Neubert U, Krampitz H E, Engl H
Zentralbl Bakteriol Mikrobiol Hyg A. 1986 Dec;263(1-2):237-52. doi: 10.1016/s0176-6724(86)80127-4.
In order to evaluate the virtual advantage of proving borrelial infection in dermatoses clinically diagnosed as erythema (chronicum) migrans (ECM), acrodermatitis chronica atrophicans (ACA) or lymphadenosis cutis benigna (LCB) by means of histological, cultural or serological trials, skin and serum samples obtained from altogether 99 patients suffering from these dermatoses were examined. Serum and--to some extent--skin specimens gained from healthy individuals (n = 36), patients with not tick bite associated disorders of skin, internal organs and nervous system (n = 121) were used as controls. In addition, serum specimens from patients enduring circumscribed scleroderma (morphea), n = 31, and sera of Bavarian forest workers (n = 211) were proven for the presence of borrelial antibodies. Using an indirect immunofluorescence assay with borrelial strains, propagated in inbred mice, as antigens, elevated IgM- and/or IgG antibody titers were found in 51 (84%) out of 61 ECM-, in 17 (100%) ACA- and in 2 (33%) out of 6 LCB-sera. Antibody titers decreased significantly after adequate antibiotic therapy. The groups in comparison yielded spirochetal serum antibodies as follows: Healthy individuals and patients with various diseases 7 out of 157 (4.5%), morphea patients 7 out of 31 (23%) and forest workers 71 out of 211 (34%). Borrelia burgdorferi was cultivated from 6 out of 32 skin and from 1 blood specimen obtained from ECM patients and from 1 out of 5 ACA skin specimens. Borreliae could also be detected in the blood of 3 out of 11 thymusaplastic nude mice after intraperitoneal implantation of ECM-tissue. More frequently than borreliae spindle-shaped bacteria resembling fusobacterium sp. were detected not only by in vitro cultivation of ECM and ACA skin samples, but also in the blood of thymusaplastic mice after implantation of ECM-tissue. By Warthin-Starry silver strain borrelia-like structures were detected in 9 out of 28 ECM, in 3 out of 12 ACA and in 1 out of 5 LCB skin specimens. Therefore in our experience serological examinations turned out to be the most productive diagnostic tool.
为了评估通过组织学、培养或血清学试验来证实临床诊断为游走性红斑（慢性）（ECM）、慢性萎缩性肢端皮炎（ACA）或良性皮肤淋巴结病（LCB）的皮肤病中疏螺旋体感染的实际优势，我们对总共99例患有这些皮肤病的患者的皮肤和血清样本进行了检查。从健康个体（n = 36）、无蜱叮咬相关皮肤、内脏和神经系统疾病的患者（n = 121）获取的血清以及在一定程度上的皮肤标本用作对照。此外，还检测了31例局限性硬皮病（硬斑病）患者的血清标本以及巴伐利亚森林工人（n = 211）的血清中是否存在疏螺旋体抗体。以在近交系小鼠中繁殖的疏螺旋体菌株作为抗原，采用间接免疫荧光法检测，结果发现61份ECM血清中有51份（84%）、17份ACA血清（100%）和6份LCB血清中有2份（33%）的IgM和/或IgG抗体滴度升高。经过适当的抗生素治疗后，抗体滴度显著下降。相比之下，各组的螺旋体血清抗体情况如下：健康个体和患有各种疾病的患者中，157人中有7人（4.5%）；硬斑病患者中，31人中有7人（23%）；森林工人中，211人中有71人（34%）。从32份ECM患者的皮肤标本中的6份以及1份血液标本中培养出了伯氏疏螺旋体，从5份ACA皮肤标本中的1份培养出了伯氏疏螺旋体。在将ECM组织腹腔植入11只胸腺发育不全的裸鼠后，在其中3只裸鼠的血液中也检测到了疏螺旋体。不仅通过对ECM和ACA皮肤样本进行体外培养，而且在植入ECM组织后的胸腺发育不全小鼠的血液中，检测到类似梭杆菌属的梭形疏螺旋体的频率更高。通过Warthin-Starry银染法，在28份ECM皮肤标本中的9份、12份ACA皮肤标本中的3份和5份LCB皮肤标本中的1份中检测到了类疏螺旋体结构。因此，根据我们的经验，血清学检查是最有效的诊断工具。
