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Eva Åsbrink - One of the best experts on this subject based on the ideXlab platform.
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successful cultivation of spirochetes from skin lesions of patients with erythema chronicum migrans afzelius and Acrodermatitis Chronica Atrophicans
Acta Pathologica Microbiologica Scandinavica Series B: Microbiology, 2009Co-Authors: Eva Åsbrink, Anders HovmarkAbstract:Spirochetes could be cultivated from 9 out of 13 skin biopsies from patients with erythema chronicum migrans Afzelius (ECMA) and from 2 out of 5 biopsies from patients with Acrodermatitis Chronica Atrophicans (ACA) by using a newly modified serumless Kelly's medium. The different spirochete strains grew best at a low oxygen tension. Attempts to grow spirochetes from blood and cerebrospinal fluid failed. The cultivation of spirochetes from secondary ECMA lesions favours the presumption that a spirochetemia may occur in ECMA. The isolation of spirochetes from an ACA patient who had a disease duration of greater than 10 years proves that the spirochetes may survive in the human body for a considerable time.
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peripheral neuropathy in Acrodermatitis Chronica Atrophicans effect of treatment
Journal of The Peripheral Nervous System, 2003Co-Authors: E Kindstrand, Anders Hovmark, B Y Nilsson, R Pirskanen, Eva ÅsbrinkAbstract:Forty-seven patients with the late borrelial manifestation Acrodermatitis Chronica Atrophicans (ACA) and with objective neurological and/or neurophysiological findings were followed up after antibiotic treatment with dermatological, serological, neurological and neurophysiological controls. Despite a good therapeutic effect on ACA lesions, specific antibody values and symptoms of irritative nerve lesions, the objective neurological and neurophysiological findings of nerve deficit remained unchanged. There was no progress of neuropathy findings during the follow-up time. Our interpretation of the results is that the remaining neuropathy signs after treatment of ACA are neurological sequelae and not manifestations of persisting Borrelia infection.
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Acrodermatitis Chronica Atrophicans histopathologic findings and clinical correlations in 111 cases
Acta Dermato-venereologica, 1998Co-Authors: Eva Brehmerandersson, Anders Hovmark, Eva ÅsbrinkAbstract:We studied 111 consecutive, untreated and serologically confirmed patients with Acrodermatitis Chronica Atrophicans. Emphasis was on the histopathologic patterns of erythematous and fibrous lesions, and on an assay used to correlate histopathologic findings with such clinical features as fibrous nodules, ulnar bands and the pain reaction allodynia. There was a significant correlation between allodynia and signs of marked inflammation, but not between allodynia and neural and perineural cell infiltrates or fibrosis. Moreover, there was no significant correlation between serum IgG titers to Borrelia and the density of inflammatory cell infiltrates or the proportion of plasma cells in tissue. Histopathologic examination did not reveal any important differences between fibrous nodules, ulnar bands and sclerodermatous lesions. The histopathologic pattern is not diagnostic per se, but characteristic enough to alert the experienced pathologist.
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peripheral neuropathy in Acrodermatitis Chronica Atrophicans a late borrelia manifestation
Acta Neurologica Scandinavica, 1997Co-Authors: E Kindstrand, Anders Hovmark, B Y Nilsson, R Pirskanen, Eva ÅsbrinkAbstract:Clinical and/or neurophysiological signs of peripheral neuropathy were found in 64% of 63 consecutive untreated patients with the late borrelial manifestation Acrodermatitis Chronica Atrophicans (ACA). The neuropathy frequency was significantly higher in the patients than in 30 age- and sex-matched control persons of whom 27% had neuropathy findings. The most common neuropathy in ACA was a symmetric distal sensory polyneuropathy. In a subgroup of patients with localized or asymmetric neuropathy, the changes were found more often in extremities with than without visible ACA lesions. Neuropathy symptoms, most often pain and/or paresthesia, were present in 64% of the patients, compared to in 13% of the control persons. Thus, both symptoms and signs of neuropathy were significantly more frequent in patients with untreated ACA than in control subjects.
