title: Comparative study of early Lyme disease: Erythema migrans in New York State and Northeastern Poland.
abstract: BACKGROUND
  The objective was to compare the clinical features of early local Lyme Disease: Erythema Migrans (EM) between two highly endemic areas: New York State and Northeastern Poland. Study was based on self reporting questionnaires, physical examination, and laboratory results.
  
  
  METHODS
  Group I (n=27) consisted of citizens from New York State presenting with EM, referred to the study by their physicians. Group II (n=25) consisted of patients treated as outpatients in 1998-1999 at the Department of Infectious Diseases and Neuroinfections, Medical University of Bialystok, Poland. The diagnosis of EM was based on patient history and clinical picture.
  
  
  RESULTS
  Depending on the immune reaction of the host, the clinical picture is variable. The initial symptoms range from discrete to strongly expressed. The inflammatory reaction at the site of tick-bite seems to be milder in Europe than in North America, which is reflected in the prevalence of the annular form of rash and milder expression of general symptoms. Mild or absent general symptoms and the prevalence of the annular over homogenous form are observed in those areas of Europe where Ixodes ricinus is the main vector. In the endemic area of New York State, where Ixodes scapularis mainly occurs, uniform EM with flu-like symptoms is more common.
  
  
  CONCLUSIONS
  There are distinct differences in the typical clinical pictures between the two separated endemic areas of New York State and Northeastern Poland, due to different vectors (saliva components?), bacterial genospecies, likely intermediate hosts and climatic differences. Familiarity with the presenting form of the disease can be very important, especially for primary care physicians.
authors.affiliation: Department of Infectious Diseases and Neuroinfections, Medical University of Bialystok, Poland.
authors.forename: Joanna
authors.initials: J
authors.lastname: Zajkowska
authors.forename: Teresa
authors.initials: T
authors.lastname: Hermanowska-Szpakowicz
authors.forename: Patricia
authors.initials: P
authors.lastname: Coyle
authors.forename: Jolanta
authors.initials: J
authors.lastname: Ostrowska
authors.forename: Slawomir
authors.initials: S
authors.lastname: Pancewicz
authors.forename: Maciej
authors.initials: M
authors.lastname: Kondrusik
mesh_terms: D000328:Adult; D000368:Aged; D004890:Erythema / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D006801:Humans; D008193:Lyme Disease / Q000175:diagnosis* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009518:New York; D011044:Poland; D013997:Time Factors