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1/7. 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.
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2/7. 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.
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3/7. 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.
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4/7. Lyme and/or Lyme-like disease in missouri.

    missouri patients who fulfill the strict CDC surveillance definition for lyme disease have been reported in significant numbers since 1987, although there are no viable missouri human cultures of borrelia burgdorferi. The missouri erythema migrans rashes are indistinguishable from those in other areas, and the clinical syndrome appears similar to lyme disease nationally. The authors suspect atypical B. burgdorferi, and/or other Borrelia spirochetes of causing this clinical borreliosis syndrome.
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5/7. Cultivation of borrelia burgdorferi from human tick bite sites: a guide to the risk of infection.

    BACKGROUND: The risk of acquiring lyme disease has been evaluated by xenodiagnostic procedures with laboratory strains of borrelia burgdorferi and laboratory-reared ixodes ticks, or by clinical trials in which diagnosis was based on clinical findings, culture, or serologic tests. OBJECTIVE: Our purpose was to determine the risk of infection from tick bites in a natural setting in which wild strains of B. burgdorferi were involved, by a biopsy culture technique. methods: skin biopsy specimens were obtained from ixodes scapularis tick bite sites, processed, and examined for the presence of B. burgdorferi. RESULTS: B. burgdorferi was cultivated from only 2 of 48 skin biopsy specimens. In both instances duration of tick attachment was approximately 24 hours. CONCLUSION: In a hyperendemic region for lyme disease the risk of infection after a deer tick bite appears to be low, particularly if the tick has been attached for less than 24 hours.
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6/7. Persistence of borrelia burgdorferi sensu lato in resolved erythema migrans lesions.

    Erythema migrans skin lesions resulting from a tick bite and infection with borrelia burgdorferi sensu lato eventually resolve, even without antibiotic therapy. The aim of the present study was to gauge the frequency of persistence of B. burgdorferi sensu lato in such lesions. Thus, the site of a previous lesion was biopsied and cultured in 48 patients: 39 with systemic or localized symptoms/signs and nine with no symptoms. B. burgdorferi sensu lato was isolated from biopsied skin from three symptomatic patients. Cultures of other tissues and fluids were negative. By genospecies-specific polymerase chain reaction (PCR) and pulsed-field gel electrophoretic (PFGE) analysis, two isolates were classified as Borrelia afzelii. The remaining isolate was a member of an unusual group of strains that type as B. burgdorferi sensu stricto by genospecies PCR but possess an atypical PFGE profile. All three patients had a dramatic clinical response to antibiotic treatment. These findings demonstrate the capacity of viable B. burgdorferi sensu lato organisms to persist in clinically normal-appearing skin at the site of a resolved erythema migrans rash for periods ranging from 2 months to 3.5 years. This observation may provide new insight into the organisms' ability to evade the host's immune response.
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7/7. Use of the C3H/He lyme disease mouse model for the recovery of a Spanish isolate of Borrelia garinii from erythema migrans lesions.

    A skin biopsy from a patient with erythema migrans was inoculated into C3H/He mice and into culture medium. A Borrelia garinii strain named Rio1 was isolated from both a direct BSK medium culture and a mouse ear-punch biopsy culture. Inoculating human tissue into mice produced a disease resulting in severe inflammation of the left tibio-tarsal joint, development of perivascular infiltrates as seen in ear-punch biopsies and the spread of spirochaetes along the skin, far from the inoculation site. The isolation of this strain confirms the circulation of this Borrelia species in spain as a human pathogen, as well as its arthrogenicity in an animal model. The method used to recover strain Rio1 from human tissue is described as rapid and sensitive compared to direct inoculation of tissue into BSK medium.
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