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Microbiol Spectr 2022 Apr 17;10(2):e0051022. Epub 2022 Mar 17.

Centre for Infectious Disease Control, National Institute for Public Health and the Environmentgrid.31147.30 (RIVM), Bilthoven, the Netherlands.

In this retrospective study, the performance of nine serological screening assays for Lyme borreliosis (LB) diagnostics was evaluated using a study population of LB cases and controls. Sera derived from 74 well-defined LB cases and 122 controls were included. The LB cases were diagnosed with erythema migrans (EM;  = 11), Lyme neuroborreliosis (LNB;  = 35), Lyme arthritis (LA;  = 20), or acrodermatitis chronica atrophicans (ACA;  = 8). Read More

Clin Exp Dermatol 2022 Apr 10;47(4):795-798. Epub 2022 Jan 10.

Dermatology, Imperial College Healthcare NHS Trust, London, UK.

We report the case of a 75-year-old woman presenting with acrodermatitis chronica atrophicans affecting the right hand dorsum, developing after an insect bite sustained in Greece. Diagnosis was confirmed by serology, PCR and histopathological findings. The plaque resolved following a 3-week course of oral doxycycline. Read More

Am J Dermatopathol 2022 May;44(5):338-347

Dermatologikum Hamburg, Hamburg, Germany; and.

Abstract: Lyme borreliosis (LB) is the most common tick-borne infection in Europe and North America. Polymerase chain reaction (PCR) is an important tool to confirm the diagnosis, but not always successful, especially when organisms are sparse. We developed a novel, seminested real-time PCR assay [target: 5S-23S intergenic spacer region (IGS)] and compared it with 3 well-established conventional PCR assays (IGS/OspA/real-time IGS) on 596 formalin-fixed, paraffin-embedded routine skin biopsies. Read More

Ugeskr Laeger 2021 11;183(45)

Tidsskr Nor Laegeforen 2021 11 8;141(16). Epub 2021 Nov 8.

Background: Acrodermatitis chronica atrophicans (ACA) is a late manifestation of Borrelia infection and is easily overlooked, especially in elderly patients.

Case Presentation: A woman in her fifties presented with dizziness, general muscle stiffness, chills, nausea and a feeling of transient shock in her head during dosage reduction of escitalopram. The symptoms were therefore initially misinterpreted as related to her psychiatric disorder. Read More

Lancet Reg Health Eur 2021 Jul 27;6:100142. Epub 2021 May 27.

National Institute for Public Health and the Environment (RIVM), Center for Infectious Disease Control, P.O. Box 1, 3720 BA, Bilthoven, Netherlands.

Background: Concerns about long-lasting symptoms attributed to Lyme borreliosis (LB) are widespread in the Western world, while such symptoms are highly prevalent in the general population.

Methods: In the largest prospective study to date, adults with physician-confirmed LB were included at the start of antibiotic treatment. Primary outcomes, prevalence of persistent symptoms and symptom severity, were assessed using three-monthly standardised questionnaires during one year. Read More

J Eur Acad Dermatol Venereol 2022 Feb 16;36(2):e107-e109. Epub 2021 Sep 16.

Infectious and Tropical Diseases Department, Angers University Hospital, Angers, France.

J Intern Med 2021 08 13;290(2):335-348. Epub 2021 Mar 13.

From the, Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia.

Background: Information on large groups of patients with acrodermatitis chronica atrophicans (ACA) is limited.

Methods: We assessed clinical and microbiological characteristics of patients with ACA diagnosed at a single medical centre and compared findings in periods 1991-2004 vs. 2005-2018. Read More

Ticks Tick Borne Dis 2021 01 9;12(1):101591. Epub 2020 Oct 9.

Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.

To provide better care for patients suspected of having a tick-transmitted infection, the Clinic for Tick-borne Diseases at Rigshospitalet, Copenhagen, Denmark was established. The aim of this prospective cohort study was to evaluate diagnostic outcome and to characterize demographics and clinical presentations of patients referred between the 1st of September 2017 to 31st of August 2019. A diagnosis of Lyme borreliosis was based on medical history, symptoms, serology and cerebrospinal fluid analysis. Read More

Rheumatology (Oxford) 2020 Dec;59(12):3995-3996

Department of Rheumatology.

Healthcare (Basel) 2020 Jun 4;8(2). Epub 2020 Jun 4.

International Lyme and Associated Diseases Society, 2 Wisconsin Circle, Suite 700, Chevy Chase, MD 20815-7007, USA.

