Department of Dermatology, Münster University, Von Esmarch Strasse 58, Münster, 48149, Germany.
Br J Dermatol. 2014 Sep;171(3):528-43. doi: 10.1111/bjd.12855. Epub 2014 Aug 27.
Lyme borreliosis has a broad spectrum of clinical presentations involving the skin, joints and nervous system. The variable manifestations have been attributed to different Borrelia genospecies but genotyping required culture or fresh tissue. However, in dermatology practice, formalin-fixed paraffin-embedded biopsies are used for dermatopathological examination. Polymerase chain reaction (PCR) for Borrelia burgdorferi sensu latu has been established on such specimens, but studies attempting genotyping of subspecies or strains are lacking.
To adapt PCR assays for genotyping of Borrelia using paraffin-embedded biopsies, to identify Borrelia genospecies and to compare clinicopathological features of different genospecies.
Eighty-two paraffin-embedded biopsies from 68 patients, with erythema migrans, acrodermatitis chronica atrophicans, lymphocytoma cutis or tick bite reactions, were studied with assays targeting the intergenic spacer (IGS), ospA and ospC, followed by sequencing and phylogenetic analysis. Clinicopathological data were analysed comparing different Borrelia genospecies.
Genotyping by IGS, ospA and ospC was successful in 85% of patients (91% B. afzelii, 7% B. garinii, 2% B. bavariensis). ospA serotyping identified type 2 (90%), type 3 (8%) and type 4 (2%). ospC-PCR was positive in 40% of the patients revealing 12 different groups, noninvasive forms being seen only in tick bite reactions and erythema migrans. No major clinicopathological differences could be identified between the genospecies, but neural inflammation and arthralgia were seen more often in lesions caused by invasive ospC strains.
Genotyping of Borrelia can be easily implemented in a routine dermatopathology setting, especially as a fast method to confirm early cutaneous borreliosis. Genotyping could also enable earlier treatment of patients infected with invasive strains.
莱姆病具有广泛的临床表现，涉及皮肤、关节和神经系统。不同的表现形式归因于不同的伯氏疏螺旋体基因型，但基因分型需要培养或新鲜组织。然而，在皮肤科实践中，福尔马林固定石蜡包埋活检用于皮肤病理检查。已经在这些标本上建立了用于伯氏疏螺旋体 sensu lato 的聚合酶链反应（PCR），但缺乏尝试亚种或菌株基因分型的研究。
适应使用石蜡包埋活检进行伯氏疏螺旋体基因分型的 PCR 检测，鉴定伯氏疏螺旋体基因型，并比较不同基因型的临床病理特征。
对 68 例患者的 82 例石蜡包埋活检进行研究，这些患者患有游走性红斑、慢性萎缩性肢端皮炎、皮肤淋巴细胞瘤或蜱咬反应，采用针对基因间 spacer（IGS）、ospA 和 ospC 的检测方法进行基因分型，随后进行测序和系统发育分析。通过分析比较不同伯氏疏螺旋体基因型的临床病理数据。
通过 IGS、ospA 和 ospC 进行基因分型，85%的患者（91%为伯氏疏螺旋体 afzelii、7%为伯氏疏螺旋体 garinii、2%为伯氏疏螺旋体 bavariensis）成功。ospA 血清型鉴定出 2 型（90%）、3 型（8%）和 4 型（2%）。ospC-PCR 在 40%的患者中阳性，显示出 12 个不同的组，仅在蜱咬反应和游走性红斑中可见非侵入性形式。未发现基因型之间存在明显的临床病理差异，但神经炎症和关节痛在由侵袭性 ospC 株引起的病变中更为常见。
伯氏疏螺旋体的基因分型可以在常规皮肤病理检查中轻松实施，特别是作为快速确认早期皮肤莱姆病的方法。基因分型还可以使感染侵袭性菌株的患者更早得到治疗。
