A friend of mine with Lyme has had an extended EM rash for over six months now. She had a classic Lyme onset -- tick bite, bullseye rash -- but her LLMD is perplexed by the fact that a) she has gotten very very sick, worse than most patients, b) the rash is not going away, and c) she has evidence of viral infection but still hasn't had a positive Lyme test (or a positive test for babesia or bartonella).
She is looking for a lab to biopsy the EM rash. Does anyone know of a lab that does this or how it is done? (i.e. is it a surgical procedure or can someone just scrape the dermal area?).
Also, does anyone have an explanation for why the rash might have lingered for so long?
My friend is unable to use the computer right now but I am going to relay responses to her. Thanks!
Posted by CaliforniaLyme (Member # 7136) on :
YES- this is what I had- it is called an ECM- an Erthema Chronicum Migrans. I don't know why some are like that- but they have been documented for years in medical literature.
I had my rash biopsied by an ignorant local dermie. He punch biopsied it, went into other room, came back in 5 minutes, "Can't see any spirochetes!"
No, you doofus, you have to culture it for two weeks first to get enough to be visible under microscope!!!!!!!! AGh!!!!!!
His method was WRONG.
The RIGHT thing to do would be to punch biopsy it and culture it for a couple of weeks to grow enough spirochetes to actually see!!! So tell her to be careful, not to waste this opportunity for diagnosis. Have her nag her dermie to do the right thing!!!
Best wishes, Sarah
Posted by CaliforniaLyme (Member # 7136) on :
p.s. But even a punch biopsy and then culture does not necessarily work 100% of the time!! But it can help diagnostically- and wow, not TWO weeks- here they have a MEAN, an average, of 3.5 weeks! WOW! Not many dermies are going to do it right unless especially trained in my opinion- ************************************************* J Clin Microbiol v.43(10); Oct 2005
Two-Year Evaluation of Borrelia burgdorferi Culture and Supplemental Tests for Definitive Diagnosis of Lyme Disease
Peggy Coulter,1 Clara Lema,1 Diane Flayhart,1 Amy S. Linhardt,1 John N. Aucott,2 Paul G. Auwaerter,2 and J. Stephen Dumler1*
Lyme disease is usually diagnosed and treated based on clinical manifestations.
However, laboratory testing is useful for patients with confusing presentations and for validation of disease in clinical studies.
Although cultivation of Borrelia burgdorferi is definitive, prior investigations have shown that no single test is optimal for Lyme disease diagnosis.
We applied high-volume blood culture, skin biopsy culture, PCR, and serodiagnosis to a cohort of patients with suspected Lyme disease acquired in Maryland and southern Pennsylvania.
The study was performed to confirm the relative utility of culture and to identify laboratory testing algorithms that will supplement clinical diagnosis.
Overall, 30 of 86 patients (35%) were culture positive, whereas an additional 15 of 84 (18%) were seropositive only (51% total sero- and culture positive), and PCR on skin biopsy identified 4 additional patients who were neither culture nor seropositive.
Among 49 laboratory test-positive patients, the highest sensitivity (100%) for diagnosis was obtained when culture, skin PCR, and serologic tests were used, although serologic testing with skin PCR was almost as sensitive (92%). Plasma PCR was infrequently positive and provided no additional diagnostic value.
Although culture is definitive and has a relatively high sensitivity, the results required a mean of 3.5 weeks to recovery.
The combination of acute-phase serology and skin PCR was 75% sensitive, offering a practical and relatively rapid alternative for confirming clinical impression.
The full battery of tests could be useful for patients with confusing clinical signs or for providing strong laboratory support for clinical studies of Lyme disease.
Posted by CaliforniaLyme (Member # 7136) on :
p.s.s. My ECM stayed for somewhere between 7-9 months, I forget- a looooong time!!!