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Erythema chronicum migrans: an electron-microscopic study

P Van Mierlo1, W Jacob, P Dockx

  • 1Department of Dermatology, University of Antwerp (UIA), Belgium.

Dermatology (Basel, Switzerland)
|January 1, 1993
PubMed
Summary

Spirochaetal organisms, identified as Borreliae, were found in skin biopsies of erythema chronicum migrans. These bacteria move freely in the dermis, contributing to the characteristic spreading rash.

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Area of Science:

  • Microbiology
  • Dermatology
  • Histopathology

Background:

  • Erythema chronicum migrans (ECM) is a hallmark clinical manifestation of early Lyme disease.
  • The causative agent of Lyme disease is Borrelia burgdorferi sensu lato, a spirochaete.
  • Understanding the pathogen's presence and behavior within skin lesions is crucial for diagnosis and treatment.

Observation:

  • Skin biopsy specimens from ECM lesions revealed the presence of spirochaetal organisms.
  • Histological examination showed a lymphohistiocytic infiltrate, with distribution varying between the central papule and peripheral erythematous border.
  • Electron microscopy confirmed the organisms' morphology, consistent with Borrelia species, exhibiting characteristic coils and striations.

Findings:

  • The electron-microscopic features of the spirochaetes in skin specimens matched those of Borreliae isolated from blood.
  • Borreliae were observed to move freely within the dermal matrix.
  • Evidence suggests that these spirochaetes are not phagocytized by host immune cells.

Implications:

  • The direct visualization of Borreliae in ECM lesions supports their role in the pathogenesis of Lyme disease.
  • The observed motility and lack of phagocytosis may explain the characteristic centrifugal spread of the ECM rash.
  • These findings underscore the importance of integrating histopathological and electron microscopic analysis in diagnosing tick-borne spirochaetal infections.

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