Andreychyn Mykhaylo, Korda Mykhaylo, Kopcha Vasyl, Shkilna Maria Ivanivna, Komorovsky Roman
Department of Infectious Diseases, Epidemiology and Dermatovenereology, Ivan Horbachevsky Ternopil National Medical University, Ternopil, Ukraine.
Department of Medical Biochemistry, Ivan Horbachevsky Ternopil National Medical University, Ternopil, Ukraine.
Infect Drug Resist. 2025 Sep 5;18:4741-4748. doi: 10.2147/IDR.S540248. eCollection 2025.
In 11-18% of patients, infection with is not accompanied by the characteristic skin lesion known as erythema migrans, complicating the timely diagnosis of Lyme borreliosis. To aid in identifying this atypical presentation, we assessed the tick bite site with thermographic imaging.
To determine the diagnostic value of infrared thermography in patients with Lyme borreliosis without erythema migrans.
We observed 16 patients with Lyme borreliosis without erythema migrans. The diagnosis was based on a history of tick bite and laboratory confirmation using two-tiered serological testing, performed 10-20 days after tick exposure. Thermographic imaging was performed with the device positioned 100-150 cm from the area of interest. Temperature differences (ΔT) were recorded.
Thermographic imaging revealed localized hyperthermia in all 16 patients at the site of tick attachment, presenting as annular thermal changes (ΔT = 0.6-3.8 °C) that persisted for at least two weeks, even with ongoing antibacterial therapy. Nearly one-third of patients had ΔT in the range of 0.6-1.1 °C, half showed values of 1.2-1.6 °C, and in 18.7% of cases, ΔT exceeded 1.6 °C. These measurements were obtained and quantified using software-assisted analysis of the thermograms. Therefore, the absence of visible erythema migrans does not rule out localized inflammatory changes: centrifugal spread of from the bite site can still induce subclinical cutaneous inflammation detectable with infrared thermography.
Infrared thermography of the tick bite site can reveal a "thermal erythema migrans" pattern, an annular zone of hyperthermia corresponding to the distribution of erythema migrans even when no rash is visible on clinical inspection. This early thermographic sign, detectable when a temperature exceeds 0.5 °C between the bite site and adjacent or symmetrical areas, may support timely initiation of etiotropic therapy to prevent long-term complications of Lyme disease.
在11%至18%的患者中，感染 后并未出现被称为游走性红斑的典型皮肤病变，这使得莱姆病的及时诊断变得复杂。为了帮助识别这种非典型表现，我们用热成像技术评估了蜱叮咬部位。
确定红外热成像技术在无游走性红斑的莱姆病患者中的诊断价值。
我们观察了16例无游走性红斑的莱姆病患者。诊断基于蜱叮咬史以及在蜱暴露后10至20天进行的两层血清学检测的实验室确诊。热成像检查时，设备距离感兴趣区域100至150厘米。记录温度差异（ΔT）。
热成像显示，所有16例患者蜱附着部位均出现局部体温过高，表现为环形热变化（ΔT = 0.6至3.8°C），即使在进行抗菌治疗的情况下，这种变化仍持续至少两周。近三分之一的患者ΔT在0.6至1.1°C范围内，一半患者显示值为1.2至1.6°C，18.7%的病例中，ΔT超过1.6°C。这些测量值是通过热成像图的软件辅助分析获得并量化的。因此，没有可见的游走性红斑并不排除局部炎症变化：病原体从叮咬部位的离心扩散仍可诱发红外热成像检测到的亚临床皮肤炎症。
蜱叮咬部位的红外热成像可显示“热游走性红斑”模式，即即使临床检查未见皮疹，也会出现与游走性红斑分布相对应的环形体温过高区域。当叮咬部位与相邻或对称区域之间的温度超过0.5°C时可检测到的这种早期热成像征象，可能有助于及时开始针对病因的治疗，以预防莱姆病的长期并发症。