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changes in borrelia burgdorferi specific serum igg antibody levels in patients treated for Acrodermatitis Chronica Atrophicans
Acta Dermato-venereologica, 1994Co-Authors: I Olsson, Eva Åsbrink, M Von Stedingk, L V Von StedingkAbstract:The kinetics of Borrelia burgdorferi-specific serum IgG antibody values in 74 patients treated for Acrodermatitis Chronica Atrophicans was analysed by means of enzyme-linked immunosorbent assay. At the last clinical control, there had been no clinical signs of active infection. The serological follow-up time ranged from 12 months to 5 1/2 years (median 2 years and 1 month). In 68 (92%) of the 74 patients, a significant decrease of the specific antibody values was found within 3 years after the initiation of therapy. In 53 (72%) of the patients, this decrease was found within 15 months. Most of the patients remained seropositive during the follow-up period. The results show that a significant decline of the levels of serum IgG antibodies to Borrelia burgdorferi can be expected in the majority of patients who do not exhibit clinical evidence of persistent infection after antibiotic treatment of Acrodermatitis Chronica Atrophicans.
Franc Strle - One of the best experts on this subject based on the ideXlab platform.
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Acrodermatitis Chronica Atrophicans clinical and microbiological characteristics of a cohort of 693 slovenian patients
Journal of Internal Medicine, 2021Co-Authors: Katarina Ogrinc, Vera Maraspin, Eva Ruzicsabljic, Lara Lusa, Cerar T Kisek, Franc StrleAbstract:BACKGROUND Information on large groups of patients with Acrodermatitis Chronica Atrophicans (ACA) is limited. METHODS We assessed clinical and microbiological characteristics of patients with ACA diagnosed at a single medical centre and compared findings in periods 1991-2004 vs. 2005-2018. The cohort is representative of Slovenian ACA patients. RESULTS We assessed 693 patients: 461 females and 232 males, with median age of 64 years. Median duration of ACA before diagnosis was 12 months. In all but 2 patients, the skin lesions were located on extremities, more often on the lower (70.0%) than the upper (45.2%), bilaterally in 42.4%. Reddish-blue discoloration, swelling, thinning and wrinkling of skin were present in 95.2%, 28.1%, 46.4% and 20.5% of patients, respectively. Overall, 64.4% of patients reported constitutional symptoms, 23.1% had local symptoms, and 20.8% had symptoms/signs of peripheral neuropathy. Nodules, arthritis, joint deformity, muscle atrophy and paresis were rare (<3%). Borreliae were isolated from 200/664 (30.1%) skin samples; 92.8% were Borrelia afzelii. B. garinii and B. burgdorferi s.s. were more often isolated from the skin of male patients (OR = 4.17) and from those with arthropathy (OR = 11.74). Patients included in the more recent period were older, complained less often of constitutional symptoms but more often of local symptoms, and more often had local swelling but less often skin atrophy and bilateral involvement, probably as a consequence of earlier diagnosis. CONCLUSIONS ACA, typically caused by B. afzelii, usually affects older women. Clinical presentation depends on the duration of illness and probably on the Borrelia species causing the disease.
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Acrodermatitis Chronica Atrophicans in children: Report on two cases and review of the literature.
Ticks and Tick-borne Diseases, 2019Co-Authors: Vera Maraspin, Tatjana Mrvič, Eva Ružić-sabljić, Vesna Jurčić, Franc StrleAbstract:Abstract Acrodermatitis Chronica Atrophicans is a late manifestation of European Lyme borreliosis and is characterized by high levels of borrelial IgG antibodies, slowly expanding skin redness usually beginning on distal parts of extremities, and corresponding histologic findings. It very rarely develops in children. The main prerequisite for the diagnosis is clinical suspicion. In the present article we report on two children with Acrodermatitis Chronica Atrophicans and on the findings of a PubMed literature search on Acrodermatitis Chronica Atrophicans in childhood, published in the past three decades.
