LETTER
Isolating Borrelia burgdorferi from Erythema Migrans
William A. Agger
1 November 1993 | Volume 119 Issue 9 | Pages 953-954
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- microns filtration 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.
1. Dennis DT, Campbell GL, Quan TJ. Isolation of Borrelia burgdorferi from a patient infected in Maryland (Letter). Clin Infect Dis. 1992; 15:1058-9.
2. Berger BW, Johnson RC, Kodner C, Coleman L. Cultivation of Borrelia burgdorferi from erythema migrans lesions and perilesional skin. J Clin Microbiol. 1992; 30:359-61.
3. Wormser GP, Forseter G, Cooper D, Nowakowski J, Nadelman RB, Horowitz H, et al. Use of a novel technique of cutaneous lavage for diagnosis of Lyme disease associated with erythema migrans. JAMA. 1992; 268:1311-3.
4. Callister SM, Agger WA, Schell RF, Ellingson JL.Borrelia burgdorferi infection surrounding La Crosse, Wisconsin. J Clin Microbiol. 1988; 26:2632-6.
5. Jobe DA, Callister SM, Schell RF. Recovery of Borrelia burgdorferi by filtration. J Clin Microbiol. 1993; 31:1896-8.
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