Dermatological Manifestationsof Lyme Borreliosis in Patients of the First Dermatovenerological Clinic, MedicalFaculty Comenius University, Bratislava, Slovak Republic, in 1996–1998

Overview

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) transmitthe causal organism, the spirochete Borrelia burgdorferi sensu stricto and Borrelia burgdorferisensu 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 earlyand 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 oftreatment and the antibiotic used. The dynamics of the antibody titre against B. burgdorferi (IFAtest) were assessed in 21 patients with EM for a period of 1 to 22 months and in 5 patients withacrodermatitis 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 and20% did not know. An incubation of 1 and 2 weeks was reported in 34%, the lower extremities wereaffected 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 ofthe antibody titre were followed up for 1 to 22 months and no substantial changes were found. Serumpositivity in patients with ACA persisted without change of the titre for several years. In thetreatment 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 theearly stage of infection, antibodies against B. burgdorferi need not develop. There is no correlationbetween clinical complaints and serological results and the type of treatment. The prognosis of thedisease is favourable in the majority of patients. Vaccination offers new possibilities in activeprotection against Borrelia infection, in particular in endemic areas. For European countries atpresent a recombined vaccine is being prepared from the surface lipoprotein A (OspA) made fromprevalent strains of B. afzelii and B. garinii.

Key words:
Lyme borreliosis – erythema migrans – acrodermatitis chronica atrophicans – Borrelia