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isolation of borrelia burgdorferi sensu lato from blood of adult patients with borrelial lymphocytoma lyme neuroborreliosis lyme arthritis and Acrodermatitis Chronica Atrophicans
Infection, 2011Co-Authors: Vera Maraspin, Eva Ruzicsabljic, Stanka Lotricfurlan, Katarina Ogrinc, Franc StrleAbstract:Reports on patients with European Lyme borreliosis in whom borreliae were isolated from the blood are rare and nearly exclusively limited to those with solitary or multiple erythema migrans. Here we report on patients with other manifestations of Lyme borreliosis in whom borreliae were isolated from their blood. This is a retrospective review of the medical files of patients diagnosed with borrelial lymphocytoma, Lyme neuroborreliosis, Lyme arthritis and Acrodermatitis Chronica Atrophicans at the Department of Infectious Diseases of the UMC Ljubljana, Slovenia, for whom a borrelia blood culture was ordered. The clinical features of patients whose blood culture tested positive for Borrelia burgdorferi sensu lato were reviewed, and the association between the proportion of patients with a positive blood culture and various clinical manifestations was examined. Borrelia burgdorferi sensu lato was isolated from the blood of 1/53 (1.9%) patients with borrelial lymphocytoma, 6/176 (3.4%) patients with Lyme neuroborreliosis, 1/13 (7.7%) patients with Lyme arthritis, and 3/200 (1.5%) patients with Acrodermatitis Chronica Atrophicans. The time interval from the onset of symptoms attributed to Lyme borreliosis and the blood culture ranged from 1 day to >2 years (median 3.5 weeks). At the time of the blood culture, erythema migrans was present in 4/11 (36.4%) borrelia blood culture-positive patients, i.e. in the patient with borrelial lymphocytoma, the patient with Lyme arthritis and the 2/6 patients with Lyme neuroborreliosis. Only two of these 11 (18.2%) patients had fever at the time of the blood culture. In European patients with Lyme borreliosis, borreliae can be cultured from the blood not only early in the course of the disease but also occasionally later during disease progression.
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isolation of borrelia burgdorferi sensu lato from a fibrous nodule in a patient with Acrodermatitis Chronica Atrophicans
Wiener Klinische Wochenschrift, 2002Co-Authors: Vera Maraspin, Eva Ruzicsabljic, Franc StrleAbstract:A 66-year-old woman presented with a 2-year history of Acrodermatitis chonica Atrophicans of her left hand and associated fibrous nodules. In addition to skin changes she experienced profound fatigue, and pains and swelling of the left elbow and dorsum of the left hand. On clinical examination, typical livid-red discoloration of the skin distally from the left elbow was evident with atrophy on the dorsum of the hand. Nodules with diameters from 0.5 to 2 cm were present around the olecranon and along the ulnar region. The indirect immunofluorescent assay (IFA) without absorption in serum revealed negative borrelial IgM and positive IgG (1:512) antibody titres. Histological findings on tissue specimens were compatible with Acrodermatitis Chronica Atrophicans and fibrous nodule tissue, respectively. Cultures in MKP medium of biopsy specimens from the involved skin and from one of the nodules were positive. Both isolates were identified as B. afzelii with concordant protein and plasmid profiles. The patient received a 3-week course of ceftriaxone (2 g daily, i.v.). Her condition progressively improved: pains and swelling vanished by the end of treatment, fibrous nodules diminished and skin lesions gradually began to fade. According to a MEDLINE literature search this is the first report of the isolation of B. burgdorferi sensu lato from a fibrous nodule in a patient with Acrodermatitis Chronica Atrophicans.
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identification of three species of borrelia burgdorferi sensu lato b burgdorferi sensu stricto b garinii and b afzelii among isolates from Acrodermatitis Chronica Atrophicans lesions
Journal of Investigative Dermatology, 1998Co-Authors: Roger N Picken, Vera Maraspin, Franc Strle, Maria M Picken, Eva Ruzicsabljic, Stanka Lotricfurlan, Joze CimpermanAbstract:In Europe, at least three species of Borrelia are known to be causative agents of Lyme borreliosis: B. burgdorferi sensu stricto, B. garinii, and B. afzelii. Observable differences in the molecular characteristics of the three species have led to speculation that they may also differ in their pathogenic potential and/or tissue tropisms. Several studies have found an association between the chronic skin manifestation of Lyme borreliosis, Acrodermatitis Chronica Atrophicans, and infection by B. afzelii. We sought to find further evidence for such a correlation by studying the genetic profiles of 22 strains of B. burgdorferi sensu lato derived from 21 patients who presented to the University Medical Center, Ljubljana, Slovenia between 1992 and 1995. Strains were isolated in culture from skin biopsies of Acrodermatitis Chronica Atrophicans lesions; in the case of one patient two separate Acrodermatitis Chronica Atrophicans lesions were cultured. All 21 patients had clinically typical lesions with "classic" histopathology and high IgG antibody titers to B. burgdorferi sensu lato. Strains were characterized and typed by 16S ribosomal RNA-specific polymerase chain reaction and determination of their large restriction fragment patterns using pulsed-field gel electrophoresis of MluI-digested genomic DNA. Of the 22 isolates studied, 17 possessed the highly conserved MLa1 pattern characteristic of B. afzelii. The remaining five isolates possessed large restriction fragment patterns that were typical of B. garinii (MLg2, four isolates from three patients) and B. burgdorferi sensu stricto (MLb2, one isolate). The results of 16S ribosomal RNA-specific polymerase chain reaction were concordant with these species designations. These data show that B. afzelii is the predominant, but not the exclusive, etiologic agent of Acrodermatitis Chronica Atrophicans.
