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Focus Floating Microscopy
“Gold Standard” for Cutaneous Borreliosis?

Klaus Eisendle MD, PhD, Tanja Grabner MD, Bernhard Zelger MD, MSc
DOI: http://dx.doi.org/10.1309/3369XXFPEQUNEP5C 213-222 First published online: 1 February 2007


Borrelia burgdorferi is difficult to detect in routine biopsy material from patients with skin lesions of borreliosis. In this study, a new immunohistochemical method, focus floating microscopy (FFM), was developed to detect B burgdorferi in tissue sections and was compared with polymerase chain reaction (PCR). By using standard histologic equipment, tissue sections stained with a polyclonal B burgdorferi antibody were simultaneously scanned through 2 planes: horizontally in serpentines and vertically by focusing through the thickness of the section.

Borrelia were detected in 47 of 71 ticks, 34 of 66 tick bites, 30 of 32 erythema chronicum migrans cases, 41 of 43 borrelial lymphocytomas, and 50 of 51 acrodermatitis chronica atrophicans cases. FFM proved to be more sensitive than PCR (96.0% vs 45.2%) and nearly equally specific (99.4% vs 100%). All 169 control cases, except 1 false-positive case of secondary syphilis, were negative with FFM. FFM is an easy, quick, and inexpensive method to reliably detect Borrelia in cutaneous tissue sections.

Key Words:
  • Borreliosis
  • Lyme disease
  • Focus floating microscopy
  • Borrelia burgdorferi
  • Immunohistochemistry
  • Polymerase chain reaction