with erythema chronicum migrans (the primary stage of the disease) were assigned to the three different species. All the six strains isolated from patients with acrodermatitis chronica atrophicans were of the species B. afzelii, which was not found to be associated with another chronic manifestation of Lyme disease. Arthritis was caused prevalently by B. burgdorferi sensu stricto, and neuroborreliosis by B. burgdorferi sensu stricto and B. garinii. In conclusion, our results confirm the association between some of the different chronic manifestations of the disease and the species of B. burgdorferi sensu lato.

Acrodermatitis↗

PubMed1986

[Borrelia-associated dermatoses].

Erythema chronicum migrans (E.c.m.), Acrodermatitis chronica atrophicans (A.c.a.) and Lymphadenosis benigna cutis (L.b.c.) are infectious diseases according to Koch's criteria, after the infectious agent-Borrelia-Burgdorferi-could could be isolated. Clinic, pathology and therapy of these three diseases are presented in detail. The correlation to the lyme disease is being discussed. We believe that E.c.m., A.c.a. and L.b.c. are different entities determined by the virulence of the infectious agent and the individual immunological response.

Acrodermatitis↗

PubMed1986

[Enlarged spectrum of tick transmitted spirochaetoses].

After the successful identification of Borrelia burgdorferi as the cause of Lyme disease, a new tick-borne infection occurring in the United States, almost identical spirochaetes have been isolated from the tick Ixodes ricinus in Europe. As a result, the spirochaetal aetiology of skin diseases, which had long been recognized as tick-borne infections, namely erythema chronicum migrans with its neurological complications of the tick-borne meningopolyneuritis of Garin-Bujadoux-Bannwarth, acrodermatitis chronica atrophicans and lymphadenosis cutis benigna, could be confirmed by means of microbiological, histological and serological methods. On the basis of case histories it had already been assumed for some time that anetodermia maculosa and the localised sclerodermas might also be caused by a tick-borne agent. The results of serological investigations have now strengthened this assumption, although microbiological confirmation is still lacking.

Acrodermatitis↗

PubMed1990

The many faces and phases of borreliosis II.

Borrelia burgdorferi, the etiologic agent of Lyme disease, has also been associated with other cutaneous conditions. Acrodermatitis chronica atrophicans and lymphadenosis benigna cutis are also caused by B. burgdorferi. Recent evidence links some cases of progressive facial hemiatrophy of Parry-Romberg, benign lymphocytic infiltrate of the skin (Jessner-Kanof), lichen sclerosus et atrophicus, morphea, and Shulman syndrome with borreliae. This article reviews the manifestations of the diseases definitely linked to borreliosis and the evidence linking borreliae to progressive facial hemiatrophy, benign lymphocytic infiltrate, lichen sclerosus et atrophicus, morphea, and Shulman syndrome.

Acrodermatitis↗