Vera Maraspin - One of the best experts on this subject based on the ideXlab platform.
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Acrodermatitis Chronica Atrophicans clinical and microbiological characteristics of a cohort of 693 slovenian patients
Journal of Internal Medicine, 2021Co-Authors: Katarina Ogrinc, Vera Maraspin, Eva Ruzicsabljic, Lara Lusa, Cerar T Kisek, Franc StrleAbstract:BACKGROUND Information on large groups of patients with Acrodermatitis Chronica Atrophicans (ACA) is limited. METHODS We assessed clinical and microbiological characteristics of patients with ACA diagnosed at a single medical centre and compared findings in periods 1991-2004 vs. 2005-2018. The cohort is representative of Slovenian ACA patients. RESULTS We assessed 693 patients: 461 females and 232 males, with median age of 64 years. Median duration of ACA before diagnosis was 12 months. In all but 2 patients, the skin lesions were located on extremities, more often on the lower (70.0%) than the upper (45.2%), bilaterally in 42.4%. Reddish-blue discoloration, swelling, thinning and wrinkling of skin were present in 95.2%, 28.1%, 46.4% and 20.5% of patients, respectively. Overall, 64.4% of patients reported constitutional symptoms, 23.1% had local symptoms, and 20.8% had symptoms/signs of peripheral neuropathy. Nodules, arthritis, joint deformity, muscle atrophy and paresis were rare (<3%). Borreliae were isolated from 200/664 (30.1%) skin samples; 92.8% were Borrelia afzelii. B. garinii and B. burgdorferi s.s. were more often isolated from the skin of male patients (OR = 4.17) and from those with arthropathy (OR = 11.74). Patients included in the more recent period were older, complained less often of constitutional symptoms but more often of local symptoms, and more often had local swelling but less often skin atrophy and bilateral involvement, probably as a consequence of earlier diagnosis. CONCLUSIONS ACA, typically caused by B. afzelii, usually affects older women. Clinical presentation depends on the duration of illness and probably on the Borrelia species causing the disease.
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Acrodermatitis Chronica Atrophicans in children: Report on two cases and review of the literature.
Ticks and Tick-borne Diseases, 2019Co-Authors: Vera Maraspin, Tatjana Mrvič, Eva Ružić-sabljić, Vesna Jurčić, Franc StrleAbstract:Abstract Acrodermatitis Chronica Atrophicans is a late manifestation of European Lyme borreliosis and is characterized by high levels of borrelial IgG antibodies, slowly expanding skin redness usually beginning on distal parts of extremities, and corresponding histologic findings. It very rarely develops in children. The main prerequisite for the diagnosis is clinical suspicion. In the present article we report on two children with Acrodermatitis Chronica Atrophicans and on the findings of a PubMed literature search on Acrodermatitis Chronica Atrophicans in childhood, published in the past three decades.
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pathogenetic implications of the age at time of diagnosis and skin location for Acrodermatitis Chronica Atrophicans
Ticks and Tick-borne Diseases, 2017Co-Authors: Katarina Ogrinc, Vera Maraspin, Eva Ruzicsabljic, Stanka Lotricfurlan, Joze Cimperman, Gary P Wormser, Paul Visintainer, Petra Bogovic, Tereza Rojko, Dasa StupicaAbstract:Abstract Background The pathogenesis of Acrodermatitis Chronica Atrophicans (ACA) is not well understood. Objective The purpose of this study was to gain a better understanding of ACA by utilizing a large data set of adult Slovenian patients with Lyme borreliosis. Methods The age of 590 ACA patients was compared with that of patients with other manifestations of Lyme borreliosis. The location of the ACA lesion on the body was compared with that of erythema migrans (EM). Results Patients diagnosed with ACA were on average 14.3 years older than patients with EM (p Conclusions ACA is more likely to be diagnosed in older individuals than any other manifestation of Lyme borreliosis. ACA is more likely than EM to be localized anatomically to the extremities. Available data favor the hypothesis that ACA occurs most often on the extremities of older individuals because of predisposing age-related anatomic or physiologic changes, but more data are needed to define the latency period and other aspects of the pathogenesis of this skin condition.
