Use of a novel technique of cutaneous lavage for diagnosis of Lyme disease associated with erythema migrans
G. P. Wormser, G. Forseter, D. Cooper, J. Nowakowski, R. B. Nadelman, H. Horowitz, I. Schwartz, S. L. Bowen, G. L. Campbell and N. S. Goldberg
Department of Medicine, Westchester County Medical Center, New York Medical College, Valhalla 10595.
OBJECTIVE--Determining the microbial cause of cellulitis is often
difficult. In this study, a novel two-needle lavage technique was used to
culture Borrelia burgdorferi from the skin of suspected erythema migrans
lesions. DESIGN--The yield of lavage cultures for B burgdorferi was
compared with that of a 2-mm skin biopsy sample. SETTING--A Lyme disease
diagnostic center located in an area in which Lyme disease is epidemic.
PATIENTS--Forty-five patients with suspected erythema migrans who had not
been treated with antimicrobial agents. INTERVENTION--Cutaneous lavage of
the advancing edge of a suspected primary erythema migrans lesion was done
for all 45 participants, 33 of whom also had a skin biopsy of the same
lesion at an identical (14) or an adjacent (19) site. MAIN OUTCOME
MEASURES--Growth of B burgdorferi in in vitro culture. RESULTS--Lavage
fluid cultures grew B burgdorferi in 13 (29%) of the 45 cases (95%
confidence interval [CI], 16% to 44%). Among the 33 cases in which both
lavage and skin biopsy cultures were done, the yield of lavage culture was
less than that of biopsy culture (P less than .09, 12/33 vs 20/33). If
contaminated cultures are excluded, this difference is significant (P less
than .05, 12/30 vs 20/27). CONCLUSION--Cutaneous lavage is a new diagnostic
technique for recovery of B burgdorferi from erythema migrans lesions that
has potential applicability to other types of cutaneous infections.
