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Skin infections
Published in Rashmi Sarkar, Anupam Das, Sumit Sethi, Concise Dermatology, 2021
Shankila Mittal, Rashmi Sarkar
This has been described in several areas of Europe, including the UK, and in the United States. It is a multi-system disease with arthropathy, cardiovascular, and central nervous components, as well as systemic upset. The skin may be involved in the early stages and show an erythematous ring that expands outwards (erythema chronicum migrans). In late stages, skin atrophy may be seen (acrodermatitis chronica atrophicans), or fibrosis in a morphoea-like condition. Diagnosis is made by identification of the organism in the tissues or by detection of antibodies in the blood.
Skin infections
Published in Ronald Marks, Richard Motley, Common Skin Diseases, 2019
Lyme disease is caused by the Borrelia burgdorferi microorganism, which is spread by the bite of a tick and has been described in several areas of Europe, including the UK, and in the USA. The disorder is multi-system in that there may be arthropathy, cardiovascular and central nervous components, as well as systemic upset. The skin may be involved in the early stages and show an erythematous ring that expands outwards (erythema chronicum migrans). Later, skin atrophy may be seen (acrodermatitis chronica atrophicans), or fibrosis in a morphoea-like condition. Diagnosis is made by identification of the organism in the tissues or by detection of antibodies in the blood.
Infections and infestations affecting the nail
Published in Eckart Haneke, Histopathology of the NailOnychopathology, 2017
In acrodermatitis chronica atrophicans, usually only one extremity is affected with a bluish-red discoloration and a peculiarly soft skin that gradually turns into atrophy with cigarette-paper like atrophy. The epidermis is atrophic with loss of the rete ridges, a thin granular layer, but nevertheless often a hyperkeratosis is seen. The papillary dermis may be edematous. A band-like lymphocytic infiltrate often containing considerable numbers of plasma cells may develop in the upper dermis that rarely may become lichenoid. In the dermis the infiltrate is seen around vessels, sweat glands, and follicles and typically contains many plasma cells (Figure 4.8). Pseudorosettes defined by histiocytes completely surrounding collagen bundles may be observed.164 The collagen fibers may be destroyed and elastic fibers disappear. In the late stage, epidermal and dermal atrophy prevail.
Serological testing for Lyme Borreliosis in general practice: A qualitative study among Dutch general practitioners
Published in European Journal of General Practice, 2020
Tjitske M. Vreugdenhil, Mariska Leeflang, Joppe W. Hovius, Hein Sprong, Jettie Bont, C. W. Ang, Jeanette Pols, Henk C. P. M. Van Weert
Diagnosis of LB is straightforward in patients with classic EM, as the typical annular rash is pathognomonic. Recognising disseminated LB is more difficult because it may mimic other more frequently occurring diseases, for example, Bell’s palsy. Diagnosis of disseminated LB is based on clinical symptoms and a history of a tick bite, confirmed by serological testing. The accuracy of the commonly used serological tests depends on the stage of the disease. The sensitivity ranges from approximately 50% in patients with EM to 77% in patients with neuroborreliosis and 97% in patients with acrodermatitis chronica atrophicans [6]. The specificity is approximately 80% in clinical practice and 95% in healthy controls, due to cross-reactivity and persisting antibodies after a resolved Borrelia infection. Discrimination between active and resolved infections based on test results may be difficult [8].
Diagnosis and management of Lyme neuroborreliosis
Published in Expert Review of Anti-infective Therapy, 2018
Like syphilis, untreated Lyme borreliosis can cause a persisting infection in some, but by no means all, infected individuals. While longitudinal studies of patients identified before this was recognized as an antibiotic-responsive disease suggest that symptomatic infection typically resolves even without treatment, resolution of the infection is clearly more rapid and more consistent with antibiotics. Interestingly, the manifestations of prolonged infection do differ between US and European strains. Untreated, B burgdorferi sensu stricto may cause a relapsing large joint arthritis – typically affecting one joint at a time. Each spontaneously becomes painful, red, and swollen, then resolves over weeks, only to recur in a different large joint weeks or months later. Although ‘rheumatism’ was recognized in the early European literature [4], this typically does not evolve to frank arthritis. In contrast, European strains may cause acrodermatitis chronica atrophicans (ACA) – a peculiar thinning of the skin, typically of one limb, with reddish blue discoloration, evolving to paper-thin skin. This has never been reported in patients infected in the US.
Laboratory diagnosis of Lyme borreliosis: Current state of the art and future perspectives
Published in Critical Reviews in Clinical Laboratory Sciences, 2018
Benedikt Lohr, Volker Fingerle, Douglas E. Norris, Klaus-Peter Hunfeld
The infection may go without signs and symptoms, but in clinically apparent cases, typical symptoms associated with infection (Table 1) include erythema migrans (EM), neurological manifestations (e.g. poly-meningo-radiculo-neuritis, also named M. Bannwarth), Lyme arthritis (LA), and acrodermatitis chronica atrophicans (ACA), which, together with some other rare manifestations, were well recognized in Europe [11–15] decades before the final discovery of the causative pathogen, B. burgdorferi s.l. The causative agent of LB, however, remained a mystery until the discovery of spirochetal bacteria in the midgut of ticks collected at Long Island, NY, in 1982 by the Swiss-borne entomologist, Willy Burgdorfer [16]. The subsequent epidemiological and laboratory investigations led to the establishment of LB as a new multi-systemic infectious disease entity, one of the most important biomedical discoveries of the twentieth century [17]. Over the last few decades, tremendous scientific progress has resulted in better understanding of the clinical syndromes of LB, provided deeper insights into the pathophysiology of the infection, continually improved laboratory diagnostics, and established well-recognized treatment options. Nevertheless, LB, like syphilis, remains a chameleon of clinical medicine [18] for inexperienced clinicians and results in numerous problems, especially in the direct and indirect laboratory diagnosis of the pathogen. This review aims to present the current state of the art for the laboratory diagnosis of LB, including a discussion on the current pitfalls and limitations, as well as the future prospects in this challenging area of modern laboratory medicine.