The full content of Annals is available to subscribers

Subscribe/Learn More  >
Brief Communications |

Comparison of Culture-Confirmed Erythema Migrans Caused by Borrelia burgdorferi sensu stricto in New York State and by Borrelia afzelii in Slovenia

Franc Strle, MD; Robert B. Nadelman, MD; Joze Cimperman, MD; John Nowakowski, MD; Roger N. Picken, PhD; Ira Schwartz, PhD; Vera Maraspin, MD; Maria E. Aguero-Rosenfeld, MD; Shobha Varde, MS; Stanka Lotric-Furlan, MD; and Gary P. Wormser, MD
[+] Article, Author, and Disclosure Information

From the University of Ljubljana, Ljubljana, Slovenia; New York Medical College and Westchester Medical Center, Valhalla, New York; and Rush Medical College, Chicago, Illinois.

Ann Intern Med. 1999;130(1):32-36. doi:10.7326/0003-4819-130-1-199901050-00006
Text Size: A A A

Background: The clinical manifestations of Lyme borreliosis in North America and Europe seem to differ, but a systematic comparison has never been done.

Objective: To compare European and U.S. patients with culture-confirmed erythema migrans.

Design: Prospective, clinical cohort study.

Setting: University medical centers in Westchester County, New York, and Ljubljana, Slovenia.

Patients: 119 U.S. patients with Borrelia burgdorferi sensu stricto infection and 85 Slovenian patients with B. afzelii infection.

Measurements: Interview, physical examination, and laboratory assays.

Results: Compared with Slovenian patients, U.S. patients had erythema migrans for a briefer duration (median duration, 4 days compared with 14 days; P < 0.001) but were more likely to have systemic symptoms (P = 0.01), abnormal findings on physical examination (P < 0.001), and seroreactivity (P < 0.001). Central clearing of erythema migrans lesions was more likely in Slovenian patients (P < 0.001).

Conclusions: Erythema migrans caused by B. afzelii in Slovenia and erythema migrans caused by B. burgdorferi in New York have distinct clinical presentations. Caution should be used when clinical and laboratory experience from one side of the Atlantic is applied to patients on the other.





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.