Untreated erythema migrans may lead to B. burgdorferi sensu lato bacteremia

Arnež M. Pediatr Infect Dis J. 2011;doi:10.1097/INF.0b013e318225b8c3.

Issue: September 2011

Bacteremia caused by Borrelia burgdorferi sensu lato was found in children from Slovenia with solitary and multiple erythema migrans that were left untreated, according to a recent report.

B. burgdorferi sensu lato bacteremia was detected in 11.4% of Slovenian children with untreated erythema migrans as early as the day of appearance of erythema migrans and as late as 39 days after the appearance of skin lesions, according to a study.

A total of 1,164 patients with previously untreated solitary erythema migrans (SEM) and multiple erythema migrans (MEM) had blood drawn and were treated with antibiotics that are recommended in Slovenia for treatment of early Lyme disease.

“Blood cultures were more often positive in patients with MEM (15.8%) than in patients with SEM (7.6%),” the researchers wrote. “The risk for B. burgdorferi sensu lato bacteremia in children with untreated [erythema migrans] can last as long as 39 days after the onset of skin rash.”

Lyme disease is caused by three different Borrelia species in Europe: B. afzelii, B. garinii and B. burgdorferi sensu stricto. Of all the isolates collected, almost all were B. afzelii; B. garinii was found more often in patients with SEM, and B. burgdorferi sensu stricto was not isolated from any patients. Patients with SEM less often reported ring-like skin lesions, but could recall a bite at the site of later erythema migrans. Homogenous red skin lesions were observed in 26% of patients with SEM and 1% of patients with MEM without central clearing, whereas no central blistering was found.

“The typical, clinical sign of early localized Borrelia infection is SEM, whereas MEM is one of the main characteristics of early disseminated infection,” the researchers wrote. “The time point at which hematogenous dissemination occurs is not known.”

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