Study Sheds New Light on Lyme Disease
This study by John D Scott reports ACA rashes on Lyme disease patients for the first time in Canada. The author sheds new light on the predominant B. burgdorferi sensu stricto genospecies in North America acting as a potential contagion in the pathogenesis of ACA.
Abstract: 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. In this study, five Canadian Lyme disease patients from a multi-age range presented various phases of the acrodermatitis chronica atrophicans (ACA) rash.
In each case of ACA, the underlying etiological pathogen was the Lyme disease spirochete. Although ACA rashes are normally found on the lower extremities, this study illustrates that ACA rashes are not directly correlated with a tick bite, geographic area, age, Bbsl genospecies, exercise, or any given surface area of the body.
Although ACA has a predilection for sites on the lower extremities, where collagenous tissue is prolific, ACA has no direct correlation with a tick bite, geographic location, age, exercise, Bbsl genospecies, and location on the skin surface.
The ACA lesion is one of a broad variation of different rashes associated with Lyme disease, and denotes that Bbsl infection can be persistent in cutaneous and/or connective tissue. As noted in this study, ACA rashes can last for months or years.
Recognition of EM and ACA rashes, and their variants, is clinically important as an indicator in the diagnosis and treatment of Lyme disease. The presence of a co-infection of Bbsl and Bartonella sp. in Case 5 displays a novel combination of rashes including an ACA, blister exudate, erythematous eruptions, and Bartonella striae.
An adolescent male (Case 4) displays an ACA rash caused by B. burgdorferi sensu stricto and, with physical deformities (clubfeet) at birth, confirms gestational Lyme disease. Because the filial son (Case 4) of B. burgdorferi sensu stricto-positive parents was likewise positive for B. burgdorferi sensu stricto, this positivity provides formidable evidence of sexual transmission of Lyme disease spirochetes between intimate partners.
Since early treatment of Lyme disease can generally mitigate or prevent late stage clinical manifestations, healthcare practitioners must include ACA rashes in their differential diagnosis for patients showing symptoms compatible with Lyme disease.
The full paper is available at Healthcare 2020, 8, 157; doi:10.3390/healthcare8020157 or
https://www.mdpi.com/2227-
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