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isolation of borrelia burgdorferi sensu lato from blood of adult patients with borrelial lymphocytoma lyme neuroborreliosis lyme arthritis and Acrodermatitis Chronica Atrophicans
Infection, 2011Co-Authors: Vera Maraspin, Eva Ruzicsabljic, Stanka Lotricfurlan, Katarina Ogrinc, Franc StrleAbstract:Reports on patients with European Lyme borreliosis in whom borreliae were isolated from the blood are rare and nearly exclusively limited to those with solitary or multiple erythema migrans. Here we report on patients with other manifestations of Lyme borreliosis in whom borreliae were isolated from their blood. This is a retrospective review of the medical files of patients diagnosed with borrelial lymphocytoma, Lyme neuroborreliosis, Lyme arthritis and Acrodermatitis Chronica Atrophicans at the Department of Infectious Diseases of the UMC Ljubljana, Slovenia, for whom a borrelia blood culture was ordered. The clinical features of patients whose blood culture tested positive for Borrelia burgdorferi sensu lato were reviewed, and the association between the proportion of patients with a positive blood culture and various clinical manifestations was examined. Borrelia burgdorferi sensu lato was isolated from the blood of 1/53 (1.9%) patients with borrelial lymphocytoma, 6/176 (3.4%) patients with Lyme neuroborreliosis, 1/13 (7.7%) patients with Lyme arthritis, and 3/200 (1.5%) patients with Acrodermatitis Chronica Atrophicans. The time interval from the onset of symptoms attributed to Lyme borreliosis and the blood culture ranged from 1 day to >2 years (median 3.5 weeks). At the time of the blood culture, erythema migrans was present in 4/11 (36.4%) borrelia blood culture-positive patients, i.e. in the patient with borrelial lymphocytoma, the patient with Lyme arthritis and the 2/6 patients with Lyme neuroborreliosis. Only two of these 11 (18.2%) patients had fever at the time of the blood culture. In European patients with Lyme borreliosis, borreliae can be cultured from the blood not only early in the course of the disease but also occasionally later during disease progression.
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isolation of borrelia burgdorferi sensu lato from a fibrous nodule in a patient with Acrodermatitis Chronica Atrophicans
Wiener Klinische Wochenschrift, 2002Co-Authors: Vera Maraspin, Eva Ruzicsabljic, Franc StrleAbstract:A 66-year-old woman presented with a 2-year history of Acrodermatitis chonica Atrophicans of her left hand and associated fibrous nodules. In addition to skin changes she experienced profound fatigue, and pains and swelling of the left elbow and dorsum of the left hand. On clinical examination, typical livid-red discoloration of the skin distally from the left elbow was evident with atrophy on the dorsum of the hand. Nodules with diameters from 0.5 to 2 cm were present around the olecranon and along the ulnar region. The indirect immunofluorescent assay (IFA) without absorption in serum revealed negative borrelial IgM and positive IgG (1:512) antibody titres. Histological findings on tissue specimens were compatible with Acrodermatitis Chronica Atrophicans and fibrous nodule tissue, respectively. Cultures in MKP medium of biopsy specimens from the involved skin and from one of the nodules were positive. Both isolates were identified as B. afzelii with concordant protein and plasmid profiles. The patient received a 3-week course of ceftriaxone (2 g daily, i.v.). Her condition progressively improved: pains and swelling vanished by the end of treatment, fibrous nodules diminished and skin lesions gradually began to fade. According to a MEDLINE literature search this is the first report of the isolation of B. burgdorferi sensu lato from a fibrous nodule in a patient with Acrodermatitis Chronica Atrophicans.
Peter Erb - One of the best experts on this subject based on the ideXlab platform.
