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Gerald Seinost, MD; William T. Golde, PhD; Bernard W. Berger, MD; John J. Dunn, PhD; Dan Qiu, MD; David S. Dunkin, BS; Daniel E. Dykhuizen, PhD; Benjamin J. Luft, MD; Raymond J. Dattwyler, MD

Arch Dermatol. 1999;135:1329-1333.

Objective  To assess human skin biopsy specimens from erythema migrans lesions for the presence of infection with multiple strains of the Lyme disease spirochete, Borrelia burgdorferi.

Design  Skin biopsy specimens were obtained prospectively from patients with erythema migrans. To determine allelic differences and strain identification of B burgdorferi, the biopsy specimens were analyzed by cold single-strand conformation polymorphism of an amplified fragment of the outer surface protein C (ospC) gene. Further single-strand conformation polymorphism patterns of amplified ospC genes from culture isolates were compared with polymerase chain reaction products obtained directly from erythema migrans biopsy specimens.

Setting  A private dermatology office and a university medical center outpatient department.

Patients  Sixteen patients presenting with erythema migrans.

Results  Two of the 16 patients in this cohort were infected with 2 B burgdorferi sensu stricto strains, as evidenced by 2 ospC alleles in their skin biopsy results.

Conclusion  This is the first documented description of the existence of more than a single strain of B burgdorferi sensu stricto in a human specimen.

From the Division of Allergy, Department of Medicine (Drs Seinost, Golde, Qui, Luft, and Dattwyler and Mr Dunkin), and the Departments of Dermatology (Dr Berger) and Ecology and Evolution (Dr Dykhuizen), State University of New York at Stony Brook; and the Department of Biology, Brookhaven National Laboratory, Upton, NY (Dr Dunn).

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