Differentiation of Reinfection from Relapse in Recurrent Lyme Disease
Differentiation of Reinfection from Relapse in Recurrent Lyme Disease
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DOI：
10.1056/nejmoa1114362
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发表时间：
2012-11-15
影响因子：
158.5
通讯作者：
Wormser, Gary P.
中科院分区：
文献类型：
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作者：
Nadelman, Robert B.;Hanincova, Klara;Wormser, Gary P.
原发性游走性红斑是莱姆病最常见的表现。复发并不罕见，虽然它们通常归因于再感染而不是原始感染的复发，但这仍然有些争议。我们使用的伯氏疏螺旋体分离株的分子分型，从患者的文化证实的事件的游走性红斑，以区分复发和reinfection.MethodsWe确定的基因编码外表面蛋白C（ospC）的B的基因型。在从具有连续游走性红斑发作的患者获得的皮肤或血液样本的培养物中检测到的伯氏菌株。聚合酶链反应扩增后，通过反向线性印迹分析或近全长基因的DNA测序进行ospC基因分型。大多数菌株通过根据16 S-23 S核糖体RNA基因间间隔区类型、多位点序列分型或两者确定基因型来进一步分析。患者接受标准疗程的抗生素治疗游走性红斑。从1991年至2011年期间接受游走性红斑诊断并且具有22次成对发作（初始发作和第二次发作）的17名患者获得的伯氏分离物可用于测试。ospC基因型被发现是不同的，在每个初始和第二次发作。显然相同的基因型被确定在一个以上的场合，只有一个病人，在第一次和第三次发作，相隔5年，但不同的基因型被确定在第二次和第四epissions.CONCLUSIONSNone的22对连续发作的游走性红斑与相同的应变B。布格多费利谈文化。我们的数据表明，在适当治疗的患者中，反复发作的游走性红斑是由于再感染而不是复发。（由美国国立卫生研究院和威廉和西尔维亚·西尔伯斯坦基金会资助。
BACKGROUNDErythema migrans is the most common manifestation of Lyme disease. Recurrences are not uncommon, and although they are usually attributed to reinfection rather than relapse of the original infection, this remains somewhat controversial. We used molecular typing of Borrelia burgdorferi isolates obtained from patients with culture-confirmed episodes of erythema migrans to distinguish between relapse and reinfection.MethodsWe determined the genotype of the gene encoding outer-surface protein C (ospC) of B. burgdorferi strains detected in cultures of skin or blood specimens obtained from patients with consecutive episodes of erythema migrans. After polymerase-chain-reaction amplification, ospC genotyping was performed by means of reverse line-blot analysis or DNA sequencing of the nearly full-length gene. Most strains were further analyzed by determining the genotype according to the 16S-23S ribosomal RNA intergenic spacer type, multilocus sequence typing, or both. Patients received standard courses of antibiotics for erythema migrans.RESULTSB. burgdorferi isolates obtained from 17 patients who received a diagnosis of erythema migrans between 1991 and 2011 and who had 22 paired episodes of this lesion (initial and second episodes) were available for testing. The ospC genotype was found to be different at each initial and second episode. Apparently identical genotypes were identified on more than one occasion in only one patient, at the first and third episodes, 5 years apart, but different genotypes were identified at the second and fourth episodes.CONCLUSIONSNone of the 22 paired consecutive episodes of erythema migrans were associated with the same strain of B. burgdorferi on culture. Our data show that repeat episodes of erythema migrans in appropriately treated patients were due to reinfection and not relapse. (Funded by the National Institutes of Health and the William and Sylvia Silberstein Foundation.)