Solitary erythema migrans in Georgia and South Carolina

Arch Dermatol. 1999 Nov;135(11):1317-26. doi: 10.1001/archderm.135.11.1317.


Objective: To evaluate the incidence of Borrelia burgdorferi infection in humans with erythema migrans (EM) in 2 southeastern states.

Design: Prospective case series.

Setting: Family medicine practice at academic center.

Patients: Twenty-three patients with solitary EM lesions meeting Centers for Disease Control and Prevention (CDC) criteria for Lyme disease.

Interventions: Patients underwent clinical and serologic evaluation for evidence of B burgdorferi infection. All lesions underwent photography, biopsy, culture and histopathologic and polymerase chain reaction analysis for B burgdorferi infection. Patients were treated with doxycycline hyclate and followed up clinically and serologically.

Main outcome measures: Disappearance of EM lesions and associated clinical symptoms in response to antibiotic therapy; short-term and follow-up serologic assays for diagnostic antibody; growth of spirochetes from tissue biopsy specimens in Barbour-Stoenner-Kelly II media; special histopathologic stains of tissue for spirochetes; and polymerase chain reaction assays of tissue biopsy specimens for established DNA sequences of B burgdorferi.

Results: The EM lesions ranged from 5 to 20 cm (average, 9.6 cm). Five patients (22%) had mild systemic symptoms. All lesions and associated symptoms resolved with antibiotic therapy. Overall, 7 patients (30%) had some evidence of B burgdorferi infection. Cultures from 1 patient (4%) yielded spirochetes, characterized as Borrelia garinii, a European strain not known to occur in the United States; 3 patients (13%) demonstrated spirochetallike forms on special histologic stains; 5 patients (22%) had positive polymerase chain reaction findings with primers for flagellin DNA sequences; and 2 patients (9%) were seropositive for B burgdorferi infection using recommended 2-step CDC methods. No late clinical sequelae were observed after treatment.

Conclusions: The EM lesions we observed are consistent with early Lyme disease occurring elsewhere, but laboratory confirmation of B burgdorferi infection is lacking in at least 16 cases (70%) analyzed using available methods. Genetically variable strains of B burgdorferi, alternative Borrelia species, or novel, uncharacterized infectious agents may account for most of the observed EM lesions.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Anti-Bacterial Agents / therapeutic use
  • Antibodies, Bacterial / blood
  • Biopsy
  • Borrelia / classification
  • Borrelia burgdorferi Group / genetics
  • Borrelia burgdorferi Group / growth & development
  • Borrelia burgdorferi Group / immunology
  • Coloring Agents
  • DNA, Bacterial / analysis
  • DNA, Bacterial / genetics
  • Doxycycline / therapeutic use
  • Erythema Chronicum Migrans / diagnosis*
  • Erythema Chronicum Migrans / drug therapy
  • Erythema Chronicum Migrans / microbiology
  • Female
  • Flagellin / analysis
  • Flagellin / genetics
  • Follow-Up Studies
  • Georgia
  • Humans
  • Incidence
  • Lyme Disease / diagnosis*
  • Male
  • Middle Aged
  • Photography
  • Polymerase Chain Reaction
  • Prospective Studies
  • South Carolina


  • Anti-Bacterial Agents
  • Antibodies, Bacterial
  • Coloring Agents
  • DNA, Bacterial
  • Flagellin
  • Doxycycline