Clinical characteristics and treatment outcome of early Lyme disease in patients with microbiologically confirmed erythema migrans.
BACKGROUND
Lyme disease has a wide spectrum of clinical manifestations. Diagnosis is usually based on the clinical and serologic picture rather than on microbiological confirmation.


OBJECTIVE
To examine the clinical presentation and treatment outcome of early Lyme disease in patients with microbiologically confirmed erythema migrans.


METHODS
Observational cohort study.


METHODS
31 university-based or clinician-practice sites in 10 endemic states.


METHODS
10 936 participants enrolled in a phase III trial of Lyme disease vaccine; 118 participants had erythema migrans in which Borrelia burgdorferi was detected by culture or polymerase chain reaction.


METHODS
Clinical characteristics and treatment outcome were noted. Skin biopsies of erythema migrans were performed for culture and detection of B. burgdorferi by polymerase chain reaction; serologic responses were determined by Western blot.


RESULTS
The 118 patients with microbiologically confirmed erythema migrans presented a median of 3 days after symptom onset. Early erythema migrans commonly had homogeneous or central redness rather than a peripheral erythema with partial central clearing. The most common associated symptoms were low-grade fever, headache, neck stiffness, arthralgia, myalgia, or fatigue. By convalescence, 65% of patients had positive IgM or IgG antibody responses to B. burgdorferi. Most patients responded promptly to antibiotic treatment.


CONCLUSIONS
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.
Smith
Robert P
RP
Maine Medical Center, Portland, Maine, USA.
Schoen
Robert T
RT
Rahn
Daniel W
DW
Sikand
Vijay K
VK
Nowakowski
John
J
Parenti
Dennis L
DL
Holman
Mary S
MS
Persing
David H
DH
Steere
Allen C
AC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001431:Bacteriological Techniques; D025065:Borrelia burgdorferi / Q000302:isolation & purification*; D015331:Cohort Studies; D004269:DNA, Bacterial / Q000032:analysis; D004311:Double-Blind Method; D015787:Erythema Chronicum Migrans / Q000175:diagnosis* / Q000188:drug therapy* / Q000276:immunology; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D016896:Treatment Outcome; D014481:United States
D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D007074:Immunoglobulin G; D007075:Immunoglobulin M