Infection with multiple strains of Borrelia burgdorferi sensu stricto in patients with Lyme disease

Arch Dermatol. 1999 Nov;135(11):1329-33. doi: 10.1001/archderm.135.11.1329.


Objective: To assess human skin biopsy specimens from erythema migrans lesions for the presence of infection with multiple strains of the Lyme disease spirochete, Borrelia burgdorferi.

Design: Skin biopsy specimens were obtained prospectively from patients with erythema migrans. To determine allelic differences and strain identification of B burgdorferi, the biopsy specimens were analyzed by cold single-strand conformation polymorphism of an amplified fragment of the outer surface protein C (ospC) gene. Further single-strand conformation polymorphism patterns of amplified ospC genes from culture isolates were compared with polymerase chain reaction products obtained directly from erythema migrans biopsy specimens.

Setting: A private dermatology office and a university medical center outpatient department.

Patients: Sixteen patients presenting with erythema migrans.

Results: Two of the 16 patients in this cohort were infected with 2 B burgdorferi sensu stricto strains, as evidenced by 2 ospC alleles in their skin biopsy results.

Conclusion: This is the first documented description of the existence of more than a single strain of B burgdorferi sensu stricto in a human specimen.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Alleles
  • Antigens, Bacterial*
  • Bacterial Outer Membrane Proteins / genetics
  • Biopsy
  • Borrelia burgdorferi Group / classification*
  • Borrelia burgdorferi Group / genetics
  • Borrelia burgdorferi*
  • Cohort Studies
  • DNA, Bacterial / analysis
  • DNA, Bacterial / genetics
  • Erythema Chronicum Migrans / microbiology*
  • Gene Expression Regulation, Bacterial
  • Humans
  • Lyme Disease / microbiology*
  • Polymerase Chain Reaction
  • Polymorphism, Single-Stranded Conformational
  • Prospective Studies
  • Sequence Analysis, DNA
  • Skin / microbiology


  • Antigens, Bacterial
  • Bacterial Outer Membrane Proteins
  • DNA, Bacterial
  • OspC protein