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Culture-Confirmed Infection and Reinfection with Borrelia burgdorferi
- John Nowakowski, MD;
- Ira Schwartz, PhD;
- Robert B. Nadelman, MD;
- Dionysios Liveris, PhD;
- Maria Aguero-Rosenfeld, MD; and
- Gary P. Wormser, MD
- From New York Medical College and the Lyme Disease Diagnostic Center, Westchester County Medical Center, Valhalla, New York. Acknowledgments: The authors thank Susan Bittker, Denise Cooper, Charles Pavia, Gilda Forseter, Diane Holmgren, Donna McKenna, Harold Horowitz, Marisa Montecalvo, and Neil Rosenfeld for their assistance. Grant Support: In part by Cooperative Agreement no. U50/CCU 210280 from the Centers for Disease Control and Prevention and by grants AR41508 and AR41511 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. The contents of this report are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Requests for Reprints: John Nowakowski, MD, Division of Infectious Diseases, Department of Medicine, New York Medical College, Macy Pavilion 209SE, Valhalla, NY 10595. Current Author Addresses: Drs. Nowakowski, Nadelman, and Wormser: Division of Infectious Diseases, Department of Medicine, New York Medical College, Macy Pavilion 209SE, Valhalla, NY 10595.
Lyme disease, the most common vector-borne disease in the United States, is caused by infection with the spirochete Borrelia burgdorferi[1]. Reinfection has been described clinically but has not been substantiated microbiologically [2-5]. We documented the occurrence of reinfection by isolating B. burgdorferi during two different clinical episodes of Lyme disease. Polymerase chain reaction (PCR)-restriction fragment length polymorphism analysis of the two isolates showed that the isolates were different strains of B. burgdorferi, suggesting reinfection and not reactivation of a previous infection. We also used enzyme-linked immunosorbent assay (ELISA) and immunoblot to evaluate the antibody response of sequential blood samples to B. burgdorferi.
Case Report
A 60-year-old woman presented on 15 July 1991 with a single 11 × 12-cm erythema migrans lesion on her right upper thigh that she had noticed 5 days before presentation. She was otherwise asymptomatic. Culture of a skin biopsy sample grew B. burgdorferi. The rash resolved after 14 days of oral amoxicillin therapy (500 mg three times daily). Two years later (on 12 July 1993), the patient presented with one 19 × 24-cm erythema migrans …
