Comparison of Culture-Confirmed Erythema Migrans Caused by Borrelia burgdorferi sensu stricto in New York State and by Borrelia afzelii in Slovenia

  1. Franc Strle, MD;
  2. Robert B. Nadelman, MD;
  3. Joze Cimperman, MD;
  4. John Nowakowski, MD;
  5. Roger N. Picken, PhD;
  6. Ira Schwartz, PhD;
  7. Vera Maraspin, MD;
  8. Maria E. Aguero-Rosenfeld, MD;
  9. Shobha Varde, MS;
  10. Stanka Lotric-Furlan, MD; and
  11. Gary P. Wormser, MD
  1. From the University of Ljubljana, Ljubljana, Slovenia; New York Medical College and Westchester Medical Center, Valhalla, New York; and Rush Medical College, Chicago, Illinois.

    Abstract

    Background: The clinical manifestations of Lyme borreliosis in North America and Europe seem to differ, but a systematic comparison has never been done.

    Objective: To compare European and U.S. patients with culture-confirmed erythema migrans.

    Design: Prospective, clinical cohort study.

    Setting: University medical centers in Westchester County, New York, and Ljubljana, Slovenia.

    Patients: 119 U.S. patients with Borrelia burgdorferi sensu stricto infection and 85 Slovenian patients with B. afzelii infection.

    Measurements: Interview, physical examination, and laboratory assays.

    Results: Compared with Slovenian patients, U.S. patients had erythema migrans for a briefer duration (median duration, 4 days compared with 14 days; P < 0.001) but were more likely to have systemic symptoms (P = 0.01), abnormal findings on physical examination (P < 0.001), and seroreactivity (P < 0.001). Central clearing of erythema migrans lesions was more likely in Slovenian patients (P < 0.001).

    Conclusions: Erythema migrans caused by B. afzelii in Slovenia and erythema migrans caused by B. burgdorferi in New York have distinct clinical presentations. Caution should be used when clinical and laboratory experience from one side of the Atlantic is applied to patients on the other.

    Article and Author Information

    • Requests for Reprints: Robert B. Nadelman, MD, Westchester Medical Center, Division of Infectious Diseases, Macy Pavilion 209SE, Valhalla, NY 10595.

    • Current Author Addresses: Drs. Strle, Cimperman, Maraspin, and Lotric-Furlan: Department of Infectious Diseases, University Medical Centre, Japljeva 2, 1525 Ljubljana, Slovenia.

    • Drs. Nadelman, Nowakowski, and Wormser: Division of Infectious Diseases, Westchester Medical Center, Macy Pavilion 209SE, Valhalla, NY 10595.

    • Dr. Picken: Department of Pathology, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153.

    • Dr. Schwartz and Ms. Varde: Department of Biochemistry and Molecular Biology, New York Medical College, Valhalla, NY 10595.

    • Dr. Aguero-Rosenfeld: Clinical Laboratories, Room 1J-11a, Westchester Medical Center, Valhalla, NY 10595.

    • Disclaimer: The content of this report is solely the responsibility of the authors and does 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.

    • Acknowledgments: The authors thank the following persons for their clinical or laboratory assistance: Susan Bittker, MS, Denise Cooper, BS, Neil S. Goldberg, MD, Diane Holmgren, RN, Kathleen O'Keefe, RN, Donna McKenna, RN, Gilda Forseter, RN, Charles S. Pavia, PhD, Marisa Montecalvo, MD, Harold W. Horowitz, MD, and Gail Gerena, MD (New York Medical College and the Lyme Disease Diagnostic Center, Westchester Medical Center, Valhalla, New York); Eva Ruzic-Sabljic, MD (University of Ljubljana, Ljubljana, Slovenia); Jeffrey A. Nelson, MD, and Yu Cheng, PhD (Rush Medical College, Chicago, Illinois); and Maria M. Picken, MD, PhD (Loyola University Medical Center, Maywood, Illinois).

    • Grant Support: In part by Cooperative Agreements U50/CCU 210286 (Dr. Nadelman) and U50/CCU 210280 (Dr. Wormser) from the Centers for Disease Control and Prevention; grants RO1-AR41508 (Drs. Nadelman and Nowakowski), RO1-AR43135 (Dr. Wormser), RO1-AR41511 (Dr. Schwartz), and RO1-AR41517 (Dr. Picken) from the National Institute of Arthritis and Musculoskeletal and Skin Diseases; grant C-011001 from the New York State Department of Health, Tick-Borne Disease Institute (Dr. Nadelman); and grant J3-5267 from the Ministry of Science and Technology of Slovenia (Dr. Strle).

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    1. Ann Intern Med January 5, 1999 vol. 130 no. 1 32-36
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