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Isolating Borrelia burgdorferi from Erythema Migrans
- William A. Agger, MD
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TO THE EDITOR:
Erythema migrans can mimic other circular, erythematous eruptions. The isolation of Borrelia burgdorferi from erythema migrans can establish the diagnosis of Lyme disease [1]; 86% of skin biopsy cultures of erythema migrans lesions were reported to grow B. burgdorferi [2]. However, biopsies are time-consuming, expensive, and more invasive than needle aspiration. Recently, a double-needle cutaneous lavage of saline was found to be slightly less sensitive than skin biopsy, but because of the discomfort of saline injection, Xylocaine anesthesia was required [3].
From June to September in 1991 and 1992, a single needle was used to aspirate erythema migrans lesions. Ten patients were identified with probable erythema migrans (circular erythema >5 cm) from among outpatients with outdoor exposures. Nine cases of erythema migrans had been reported in the hyperendemic Lyme disease area north of La Crosse, Wisconsin [4], and four patients were recently bitten by Ixodes dammini. Five patients had primary erythema migrans, and five had early disseminated Lyme disease (multiple erythema migrans).
The lesions were disinfected with alcohol, which was allowed to dry. A small amount of subcutaneous tissue fluid was aspirated with three back-and-forth passes beneath the edge of erythema migrans lesions using an 18- or 20-gauge needle on a 3-mL syringe. Saline was not injected. The same needle and syringe were then immediately flushed with 1 to 2 mL of fresh BSK-II media. After 34 C incubation, dark-field microscopy was done weekly for 4 weeks.
Five aspirates showed B. burgdorferi (confirmed by direct fluorescence antibody). Two positive cultures required 0.45-µmfiltration to remove contaminating bacteria [5]. At the time of aspiration, Lyme titers, tested by enzyme immunoassay and immunofluorescent assay were positive for IgM antibodies in four of seven patients.
Although other techniques for culturing erythema migrans lesions have similar sensitivities, a single-needle aspiration is quick, inexpensive, and easily done.
William A. Agger
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
Include no more than 300 words of text, three authors, and five references
Type with double-spacing
Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright 2004 by the American College of Physicians
