[What kind of clinical, epidemiological, and biological data is essential for the diagnosis of Lyme borreliosis? Dermatological and ophtalmological courses of Lyme borreliosis]

T Boyé
Médecine et Maladies Infectieuses 2007, 37: S175-88
Lyme borreliosis (BL) is a multisystem infectious tick-transmitted disease. The diversity of Borrelia burgdorferi is the reason for a wide spectrum of dermatological and ophthalmologic presentations between patients from Europe and from other countries. In Europe, the main manifestations are dermatological. During the early stage, the diagnosis is clinical: finding erythema migrans (EM) a few days after a tick bite is sufficient; several EM mean an early-disseminated disease. Borrelial lymphocytoma (only in Europe) is a solitary nodule or plaque (earlobe, nipple, scrotum), which appears during the second stage. The diagnosis relies on clinical and histological findings (B-cell infiltration) and a positive serological test. It is sometimes difficult to make the difference between BL and B-cell lymphoma and pseudo lymphoma; an empirical antibiotic trial period will be helpful for the diagnosis in this case. During the late stage, the clinical evolution of acrodermatitis chronica atrophicans is progressive: inflammatory then atrophic lesions appear, often on the hands, limbs, or feet. The diagnosis is made on histological findings (T-cell infiltration) and a positive serological test. The relationship between BL and morphea or lichen sclerosus was not demonstrated according to the latest reports. Ocular manifestations are rare events occurring during every stage of the disease. A wide spectrum of presentations is possible (uveitis and optic neuritis). BL is responsible for ocular infection or inflammation. A neurological presentation is often associated with the ocular manifestation. Proving the diagnosis is often difficult because of these polymorphous manifestations.

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