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Variabilität der kutanen Lyme-Borreliose

Diagnostik und Therapie

The variable spectrum of cutaneous Lyme borreliosis

Diagnosis and therapy

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Zusammenfassung

Die Lyme-Borreliose kann sich an nahezu allen menschlichen Organen manifestieren. Die erste und häufigste Manifestation bei ca. 80–90% der Patienten ist die lokalisierte Frühinfektion der Haut, das Erythema migrans, das neben der typischen Form zahlreiche atypische klinische Varianten hat. Das solitäre Borrelienlymphozytom ist sehr viel seltener und v. a. bei Kindern zu finden. Durch die Verbesserung der Früherkennung wird nur bei 10–20% der Erkrankten die Diagnose erst im disseminierten oder Spätstadium gestellt. Multiple Erythemata migrantia als Zeichen der hämatogenen Disseminierung von B. burgdorferi werden häufig nicht erkannt. Im Spätstadium treten an der Haut eine chronische plasmazelluläre Dermatitis und die Acrodermatitits chronica atrophicans im ödematös infiltrativen Stadium bis hin zum atrophen Stadium auf. Zur Sicherung ungewöhnlicher kutaner Krankheitsmanifestationen eignen sich der DNA-Nachweis mittels Polymerasekettenreaktion und die kulturelle Anzucht aus Hautgewebe. Der Nachweis von borrelienspezifischen IgG- und IgM-Antikörpern im Serum sollte im 2-Stufen-Verfahren mit ELISA und Immunoblot bzw. „Line Blot“ nach den Kriterien der MIQ 12 erfolgen. Zur Therapiekontrolle ist die Serologie nur bedingt geeignet. Die antibiotische Therapie ist wirksam, sofern sie nach den Regeln der evidenzbasierten Medizin durchgeführt wird (Leitlinien der AWMF).

Abstract

Lyme borreliosis can affect almost all human organs. Erythema migrans is the first and most frequent manifestation in 80–90% of patients in the early stage of localized skin infection. Besides the typical clinical appearance, many atypical variants can be observed. The solitary borrelial lymphocytoma is much less common and occurs mostly in children. Due to improvement in the early recognition of Lyme borreliosis, the diagnosis is made in the disseminated and late stage in only 10–20% of patients. Multiple erythemata migrantia indicating the hematogenous dissemination of B. burgdorferi remain frequently unrecognized. Late stages of infection feature chronic plasma-cell rich cutaneous inflammation and acrodermatitis chronica atrophicans in its edematous to atrophic forms. Cultivation or DNA detection of B. burgdorferi in skin biopsies are options to prove unusual skin manifestations. Serological detection of Borrelia-specific IgG- and IgM antibodies should be performed according to the two step protocol with ELISA and immunoassay according to the criteria of the MIQ 12. Serological tests have limited utility for follow-up. Antibiotic therapy is very effective if performed according to evidence-based protocols, such as the AWMF guidelines.

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  1. Klinik für Dermatologie und Allergologie, Technische Universität München, Biedersteinerstr. 29, 80802, München, Deutschland

    H. Hofmann

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Hofmann, H. Variabilität der kutanen Lyme-Borreliose. Hautarzt 63, 381–389 (2012). https://doi.org/10.1007/s00105-011-2256-0

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