Dermatological Manifestations
of Lyme Borreliosis in Patients of the First Dermatovenerological Clinic, Medical
Faculty Comenius University, Bratislava, Slovak Republic, in 1996–1998
Švecová D., Buchvald J., Opršalová K., Doležalová A.
1. dermatovenerologická klinika, Lekárska fakulta Univerzity Komenského, Bratislava, |
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Summary:
60–70 % of Lyme borreliosis is formed by early manifestations, in particular erythema migrans (EM).
All vegetative forms of the tick Ixodes ricinus (e.g. full grown tick, nymphae and larvae) transmit
the causal organism, the spirochete Borrelia burgdorferi sensu stricto and Borrelia burgdorferi
sensu lato (B. garinii, B. afzelii). The objective of the work was to evaluate clinical and epidemiolo-
gical parameters and to contribute by testing and investigating in greater detail criteria to the early
and exact diagnosis of the disease.
In a group of 50 patients the time of development of EM was evaluated, the mode of transmis sion,
the incubation period, localization, symptoms of dissemination of B. burgdorferi, the period of
treatment and the antibiotic used. The dynamics of the antibody titre against B. burgdorferi (IFA
test) were assessed in 21 patients with EM for a period of 1 to 22 months and in 5 patients with
acrodermatitis chronic atrophicans (ACA) for 3 to 55 months.
In 50% EM developed during the summer months. 66% reported as the vector a tick, 14% insects and
20% did not know. An incubation of 1 and 2 weeks was reported in 34%, the lower extremities were
affected in 52%. Manifestations of dissemination were found in 6 patients, in 2 patients EM relapsed.
Antibodies (Ab) against B. burgdorferi were present in 38 patients. In 21 patients the dynamics of
the antibody titre were followed up for 1 to 22 months and no substantial changes were found. Serum
positivity in patients with ACA persisted without change of the titre for several years. In the
treatment of EM most frequently doxycycline was administered for two weeks.EM as the early stage of LB is a seasonal disease with a natural focus. If treatment is started in the
early stage of infection, antibodies against B. burgdorferi need not develop. There is no correlation
between clinical complaints and serological results and the type of treatment. The prognosis of the
disease is favourable in the majority of patients. Vaccination offers new possibilities in active
protection against Borrelia infection, in particular in endemic areas. For European countries at
present a recombined vaccine is being prepared from the surface lipoprotein A (OspA) made from
prevalent strains of B. afzelii and B. garinii.
Key words:
Lyme borreliosis – erythema migrans – acrodermatitis chronica atrophicans – Borrelia
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