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Published on: February 14, 2011
Hematogenous dissemination in early Lyme disease
1Division of Infectious Diseases, Department of Medicine of New York Medical College, Valhalla, NY 10595, USA. gary_wormser@nymc.edu
Abstract:
Hematogenous dissemination has long been considered an important pathogenetic event in Lyme borreliosis but has been hard to document and characterize due to insensitive blood culture methods. In a series of recent investigations involving adult patients from the United States with erythema migrans, it was concluded that plasma was a better source of culture material than serum or whole blood, and yield correlated directly with the volume of material cultured. The rate of recovery of Borrelia burgdorferi from 9 mL of plasma exceeded 40%. Both the genotype of the strain of B. burgdorferi introduced by the tick and host factors, such as having a first episode of Lyme borreliosis and being more than 55 years of age, appear to affect the risk of hematogenous dissemination. Although the majority of spirochetemic patients are symptomatic, spirochetemia can be a subclinical event. In summary, hematogenous dissemination is a common and important feature of early Lyme borreliosis in the United States. The high rate, early onset and prolonged duration of risk of spirochetemia probably explain why untreated patients with erythema migrans may develop objective clinical manifestations at a distant anatomic site.
Insights
Hematogenous dissemination is common in early Lyme borreliosis (LB). Plasma cultures, especially larger volumes, significantly improve Borrelia burgdorferi recovery, aiding diagnosis and understanding disease spread.
Area of Science:
- Infectious Diseases
- Microbiology
- Epidemiology
Background:
- Hematogenous dissemination is a recognized, yet poorly documented, aspect of Lyme borreliosis pathogenesis.
- Previous blood culture methods for Borrelia burgdorferi were insensitive, hindering characterization of spirochetemia.
- Early Lyme borreliosis diagnosis and understanding dissemination are crucial for effective treatment.
Purpose of the Study:
- To investigate the frequency and characteristics of hematogenous dissemination in early Lyme borreliosis.
- To evaluate plasma as a superior culture medium for detecting Borrelia burgdorferi.
- To identify factors influencing the risk of spirochetemia in patients with erythema migrans.
Main Methods:
- Culturing of plasma, serum, and whole blood from adult patients with erythema migrans in the United States.
- Correlation of culture yield with the volume of biological material processed.
- Analysis of host factors (age, prior LB episodes) and Borrelia burgdorferi strain genotype in relation to dissemination risk.
Main Results:
- Plasma yielded significantly higher recovery rates of Borrelia burgdorferi compared to serum or whole blood.
- Culture yield correlated positively with the volume of plasma cultured, with over 40% recovery from 9 mL.
- Host factors (age >55, first LB episode) and tick-borne B. burgdorferi strain genotype influenced dissemination risk.
Conclusions:
- Hematogenous dissemination is a frequent and significant event in early Lyme borreliosis in the US.
- Plasma culture is an effective method for detecting Borrelia burgdorferi, especially with larger sample volumes.
- The high incidence and duration of spirochetemia explain the development of disseminated Lyme borreliosis manifestations.
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