Untreated erythema migrans may lead to B. burgdorferi sensu lato
bacteremia
Arnež M. Pediatr Infect Dis J.
2011;doi:10.1097/INF.0b013e318225b8c3.
Bacteremia caused by Borrelia burgdorferi sensu lato was found in
children from Slovenia with solitary and multiple erythema migrans that were
left untreated, according to a recent report.
B. burgdorferi sensu lato bacteremia was detected in 11.4% of
Slovenian children with untreated
erythema migrans as early as the day of appearance of
erythema migrans and as late as 39 days after the appearance of skin lesions,
according to a study.
A total of 1,164 patients with previously untreated solitary erythema
migrans (SEM) and multiple erythema migrans (MEM) had blood drawn and were
treated with antibiotics that are recommended in Slovenia for treatment of
early Lyme disease.
“Blood cultures were more often positive in patients with MEM
(15.8%) than in patients with SEM (7.6%),” the researchers wrote.
“The risk for B. burgdorferi sensu lato bacteremia in children with
untreated [erythema migrans] can last as long as 39 days after the onset of
skin rash.”
Lyme disease is caused by three different Borrelia species in
Europe: B. afzelii, B. garinii and B. burgdorferi sensu
stricto. Of all the isolates collected, almost all were B. afzelii;
B. garinii was found more often in patients with SEM, and B. burgdorferi sensu stricto was not isolated from
any patients. Patients with SEM less often reported ring-like skin lesions, but
could recall a bite at the site of later erythema migrans. Homogenous red skin
lesions were observed in 26% of patients with SEM and 1% of patients with MEM
without central clearing, whereas no central blistering was found.
“The typical, clinical sign of early localized Borrelia
infection is SEM, whereas MEM is one of the main characteristics of early
disseminated infection,” the researchers wrote. “The time point at
which hematogenous dissemination occurs is not known.”