Malattia di lyme: Manifestazioni extracutanee in pazienti affetti da acrodermatitis chronica atrophicans

Lyme disease (LD) is a multisystemic infection caused by a spirochete of the genus Borrelia. The transmission to humans happens essentially through the bite of tiks. The disease may be distinguished in three stages or two phases: the early phase includes the first and the second stages, the late phase the third stage. Acrodermatitis chronica atrophicans (ACA) represents the typical skin manifestation of the late LD. In the present retrospective study we have evaluated the incidence of ACA in the geographical area of the North Friuli and we established the frequency of the associated extracutaneous manifestations. The analysis was carried out during a period of 12 years (1987-1998). We observed 12615 subjects with high risk of tick bites (residents, foresters, farmers, etc.) or with clinical suspect of LD. The diagnosis was confirmed in 1984 cases (15,70%), according to the Atlanta's CDC criterions. The patients with ML in third stadium has resulted 173, of which 71 (41%) with ACA. Only in 3 cases, ACA was the only sign of the illness, in the other 68 patients ACA was associated to neurologic manifestations (8 cases), to reumatologic manifestations (12 cases), and to articular and neurologic manifestations (48 cases). Although the clinical manifestations are of difficult retrospective evaluation, we conclude that ACA is very often associated with systemic signs. The multisystemic disease should always carefully be find.