Borrelia burgdorferiInfection and Cutaneous Lyme Disease, Mexico

Four patients who had received tick bites while visiting forests in Mexico had skin lesions that met the case defi nition of erythema migrans, or borrelial lymphocytoma.Clinical diagnosis was supported with histologic, serologic, and molecular tests.This study suggests that Borrelia burgdorferi infection is in Mexico.L yme disease is the most frequently reported vector- borne infectious disease in the United States and Europe (1,2).Studies have suggested that Borrelia burgdorferi infection might be endemic to Mexico (3,4).We searched for histologic, immunologic, and molecular evidence of B. burgdorferi infection in patients with cutaneous manifestations suggestive of Lyme disease in Mexico. The StudyFrom June 1999 to October 2000, 4 patients in Mexico City had clinical manifestations suggestive of Lyme disease (5,6).Two (36 and 54 years of age) had erythema migrans lesions, and 2 (9 and 34 years of age) had borrelial lymphocytoma lesions.Two reported having been bitten by a hard tick; the other 2, by a nonfl ying insect.Bites occurred while camping in forests: 3 near Mexico City (National Park La Marquesa) and 1 in Quintana Roo, a southern state in Mexico.All patients lived in Mexico City and had never traveled outside Mexico.Two patients were treated for acute skin lesions (consistent with erythema migrans), malaise, and arthralgia.The skin lesion was an erythematous macula with regular, reddish edges and a pink center.One patient had a 5-cm lesion on the left forearm; the other had a 6-cm lesion on the left thigh.For the 2 other patients, a nodular erythematous cutaneous lesion (consistent with lymphocytoma), 0.5-2 cm in diameter with regular edges, developed 2 months after the bite.One patient's lesion was on the earlobe; the other's, on the left cheek.