Brief Communication: Hematogenous Dissemination in Early Lyme Disease

3 May 2005 | Volume 142 Issue 9 | Pages 751-755

Background: Bloodstream invasion in Lyme disease has been difficult to study because until recently blood culture methods were too insensitive to detect spirochetemia.

Objective: To evaluate the clinical and laboratory features of spirochetemic patients.

Design: Cross-sectional study.

Setting: Lyme Disease Diagnostic Center in Valhalla, New York, 1997 to 2002.

Patients: 213 untreated adults with erythema migrans.

Intervention: Blood culture for Borrelia burgdorferi.

Measurements: Symptom scores and selected laboratory measures.

Results: Spirochetemia was found in 93 (43.7%) patients. Spirochetemic patients were more often symptomatic (89.2% vs. 74.2%; P = 0.006) and more often had multiple erythema migrans lesions (41.9% vs. 15.0%; P < 0.001) than patients without spirochetemia. However, 8 (22.9%) of the 35 asymptomatic patients with a single skin lesion nevertheless had a positive blood culture. Risk for spirochetemia was present the day the patient noticed the lesion and continued for more than 2 weeks.

Limitations: Long-term outcome data were not available.

Conclusions: The high rate, early onset, and prolonged duration of risk for spirochetemia explain why untreated patients with erythema migrans are at risk for dissemination of B. burgdorferi to anatomic sites beyond the lesion site. Differences in the strain of the infecting spirochete, as well as host factors, may be important determinants of hematogenous dissemination.

Editors' Notes Context Clinical and laboratory characteristics of bloodstream invasion in patients with early Lyme disease have not been studied previously because blood culture techniques have, until recently, been too insensitive to detect spirochetemia. Contribution Spirochetemia occurs commonly in patients with erythema migrans and is associated with a higher incidence and greater severity of clinical symptoms than in patients without bloodstream invasion. Spirochetes can be identified in the blood at the onset of erythema migrans for more than 2 weeks in untreated patients. Implications Hematogenous dissemination is the likely explanation for spread of the spirochete to distant organs. –The Editors

 

Author and Article Information

From New York Medical College, Valhalla, New York, and Vanderbilt University Medical Center, Nashville, Tennessee.

Disclaimer: The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.

Acknowledgments: The authors thank Lisa Giarratano, Susan Bittker, Denise Cooper, Kathleen O'Keefe, Dennis Liveris, and Ira Schwartz for their assistance.

Grant Support: In part by Cooperative Agreement U50/CCU219613 and in part by Cooperative Agreement U50/CCU219612 from the Centers for Disease Control and Prevention.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Gary P. Wormser, MD, Division of Infectious Diseases, New York Medical College, Munger Pavilion, Room 245, Valhalla, NY 10595; e-mail, mailto:gary_wormser{at}nymc.edu.

Current Author Addresses: Dr. Wormser, Ms. McKenna, Dr. Nadelman, Ms. Holmgren, and Dr. Nowakowski: Division of Infectious Diseases, New York Medical College, Munger Pavilion Room 245, Valhalla, NY 10595.

Dr. Cavaliere: Division of Rheumatic Diseases, New York Medical College, Munger Pavilion Room G73, Valhalla, NY 10595.

Ms. Carlin: University of California, San Francisco, 1600 Divisadero, Room B-656, San Francisco, CA 94115.

Mr. Byrne: GCRC, AA-3328 MCN, Vanderbilt University, 1161 21st Avenue South, Nashville, TN 37232.

Author Contributions: Conception and design: G.P. Wormser, J. Nowakowski.

Analysis and interpretation of the data: G.P. Wormser, D.W. Byrne, D. McKenna, R.B. Nadelman.

Drafting of the article: G.P. Wormser, R.B. Nadelman.

Critical revision of the article for important intellectual content: G.P. Wormser, R.B. Nadelman, D.W. Byrne, J. Nowakowski.

Final approval of the article: G.P. Wormser, D. McKenna, J. Carlin, R.B. Nadelman, L.F. Cavaliere, D. Holmgren, J. Nowakowski.

Provision of study materials or patients: G.P. Wormser, R.B. Nadelman, J. Nowakowski.

Statistical expertise: D.W. Byrne.

Obtaining of funding: G.P. Wormser, J. Nowakowski.

Administrative, technical, or logistic support: G.P. Wormser, D. McKenna, R.B. Nadelman, L.F. Cavaliere, J. Nowakowski.

Collection and assembly of data: G.P. Wormser, D. McKenna, J. Carlin, L.F. Cavaliere, D. Holmgren, J. Nowakowski.