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lymphoproliferative responses to borrelia burgdorferi in patients with erythema migrans Acrodermatitis Chronica Atrophicans lymphadenosis benigna cutis and morphea
Archives of Dermatology, 1995Co-Authors: Stanislaw A Buechner, Peter Itin, Stephan Lautenschlager, Andreas J Bircher, Peter ErbAbstract:Background and Design: Specific humoral and cell-mediated immune responses play an important role in the pathogenesis of Lyme borreliosis. Several previous studies demonstrated that a specific cellular immune response to Borrelia burgdorferi can occur independently of a diagnostic humoral response. Little is known about T-cell reactivities against B burgdorferi in early and late cutaneous manifestations of Lyme borreliosis. We studied the lymphoproliferative response of peripheral blood mononuclear cells to B burgdorferi antigen from 99 patients (25 with erythema migrans, 16 with Acrodermatitis Chronica Atrophicans, 13 with lymphadenosis benigna cutis, and 45 with localized scleroderma) and 21 control subjects. The results are expressed as a stimulation index (SI) (mean count per minute of triplicate cultures with stimulant divided by mean count per minute without stimulant). The serum samples from all patients and control subjects were tested for antibodies to B burgdorferi by indirect immunofluorescence assay. Results: The 21 healthy seronegative controls had an SI of 3.3±2.0 (mean±SD). Compared with that of control subjects, the SIs were significantly elevated in patients with erythema migrans (9.8±9.1), Acrodermatitis Chronica Atrophicans (11.8±8.2), and lymphadenosisbenigna cutis (7.2±6.2). The 45 patients with localized scleroderma had elevated proliferative responses, with an SI of 6.5±7.3, but these responses did not significantly differ from those of controls. Elevated titers of antibodies to B burgdorferi were present in six (24%) of 25 patients with erythema migrans, five (38%) of 13 patients with lymphadenosis benigna cutis, and 13 (29%) of 45 patients with localized scleroderma. All 16 patients with Acrodermatitis Chronica Atrophicans had markedly elevated antibody titers. Conclusions: Our findings show that a significant lymphoproliferative response to B burgdorferi occurs in the majority of patients with cutaneous manifestations of Lyme borreliosis. The lymphocyte proliferation assay may be of diagnostic value in patients in whom Lyme borreliosis is strongly clinically suspected and who have nondiagnostic levels of antibodies against B burgdorferi. (Arch Dermatol. 1995;131:673-677)
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Acrodermatitis Chronica Atrophicans a chronic t cell mediated immune reaction against borrelia burgdorferi clinical histologic and immunohistochemical study of five cases
Journal of The American Academy of Dermatology, 1993Co-Authors: Stanislaw A Buechner, Theo Rufli, Peter ErbAbstract:Background: Acrodermatitis Chronica Atrophicans (ACA) is a late manifestation of infection caused by Borrelia burgdorferi. Objective: Our purpose was to study the clinical, histopathologic, and immunohistochemical findings in patients with ACA to understand better the pathogenesis of the disease. Methods: Five patients were studied. Skin biopsy specimens were obtained from active lesions for histologic and immunohistochemical studies. Results: Clinical lesions included an initial erythematous discoloration in one patient and violaceous infiltrated plaques and nodules in four patients, three of whom also had late atrophic lesions. Biopsy specimens showed a dermal perivascular and interstitial lymphocytic infiltrate with plasma cells. There was a predominance of CD3+, CD4+ T cells in the dermal infiltrate. B cells were present in three patients. The dermal infiltrate showed an intense expression of lymphocyte function-associated antigen. The intercellular adhesion molecule type 1 was expressed on endothelial cells, perivascular mononuclear cells, and focally on basal ke-ratinocytes. Conclusion: Our findings suggest that a chronic, T-cell-mediated immune reaction against B. burgdorferi is involved in the pathogenesis of ACA.
Matthias Volkenandt - One of the best experts on this subject based on the ideXlab platform.