Lyme disease (Lyme borreliosis) is a complex multisystem illness with varying clinical manifestations. This tick-borne zoonosis is caused by the spirochetal bacterium, Borrelia burgdorferi sensu lato (Bbsl) and, worldwide, presents with at least 20 different types of rashes. Certain cutaneous rashes are inherently interconnected to various stages of Lyme disease. Read More

BMJ 2020 May 26;369:m1041. Epub 2020 May 26.

Amsterdam University Medical Centers, location AMC, Department of Medicine, Division of Infectious Diseases, and Amsterdam Multidisciplinary Lyme borreliosis Center, Amsterdam, Netherlands.

Lyme borreliosis is the most common vectorborne disease in the northern hemisphere. It usually begins with erythema migrans; early disseminated infection particularly causes multiple erythema migrans or neurologic disease, and late manifestations predominantly include arthritis in North America, and acrodermatitis chronica atrophicans (ACA) in Europe. Diagnosis of Lyme borreliosis is based on characteristic clinical signs and symptoms, complemented by serological confirmation of infection once an antibody response has been mounted. Read More

Internist (Berl) 2020 Jun;61(6):617-620

Krankenhaus Bad Waldsee, Oberschwabenklinik gGmbH, Robert-Koch-Straße 38, 88339, Bad Waldsee, Deutschland.

The case of a 72-year-old female patient with exanthem and concomitant neuropathy of the instep of the foot and progressive ipsilateral lower leg pain is reported. Sonographically, a superficial vein thrombosis with extension into the deep venous system originating from the exanthem was observed. On the basis of the clinical picture as well as the serological and electrophysiological findings, a rare diagnosis of acrodermatitis chronica atrophicans with peripheral neuropathy was made, which could significantly promote the local development of venous thrombosis. Read More

Dtsch Med Wochenschr 2020 01 8;145(1):19-28. Epub 2020 Jan 8.

Lyme borreliosis is the most common zoonosis in Germany with an incidence of up to 138/100 000. More than 90 % of all cases show dermatological manifestations. Early manifestations are erythema migrans, multiple erythemata migrantia, and (less frequently) borrelial lymphocytoma. Read More

Eur J Clin Microbiol Infect Dis 2019 Oct 9;38(10):1933-1945. Epub 2019 Aug 9.

Division of Clinical Microbiology, Laboratory Medicine, Jönköping Region Jönköping County, Sweden and Department of Clinical and Experimental Medicine, Linköping University, Ryhov County Hospital, SE-551 85, Jönköping, Sweden.

Lyme borreliosis (LB), caused by spirochetes belonging to the Borrelia burgdorferi sensu lato complex, is the most common tick-borne infection in Europe. Laboratory diagnosis of LB is mainly based on the patients' medical history, clinical signs and symptoms in combination with detection of Borrelia-specific antibodies where indirect enzyme-linked-immunosorbent assay (ELISA) is the most widely used technique. The objective of the study was to evaluate and compare the diagnostic accuracy (sensitivities and specificities) of serological tests that are currently in use for diagnosis of LB in clinical laboratories in Northern Europe, by use of a large serum panel. Read More

Postepy Dermatol Alergol 2018 Oct 19;35(5):490-494. Epub 2018 Jul 19.

Department of Infectious Diseases and Neuroinfections, Medical University of Białystok, Białystok, Poland.

Introduction: Acrodermatitis chronica atrophicans (ACA) is probably the most common late and chronic manifestation of the Lyme borreliosis seen in European patients.

Aim: To analyze epidemiological data, and to investigate the effects of treatment of patients with ACA.

Material And Methods: Nine patients were included in the study. Read More

Ticks Tick Borne Dis 2019 01 26;10(1):180-185. Epub 2018 Oct 26.

Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia. Electronic address:

Acrodermatitis chronica atrophicans is a late manifestation of European Lyme borreliosis and is characterized by high levels of borrelial IgG antibodies, slowly expanding skin redness usually beginning on distal parts of extremities, and corresponding histologic findings. It very rarely develops in children. The main prerequisite for the diagnosis is clinical suspicion. Read More

Rheumatology (Oxford) 2019 04;58(4):655

Dermatology Department, and Université Paris Diderot-Paris VII, Sorbonne Paris Cité APHP, Saint-Louis Hospital, Paris, France.

J Cutan Pathol 2018 Apr 9;45(4):274-277. Epub 2018 Feb 9.

Departments of Dermatology and Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa.

Lyme disease classically evolves through clinical manifestations according to the stage of illness. Because many of the systemic symptoms are non-specific, and because serology may yield false negative results, cutaneous findings merit even greater importance to diagnosis. The prototypical skin lesion, erythema migrans (EM), occurs early and is the only independent diagnostic clinical feature according to the guidelines of the Infectious Diseases Society of America. Read More

Am J Dermatopathol 2018 May;40(5):367-370

Department of Dermatology, Medical University of Graz, Graz, Austria.

