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Infection with multiple strains of Borrelia burgdorferi sensu stricto in patients with Lyme disease.

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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.


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.


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


Sixteen patients presenting with erythema migrans.


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.


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

Arch Dermatol. 1999 Nov;135(11):1329-33. Comparative Study; Research Support, Non-U.S. Gov’t

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