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Acrodermatitis Chronica Atrophicans in an 11 year old girl
British Journal of Dermatology, 1996Co-Authors: R R Muellegger, Matthias Volkenandt, H. P. Soyer, E M Schluepen, M M Millner, Helmut KerlAbstract:We report a case of Acrodermatitis Chronica Atrophicans in an 11-year-old girl living in an area endemic for Lyme borreliosis. The diagnosis was first made on the basis of clinical, histopathological and serological findings, Moreover, Borrelia burgdorferi-specific DNA was amplified from lesional skin by polymerase chain reaction, Intravenous treatment with ceftriaxone (2 g once daily) for 2 weeks was initiated, The skin changes clearly responded to the therapy, and Borrelia burgdorferi-specific gene segments were no longer detectable by polymerase chain reaction. This is the first report of molecular-proven Acrodermatitis Chronica Atrophicans in childhood, The occurrence of this late skin manifestation of Lyme borreliosis in children is reviewed.
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No Evidence for Borrelia burgdorferi-Specific DNA in Lesions of Localized Scleroderma
The Journal of investigative dermatology, 1995Co-Authors: Ralf Wienecke, Natalie Zöchling, Uwe Neubert, Eva-maria Schlüpen, Michael Meurer, Matthias VolkenandtAbstract:A possible association of Borrelia burgdorferi with localized scleroderma is currently the focus of intense research and discussion. Skin biopsies from 30 patients with localized scleroderma (28 of the plaque type/morphea; two linear scleroderma) were analyzed for the presence of Borrelia burgdoferi using three different polymerase chain reaction systems for amplification of segments of borrelial genes. Formalin-fixed, paraffin-embedded biopsies of 14 patients and fresh-frozen, cryo-conserved biopsies of 16 patients with localized scleroderma were obtained. Lesions of all patients showed clear signs of scleroderma and disease progression at the time of biopsy. Fresh-frozen as well as formalin-fixed biopsies from patients with erythema migrans or Acrodermatitis Chronica Atrophicans were used as positive controls. With all three polymerase chain reaction systems, borrelial DNA was detected in none of the 30 specimens of localized scleroderma. In contrast, with one polymerase chain reaction system, Borrelia burgdorferi -specific DNA was found in 24 of 27 frozen biopsies from patients with erythema migrans and in all 5 analyzed frozen biopsies of patients with Acrodermatitis Chronica Atrophicans. In approximately half of the paraffin-embedded biopsies from patients with erythema migrans (nine of 23) and Acrodermatitis Chronica Atrophicans (13 of 27), Borrelia burgdorferi specific DNA was identified. These results question the association of localized scleroderma with known subtypes of Borrelia burgdorferi .
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Molecular Subtyping of Borrelia burgdorferi in Erythema Migrans and Acrodermatitis Chronica Atrophicans
Journal of Investigative Dermatology, 1994Co-Authors: Ralf Wienecke, Natalie Zöchling, Uwe Neubert, Eva-maria Schlüpen, Michael Meurer, Matthias VolkenandtAbstract:Recently, three subtypes of Borrelia burgdorferi have been identified: Borrelia burgdorferi sensu stricto, Borrelia garinii, and the VS 461 group of Borrelia burgdorferi. These subtypes differ by nucleotide sequence variations within several Borrelia burgdorferi specific genes and most likely by their pathogenetic potential. To assess whether different subtypes of Borrelia burgdorferi might be associated with different cutaneous manifestations and clinial courses of Lyme disease, lesional skin biopsies from 35 patients with erythema migrans and 18 patients with Acrodermatitis Chronica Atrophicans were analyzed. A Borrelia burgdorgeri specific gene segment encoding a 26-kD protein with subtype specific nucleotide sequence variations was amplified by a nested polymerase chain reaction technique. For molecular subtyping, the products were transcribed into complementary RNA. Upon polyacryl-amide gel electrophoresis, complementary RNA molecules separate into several metastable conformational forms resulting in patterns of bands highly specific for the nucleotide sequence of the transcribed molecules. In biopsy specimens of erythema migrans, the VS 461 subtype was detected in 28 if 35 abd the Borrelia garinii subtype in six of 35 cases. In one of 35 cases of erythema migrans Borrelia burgdorferi sensu stricto as well as Borrelia garinii was detected. In contrast, in all 18 biopsies of Acrodermatitis Chronica Atrophicans, only the VS 461 subtype was identified. This subtype is rarely found in the USA, where Acrodermatitis Chronica Atrophicans is almost unknown. These data indicate that Acrodermatitis Chronica Atrophicans might be closely associated with the VS 461 group of Borrelia burgdorferi.