Acrodermatitis chronica atrophicans (ACA) that is characterized by thin, papery dry, translucent, and alopecic patches with visible superficial veins is a late cutaneous manifestation of Lyme borreliosis. Clinical findings, a history of exposure to tick bite, and serology are helpful for the diagnosis of ACA and sometimes a biopsy is performed to rule out other infectious or inflammatory processes. In this study, we report reflectance confocal microscopy (RCM) findings in a case of ACA. Read More

Ger Med Sci 2017 5;15:Doc14. Epub 2017 Sep 5.

Klinik für Infektiologie Klinik St Georg, Leipzig, Germany.

This guideline of the German Dermatology Society primarily focuses on the diagnosis and treatment of cutaneous manifestations of Lyme borreliosis. It has received consensus from 22 German medical societies and 2 German patient organisations. It is the first part of an AWMF (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. Read More

Br J Dermatol 2017 Oct 8;177(4):1127-1130. Epub 2017 Sep 8.

Dermatology Department, Nancy University Hospital, Vandoeuvre-les-Nancy, France.

Acrodermatitis chronica atrophicans (ACA) is the late cutaneous form of Lyme borreliosis. The early inflammatory phase manifests with a bluish-red discoloration and doughy swelling of the skin. The atrophic phase represents a late-phase process with red discoloration, and a thin and wrinkled appearance of the skin. Read More

Hautarzt 2017 Apr;68(4):329-339

Abteilung für Dermatologie, Landesklinikum Wiener Neustadt, Wiener Neustadt, Österreich.

Serology, the detection of B. burgdorferi-specific IgM and IgG serum antibodies, is the most common laboratory test to diagnose cutaneous manifestations of Lyme disease. In a two-tiered approach, an ELISA is used as a screening test. Read More

Infect Genet Evol 2017 04 28;49:48-54. Epub 2016 Dec 28.

Laboratory for Zoonoses and Environmental Microbiology, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands. Electronic address:

Both early localized and late disseminated forms of Lyme borreliosis are caused by Borrelia burgdorferi senso lato. Differentiating between the spirochetes that only cause localized skin infection from those that cause disseminated infection, and tracing the group of medically-important spirochetes to a specific vertebrate host species, are two critical issues in disease risk assessment and management. Borrelia burgdorferi senso lato isolates from Lyme borreliosis cases with distinct clinical manifestations (erythema migrans, neuroborreliosis, acrodermatitis chronica atrophicans, and Lyme arthritis) and isolates from Ixodes ricinus ticks feeding on rodents, birds and hedgehogs were typed to the genospecies level by sequencing part of the intergenic spacer region. Read More

Ticks Tick Borne Dis 2017 02 24;8(2):266-269. Epub 2016 Nov 24.

Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia. Electronic address:

Background: The pathogenesis of acrodermatitis chronica atrophicans (ACA) is not well understood.

Objective: The purpose of this study was to gain a better understanding of ACA by utilizing a large data set of adult Slovenian patients with Lyme borreliosis.

Methods: The age of 590 ACA patients was compared with that of patients with other manifestations of Lyme borreliosis. Read More

Nat Rev Dis Primers 2016 12 15;2:16090. Epub 2016 Dec 15.

Bacterial Diseases Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA.

Lyme borreliosis is a tick-borne disease that predominantly occurs in temperate regions of the northern hemisphere and is primarily caused by the bacterium Borrelia burgdorferi in North America and Borrelia afzelii or Borrelia garinii in Europe and Asia. Infection usually begins with an expanding skin lesion, known as erythema migrans (referred to as stage 1), which, if untreated, can be followed by early disseminated infection, particularly neurological abnormalities (stage 2), and by late infection, especially arthritis in North America or acrodermatitis chronica atrophicans in Europe (stage 3). However, the disease can present with any of these manifestations. Read More

Expert Rev Mol Diagn 2017 01 28;17(1):19-30. Epub 2016 Nov 28.

a Institute of Microbiology ansd Immunology, Faculty of Medicine , University of Ljubljana , Ljubljana , Slovenia.

Introduction: Current laboratory testing of Lyme borreliosis mostly relies on serological methods with known limitations. Diagnostic modalities enabling direct detection of pathogen at the onset of the clinical signs could overcome some of the limitations. Molecular methods detecting borrelial DNA seem to be the ideal solution, although there are some aspects that need to be considered. Read More

Rheumatology (Oxford) 2017 03 6;56(3):398. Epub 2016 Nov 6.

Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark.