USE OF A NOVEL TECHNIQUE OF CUTANEOUS LAVAGE FOR DIAGNOSIS OF LYME-DISEASE ASSOCIATED WITH ERYTHEMA MIGRANS

Objective.-Determining the microbial cause of cellulitis is often difficult. In this study, a novel two-needle lavage technique was used to culture Borrelia burgdorferi from the skin of suspected erythema migrans lesions. Design.-The yield of lavage cultures for B burgdorferi was compared with that of a 2-mm skin biopsy sample. Setting.-A Lyme disease diagnostic center located in an area in which Lyme disease is epidemic. Patients.-Forty-five patients with suspected erythema migrans who had not been treated with antimicrobial agents. Intervention.-Cutaneous lavage of the advancing edge of a suspected primary erythema migrans lesion was done for all 45 participants, 33 of whom also had a skin biopsy of the same lesion at an identical (14) or an adjacent (19) site. Main Outcome Measures.-Growth of B burgdorferi in in vitro culture. Results.-Lavage fluid cultures grew B burgdorferi in 13 (29%) of the 45 cases (95% confidence interval [CI], 16% to 44%). Among the 33 cases in which both lavage and skin biopsy cultures were done, the yield of lavage culture was less than that of biopsy culture (P<.09, 12/33 vs 20/33). If contaminated cultures are excluded, this difference is significant (P<.05, 12/30 vs 20/27). Conclusion.-Cutaneous lavage is a new diagnostic technique for recovery of B burgdorferi from erythema migrans lesions that has potential applicability to other types of cutaneous infections.