from: Annals of Internal Medicine--Vol. 114--Number 6--March 15, 1991 pg.
490-498
title: Diagnosis of Lyme Disease Based on Dermatologic Manifestations
authors: Malane, MD, et al
".....The differential diagnosis of erythema
migrans includes cellulitis , tinea, (ringworm) contact dermatitis, fixed drug
reaction. granuloma annulare, reaction to an insect bite, or a Brown recluse
spider bite (48)......"
source: Lyme Disease 1991
Patient/Physician Perspectives from the U.S. and Canada
"....These rashes are rarely painful, as brown recluse spider bites
almost always are, and often itch..."
"......I feel that the best approach in an endemic area would be to assume
that the rash is Lyme and treat accordingly. It's better to err on the
side of overdiagnosis than to miss the diagnosis and have it haunt you
months or years later."
Skin Manifestations of Lyme Disease by John Drulle M.D.
"Since Lyme disease is a widely disseminated, multi-organ system disease,
skin involvement is common, and occurs in about half of those infected.......
"The pathognomonic (diagnostic) rash of early Lyme is called EM(erythema
migrans--in Latin LErythema means redness, and migrans means migratory or
expanding). It usually appears at the site of the tick, flea, fly, or
mosquito bite several days to a year or more later. (It was recently
reported that 18% of the cases of Lyme in Austria are due to bites of
non-tick vectors such as flies and perhaps mosquitos. Borrelia
burgdorferi -Lyme spirochete- has been isolated from these insects.) The
fact that one half of people who develope Lyme do not recall a tick bite
may be partially explained by non-tick vectors. The EM rash is usually
circular or oval, but irregularly shaped rashes are common. They may
spread or enlarge rapidly, but we have seen where pressure on the skin from
a tight garment impedes the progression of the rash causing irregularity of
shape. There may or may not be central clearing, and concentric rings of
different shades are often seen within the rash. There may be necrosis
(death of areas of tissue) or a blue violet shading at the site of the
bite. These rashes are rarely painful, as brown recluse spider bites
almost always are, and often itch. They are usually warm to the touch.
The rash may be completely flat, but occasionally the edges may be elevated
and be scaly or contain vesicular components. Ten variations of the EM
rash have been described by Dr Alan McDonald. Some of these are very
recognizable or "classic" in their appearance, but others may be confused
with other common skin infections such as ringworm, cellulitis, erythema
multiforme, eczema, or hives.
"......I feel that the best approach in an endemic area would be to assume
that the rash is Lyme and treat accordingly. It's better to err on the
side of overdiagnosis than to miss the diagnosis and have it haunt you
months or years later."
" Waiting for other symptoms to develop may delay treatment and result in
persistence of symptoms or even more serious problems in the future.
"........I must note that a treatment effective in one person may not work
in another. This is generally true for any particular symptom of Lyme.
"Another type of chronic Lyme rash we have seen, occurs in some small
children. These tend to be widely disseminated, blotchy plaques, pink in
color. They do not spare the face. They have been seen in children born
with Lyme, especially if the mother was a bit late in pregnancy. These
rashes are usually misdiagnosed as eczema, and they do not respond to
topical or systemic steroids. They do respond quite well to {*filter*}or IV
antibiotics ....
"In summary, I believe the current official description of Lyme skin
manifestations is quite incomplete. We are anxiously awaiting the PCR test
to become more readily available, since I feel that we will find evidence
of active infection in many of these chronic skin rashes."
___________________________
".....Further studies utilizing larger sample sizes, more sensitive testing
measures, or spiders from an area more endemic with B. burgdorferi may further
prove or disprove that spiders are capable of harboring this organism...."
Title: Spiders and Borrelia burgdorferi: no evidence of reservoir occurrence in
central Arkansas.
Authors: Suffridge PJ, Smoller BR, Carrington PR
Source: Int J Dermatol 1999 Apr;38(4):296-7
Organization: Department of Dermatology, University of Arkansas for Medical
Sciences, Little Rock 72205, USA.
Abstract:
BACKGROUND: Although Ixodes ticks are considered the chief vector for Borrelia
burgdorferi in the USA, B. burgdorferi has also been identified in mosquitoes,
horse flies, and deer flies. We examined the possibility of these organisms
being harbored in two species of spider in central Arkansas. METHODS: Ten wolf
spiders (Lycosa gulosa) and two brown recluse spiders (Loxosceles reclusa) were
collected in central Arkansas during early summer and fixed in formalin.
Paraffin-embedded sections of the spiders were examined for spirochetes using
the modified Steiner spirochete staining method and examined for B. burgdorferi
using immunohistochemistry. RESULTS: All 12 spiders from both species were
found to be negative for all spirochetes including B. burgdorferi. CONCLUSIONS:
Spiders in our sample appeared not to harbor B. burgdorferi. Further studies
utilizing larger sample sizes, more sensitive testing measures, or spiders from
an area more endemic with B. burgdorferi may further prove or disprove that
spiders are capable of harboring this organism.
Keywords:
Animal, Antibodies, Bacterial, ANALYSIS, Arkansas, Borrelia burgdorferi,
IMMUNOLOGY, Immunohistochemistry, Lyme Disease, ETIOLOGY, MICROBIOLOGY,
Spiders, CHEMISTRY, MICROBIOLOGY
Language: Eng
Unique ID: 99253864
Spider bite or tick bite