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Brief Communication: Hematogenous Dissemination in Early Lyme Disease

Gary P. Wormser, MD; Donna McKenna, NP; Jennafer Carlin, MPH; Robert B. Nadelman, MD; L. Frank Cavaliere, MD; Diane Holmgren, RN; Daniel W. Byrne, MS; and John Nowakowski, MD
[+] Article, Author, and Disclosure Information

From New York Medical College, Valhalla, New York, and Vanderbilt University Medical Center, Nashville, Tennessee.

Disclaimer: The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.

Acknowledgments: The authors thank Lisa Giarratano, Susan Bittker, Denise Cooper, Kathleen O'Keefe, Dennis Liveris, and Ira Schwartz for their assistance.

Grant Support: In part by Cooperative Agreement U50/CCU219613 and in part by Cooperative Agreement U50/CCU219612 from the Centers for Disease Control and Prevention.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Gary P. Wormser, MD, Division of Infectious Diseases, New York Medical College, Munger Pavilion, Room 245, Valhalla, NY 10595; e-mail, mailto:gary_wormser@nymc.edu.

Current Author Addresses: Dr. Wormser, Ms. McKenna, Dr. Nadelman, Ms. Holmgren, and Dr. Nowakowski: Division of Infectious Diseases, New York Medical College, Munger Pavilion Room 245, Valhalla, NY 10595.

Dr. Cavaliere: Division of Rheumatic Diseases, New York Medical College, Munger Pavilion Room G73, Valhalla, NY 10595.

Ms. Carlin: University of California, San Francisco, 1600 Divisadero, Room B-656, San Francisco, CA 94115.

Mr. Byrne: GCRC, AA-3328 MCN, Vanderbilt University, 1161 21st Avenue South, Nashville, TN 37232.

Author Contributions: Conception and design: G.P. Wormser, J. Nowakowski.

Analysis and interpretation of the data: G.P. Wormser, D.W. Byrne, D. McKenna, R.B. Nadelman.

Drafting of the article: G.P. Wormser, R.B. Nadelman.

Critical revision of the article for important intellectual content: G.P. Wormser, R.B. Nadelman, D.W. Byrne, J. Nowakowski.

Final approval of the article: G.P. Wormser, D. McKenna, J. Carlin, R.B. Nadelman, L.F. Cavaliere, D. Holmgren, J. Nowakowski.

Provision of study materials or patients: G.P. Wormser, R.B. Nadelman, J. Nowakowski.

Statistical expertise: D.W. Byrne.

Obtaining of funding: G.P. Wormser, J. Nowakowski.

Administrative, technical, or logistic support: G.P. Wormser, D. McKenna, R.B. Nadelman, L.F. Cavaliere, J. Nowakowski.

Collection and assembly of data: G.P. Wormser, D. McKenna, J. Carlin, L.F. Cavaliere, D. Holmgren, J. Nowakowski.

Ann Intern Med. 2005;142(9):751-755. doi:10.7326/0003-4819-142-9-200505030-00011
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Between 1997 and 2002, high-volume plasma blood cultures were performed for 213 untreated adult patients with erythema migrans. Ninety-three (43.7%) of the patients were found to be spirochetemic. We compared the clinical and laboratory features of the 93 spirochetemic patients with those of the 120 nonspirochetemic patients (Table) evaluated prospectively over the same period.

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Grahic Jump Location
Blood cultures positive for Borrelia burgdorferiaccording to duration of erythema migrans (top) and size of the primary erythema migrans lesion (bottom).

Top. In patients with multiple erythema migrans lesions, duration was based on the number of days from time of onset of the first skin lesion until the blood culture was obtained.  > 0.2, chi-square test for trend. Bottom. In patients with multiple erythema migrans lesions, the size of the largest skin lesion was measured.  = 0.23, chi-square test for trend.

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Summary for Patients

Bloodstream Infection in Patients with Lyme Disease

The summary below is from the full report titled “Brief Communication: Hematogenous Dissemination in Early Lyme Disease.” It is in the 3 May 2005 issue of Annals of Internal Medicine (volume 142, pages 751-755). The authors are G.P. Wormser, D. McKenna, J. Carlin, R.B. Nadelman, L.F. Cavaliere, D. Holmgren, D.W. Byrne, and J. Nowakowski.


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