Heterogeneity of Borrelia burgdorferi in the skin.

 Am J Dermatopathol. 1996 Dec;18,6:571-9. Heterogeneity of Borrelia burgdorferi in the 
skin. Aberer E, Kersten A, Klade H, Poitschek C, Jurecka W.
Department of Dermatology, University of Vienna, Austria.
The reliability of various in vitro techniques to identify Borrelia burgdorferi infection is still 
unsatisfactory. Using a high-power resolution videomicroscope and staining with the borrelia
genus-specific monoclonal flagellar antibody H9724, we identified borrelial structures in skin 
biopsies of erythema chronicum migrans, from which borrelia later was cultured, of 
acrodermatitis chronica atrophicans, and of morphea. In addition to typical borreliae, we noted 
stained structures of varying shapes identical to borreliae found in a "borrelia-injected skin" 
model; identical to agar-embedded borreliae; and identical to cultured borreliae following 
exposure to hyperimmune sera and/or antibiotics. We conclude that the H9724-reactive 
structures represent various forms of B. burgdorferi rather than staining artifacts. These 
"atypical" forms of B. burgdorferi may represent in vivo morphologic variants of this 
Neuralgias arising 6 months after ECM in spite of antibiotic therapy were evident in a 
seronegative patient who showed perineural rod-like borrelia structures

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