Lyme Borreliosis andBorrelia spielmanii

B. spielmanii was detected in the patient by a general approach we have used for several years. In all consenting patients, a skin specimen from an EM lesion is cultured for borreliae in modified Kelly medium before and, in case of a positive result, ≈2 months after antimicrobial drug treatment is started. Isolated strains are typed by using the 5S–23S spacer amplicon. The findings in this report are generally consistent with those in other reports of adult patients with EM (4–8). One difference was that the patient did not report a tick bite at the site of the EM. Approximately two thirds of our patients with EM recalled a tick bite and ≈10% of patients treated for early LB had previously had EM (4–8). Previous reports indicate several differences in patients with EM caused by B. burgdorferi and B. afzelii (7) and patients with EM caused by B. afzelii and B. garinii (8,9). Some of the findings in our patient are unusual and rarely found in those with early LB. However, the small number of patients infected with B. spielmanii (1 reported herein and 4 previously reported) does not allow any reliable conclusion to be made on differences in clinical manifestations of LB caused by B. spielmanii compared with those of other species. Our results corroborate previous findings that B. spielmanii is a cause of LB in Europe. Thus, in addition to the Netherlands (2), Germany (10), and Hungary (1), LB caused by B. spielmanii is also present in Slovenia.