Lyme disease: gold for Scotland and bronze for USA

Ear presentation of Lyme borreliosis in a child

OBJECTIVE

This case report aims to raise awareness amongst clinicians of ear presentation of cutaneous borrelia.

CASE REPORT

We report a recent case of borrelia lymphocytoma cutis benigna in a child presenting with unilateral earlobe swelling, who was otherwise well. A review of the English language literature, including management of the disease, is also presented.

CONCLUSION

This case highlights the fact that borrelia lymphocytoma should be included in the differential diagnosis of a persistent, unilateral, inflamed, swollen earlobe in an otherwise healthy child.

Audit of the laboratory diagnosis of Lyme disease in Scotland

An audit was performed on the laboratory diagnosis of lyme disease in Scotland. The problem of a significant number of patients with clinical symptoms of lyme disease being reported as seronegative or equivocal by the confirmatory Western blot test was identified. Comparisons of current practice were made with American and European standards, and the Western blot scoring system revised. When applied retrospectively (April 2003 to March 2004), 39 (33 %) of 116 serum samples previously negative or equivocal became weak positive or stronger. Thirty-one (80 %) of these 39 samples were from patients with clinical details suggestive of early lyme disease. The changes were implemented and assessed prospectively for 6 months. There was a significant increase in the proportion of equivocal results, with fewer negatives compared to the same time period 1 year previously. This audit has helped clinicians in the diagnosis of lyme disease and the management of these patients in Scotland.