Clinical Characteristics and Treatment Outcome of Early Lyme Disease in Patients with Microbiologically Confirmed Erythema Migrans

Abstract

In major endemic areas in the United States, Lyme disease commonly presents as erythema migrans with homogeneous or central redness and nonspecific flu-like symptoms. Clinical outcome is excellent if antibiotic therapy is administered soon after symptom onset.

Chronic Lyme Disease: A Review

“…Many studies have shown that Lyme disease is treated successfully with antibiotics in the majority of cases, and patients with objective evidence of treatment failure are rare with currently recommended regimens [11][12][13][14]. Patients with late manifestations can have a slower response to therapy, sometimes taking weeks or months to recover [15][16][17][18][19][20][21][22][23].…”

Lyme Borreliosis - the Utility of Improved Real-Time PCR Assay in Detection of Borrelia burgdorferi Infections

“…The most common clinical manifestation (80% of infected subjects) of early infection of Borrelia burgdorferi sensu lato is localized erythema migrans, which may be followed by disseminated infection affecting the skin, nervous system, heart or joints before late infection [1,4,10,11]. Nevertheless, LD may also be latent, without unequivocal clinical symptoms or may present unspecific symptoms such as headache, myalgia, arthralgias or fever [12,13]. The standard diagnostic procedure of these infections is quite simple if a positive history of tick exposure or typical erythema migrans (clinical hallmark) appears.…”

An Update on the Diagnosis and Treatment of Early Lyme Disease: “Focusing on the Bull's Eye, You May Miss the Mark”

“…However, in a study of 118 cases of EM, in which Borrelia burgdorferi infection was confirmed by culture or polymerase chain reaction, the lesion was homogeneous in 59%, had central erythema in 32% ( Figure 4), and was a "bull's eye" with central clearing in only 9% (2) ( Table 1). The punctum from the original tick bite is present 30% of the time ( Figure 5) (2). EM also may present as a vesicular lesion, as documented in 7-8% of patients ( Figure 6) (2,6).…”

“…The recognition of the early manifestations of LD by Emergency and Primary Care Physicians, as well as other caregivers, is essential, as this condition can progress to a multi-system disease if left untreated (1). One of the reasons for misdiagnosis of early LD is a lack of understanding of the protean morphologic features of erythema migrans (EM), the unique marker of early localized stage 1 disease (2). Delaying the diagnosis of EM because the lesion does not conform to a bull's eye and relying on serologic studies are often the main reasons why physicians "miss the mark" in timely recognition of early LD.…”