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Updated: May 14, 2026

Precision Implementation of Minimal Erythema Dose (MED) Testing to Assess Individual Variation in Human Inflammatory Response
Published on: October 3, 2019
[Erythema migrans]
Lenka Krbková1, Zuzana Náterová
1Clinic of Pediatric Infectious Diseases, The University Hospital Brno, Czech Republic. lkrbkova@fnbrno.cz
Abstract:
The article summarizes the latest knowledge about the etiology, epidemiology, pathogenesis, clinical signs, diagnostic procedures and therapy of erythema migrans (EM), a cutaneous form of Borrelia infection. The sole focus on this clinical entity is intentional since EM is the most common clinical involvement in Lyme borreliosis (LB) in the Czech Republic (CR). New genospecies from the Borrelia burgdorferi sensu lato complex, B. lusitaniae and B. spielmanii, as etiologic agents are reported. Although there are no commercial tests available yet for their detection, ticks are demonstrably infected with them in Europe and probably even in the CR. Six pathogenic genospecies circulate among vertebrates and Ixodes ricinus ticks in Europe. The transmission cycle in nature, hosts identified as reservoirs and distribution of borreliae in Europe are presented. Clinical forms of EM are described in detail including accompanying features. Types of erythema in the USA and Europe are compared. In the part on differential diagnosis, allergies, skin and infectious diseases with similar appearance on the skin as EM are mentioned. Although the diagnosis of EM is exclusively clinical and serology is not indicated, methods of direct detection and two-tier testing of antibodies are discussed. There are therapeutic recommendations concerning the choice of antibiotics available in the CR.
Insights
Erythema migrans (EM), a skin manifestation of Lyme borreliosis (LB), is detailed, including new Borrelia genospecies. This review covers EM
Area of Science:
- Dermatology and Infectious Diseases
- Microbiology and Vector-borne Diseases
Context:
- Erythema migrans (EM) is the most frequent clinical presentation of Lyme borreliosis (LB).
- Focus on the Czech Republic (CR) highlights regional epidemiology and diagnostics.
- Emergence of new Borrelia genospecies (B. lusitaniae, B. spielmanii) necessitates updated understanding.
Purpose:
- To provide a comprehensive overview of current knowledge on erythema migrans.
- To detail the etiology, epidemiology, pathogenesis, clinical presentation, diagnosis, and therapy of EM.
- To discuss differential diagnoses and therapeutic strategies for EM in the CR.
Summary:
- Summarizes etiology, epidemiology, pathogenesis, clinical signs, diagnostics, and therapy of erythema migrans (EM).
- Highlights new Borrelia genospecies (B. lusitaniae, B. spielmanii) and their presence in European ticks.
- Compares EM clinical forms and differential diagnoses between Europe and the USA; discusses diagnostic methods and antibiotic choices.
Impact:
- Enhances understanding of Lyme borreliosis diagnostics and treatment.
- Provides clinicians with up-to-date information for managing erythema migrans.
- Contributes to public health awareness regarding tick-borne diseases and their manifestations.
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