SOLITARY ERYTHEMA MIGRANS - A CLINICAL, LABORATORY AND EPIDEMIOLOGIC-STUDY OF 77 DUTCH PATIENTS

Regional variations in the clinical spectrum of Lyme borreliosis have been described previously. These may be related to strain variations, or reflect selection bias. We compared the clinical and epidemiologica l profiles of Dutch patients presenting with solitary erythema migrans alone, with the profiles in other European studies, and studies from the U.S.A., and cultured Borrelia burgdorferi from erythema migrans to identify the genospecies. Seventy-seven consecutive patients with a f inal diagnosis of erythema migrans were admitted into the study. Vario us clinical and epidemiological data were obtained, and serum was eval uated for antibodies to Borrelia burgdorferi with an enzyme-linked imm unosorbent assay. Skin biopsy specimens were taken from the border of the erythema migrans and cultured in modified Kelly's medium. The diff erent genospecies of Borrelia burgdorferi were identified by reactivit y with monoclonal antibodies H3TS, LA-26, LA-31 and D6, and by rRNA ge ne restriction patterns. Patients were treated with tetracycline or do xycycline, and were seen for follow-up 6 weeks after treatment. Long-t erm follow-up was by telephone interview. A tick bite had been noticed by 45% of the patients. The onset of erythema migrans occurred in 97% of these patients within 3 months of the tick bite. Erythema migrans was present for 1-319 days (median 2 months). No concomitant manifesta tions were spontaneously reported. Borrelia burgdorferi was cultured f rom 52 (84%) of 62 skin biopsy specimens. Fifty isolates (96%) were id entified as Borrelia burgdorferi group VS461. No therapy failures occu rred among patients treated with tetracycline (follow-up 1-4 years, me dian 27 months) or doxycycline (follow-up 6-31 months, median 19 month s). The clinical and epidemiological profile of Dutch patients with er ythema migrans alone did not differ from that reported in other Europe an studies. The predominant organism isolated from erythema migrans le sions was Borrelia burgdorferi group VS461. Multiple skin lesions and concomitant clinical manifestations appear to be more frequent in pati ents in the U.S.A. However, selection bias cannot be excluded. At pres ent, Borrelia burgdorferi sensu stricto is the only genospecies identi fied in the U.S.A. Hence, regional variations in the clinical spectrum of Lyme borreliosis may be the result of different genospecies.