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Volume 31, Number 4—April 2025
Synopsis
Lower Frequency of Multiple Erythema Migrans Skin Lesions in Lyme Reinfections, Europe
, Vera Maraspin, Stanka Lotrič-Furlan, Katarina Ogrinc, Tereza Rojko, Andrej Kastrin, Klemen Strle, Gary P. Wormser, and Petra Bogovič
Table
Erythema migrans diagnosed at the LBOC in Slovenia in relation to having had, or not having had, a previous episode of Lyme borreliosis*
| EM diagnosed at LBOC, n = 12,384 | No. cases | Years (IQR; range) before current EM | Solitary EM, n = 11,507 | Multiple EM, n = 877 | OR (95% CI)† | p value |
|---|---|---|---|---|---|---|
| No previous episode of LB: EM because of primary infection | 10,422 | NA | 9,653 | 769 | ||
| Previous episode(s) of LB: EM because of reinfection |
1,962 |
NA |
1,854 |
108 |
0.73 (0.59–0.90) |
0.002 |
| Initial LB manifestation‡ | ||||||
| EM§ | 1,849 | 6 (3.5–8; <1–23) | 1745 (94.4; 93.2–95.4) | 104 (5.6; 4.6–6.8) | 0.75 (0.60–0.92) | 0.005 |
| Other well-defined manifestation¶ | 60 | 5 (3–6.5; 1–12) | 59 (98.3; 91.1–99.9) | 1 (1.7;0.0–8.9) | 0.21 (0.03–1.54) | 0.12 |
| LNB | 37 | 4 (2.5–6) | 36 (97.3; 85.8–99.9) | 1 (2.7; 0.1–14.2) | 0.35 (0.05–2.55) | 0.30 |
| LA | 10 | 6 (4.5–7.5) | 10 (100; 69.2–100) | 0 (0; 0.0–30.9) | 0.00 (0.00–∞) | >0.99 |
| ACA | 12 | 6.5 (4–8.0) | 12 (100; 73.5–100) | 0 (0; 0.0–26.5) | 0.00 (0.00–∞) | >0.99 |
| Borrelial lymphocytoma | 1 | 2 | 1 (100; 25–100) | 0 (0; 0.0–97.5) | 0.00 (0.00–∞) | >0.99 |
| Nonspecific symptoms in conjunction with the presence of borrelial serum antibodies# | 53** | 4.5 (2.5–7.0) | 50 (94.3; 84.3–98.8) | 3 (5.7; 1.2–15.7) | 0.75 (0.23–2.42) | 0.64 |
*Values are no. (%; 95% CI) except as indicated. ACA, acrodermatitis chronica atrophicans; EM, erythema migrans; IQR, interquartile range; LA, Lyme arthritis; LB, Lyme borreliosis; LBOC, Lyme borreliosis outpatient clinic; LNB, Lyme neuroborreliosis; NA, not applicable. †In comparison to the ratio of multiple EM versus solitary EM in EM skin lesions because of primary infection (769/9653, 7.97%; OR 1). ‡If >1 manifestation, only the non-EM manifestation is shown (for example, in patients with EM and LNB, only LNB is tabulated. No patient had >1 non-EM manifestation). §Initial EM was diagnosed elsewhere (n = 1,102) or at the LBOC (n = 747). ¶The listed initial manifestations of LB were diagnosed at the LBOC. #Treated with antibiotics effective to treat LB for nonspecific symptoms (myalgia, arthralgia, headache, fatigue, etc,, but without an objective clinical manifestation of LB) in association with the presence of serum borrelial antibodies. **51 cases diagnosed elsewhere, 2 at the LBOC.