The description of
Lyme disease in 1976 and the detection of its causative agent, the spirochete Borrelia burgdorferi (B. burgdorferi), in 1982 led to an increase in our knowledge of the course of B. burgdorferi
infection and its clinical manifestations. The classic tick-borne
dermatoses erythema chronicum migrans (ECM), lymphadenosis benigna cutis (LABC) and
acrodermatitis chronica atrophicans (ACA) were proven by isolation of the spirochete from skin lesions to be caused by B. burgdorferi
infection. In early disease (less than 1 year) ECM and LABC can develop locally at the site of
infection (stage I), but both these
skin manifestations can also occur together with multiple lesions after dissemination of the causative organism (stage II). ACA is typical for late
infection (greater than 1 year, stage III). High titres of B. burgdorferi
antibodies have been found in patients with localized sclerodermalike lesions (
circumscribed scleroderma,
lichen sclerosus et atrophicus,
anetoderma), and frequent simultaneous occurrence of ACA suggests an association with late B. burgdorferi
infection. Similarly, we found four cases of cutaneous
B-cell lymphoma possibly arising from LABC in association with the same markers of late B. burgdorferi
infection. Additionally, some cases of Schönlein-
Henoch purpura and of
Shulman syndrome may be associated with
Lyme borreliosis. The disease is endemic in central Europe, and almost exclusively ticks of the Ixodes ricinus complex seem to transmit B. burgdorferi to humans, whereas the reservoir of
infection seem to be rodents, especially mice. The main diagnostic tool is serological examination for B. burgdorferi
antibodies, which will become detectable 3-6 weeks after
infection.
Enzyme-linked
immunosorbent assay (ELISA) and the indirect immunofluorescence test (IFT) revealed similar sensitivity. In early disease, sensitivity for antibody detection could be improved by immunoblot technique and by flagellum-ELISA, which is specific for this early sensitizing B. burgdorferi
antigen. For treatments,
penicillin is no longer recommended as the
drug of first choice, because low sensitivity of B. burgdorferi has been observed in vitro and in vivo.
Tetracycline,
doxycycline and
amoxicillin p.o. are now preferred for the treatment of
Lyme borreliosis, and in neurologic and cardiac abnormalities
ceftriaxone i.v. is recommended.
Treatment duration should be 14 days in early disease and 30 days in late disease.