Robert P. Smith, MD, MPH; Robert T. Schoen, MD; Daniel W. Rahn, MD; Vijay K. Sikand, MD; John Nowakowski, MD; Dennis L. Parenti, MD; Mary S. Holman, BA; David H. Persing, MD, PhD; Allen C. Steere, MD
Acknowledgments: The authors thank the vaccine trial participants, investigators of the Lyme Disease Vaccine Study Group, and SmithKline Beecham Pharmaceuticals for data in this report. They also thank Peter Rand, Eleanor Lacombe, and Charles Lubelczyk at the Lyme Disease Laboratory at Maine Medical Center Research Institute for advice and support.
Grant Support: By SmithKline Beecham Pharmaceuticals.
Requests for Single Reprints: Robert P. Smith, MD, Maine Medical Center Research Institute, Lyme Disease Research Laboratory, 13 Charles Street, Third Floor, Portland, ME 04102-3109.
Current Author Addresses: Dr. Smith and Ms. Holman: Maine Medical Center Research Institute, Lyme Disease Research Laboratory, 13 Charles Street, Third Floor, Portland, ME 04102.
Dr. Schoen: Yale University, 60 Temple Street, New Haven, CT 06510.
Dr. Rahn: Medical College of Georgia, 1120 15th Street, Augusta, GA 30912.
Dr. Sikand: PO Box 610, East Lyme, CT 06333.
Dr. Nowakowski: New York Medical College, Munger Pavilion, Division of Infectious Disease, Valhalla, NY 10595.
Dr. Parenti: Wyeth-Ayerst Pharmaceuticals, 555 East Lancaster Avenue, Third Floor, St. Davids, PA 19101-8299.
Dr. Persing: Corixa Corporation, IDRI, 1124 Columbia Street, Seattle, WA 98104.
Dr. Steere: New England Medical Center 406, 750 Washington Street, Boston, MA 02111.
Author Contributions: Conception and design: R.P. Smith, R.T. Schoen, D.W. Rahn, M.S. Holman, A.C. Steere.
Analysis and interpretation of the data: R.P. Smith, R.T. Schoen, D.W. Rahn, M.S. Holman, D.H. Persing, A.C. Steere.
Drafting of the article: R.P. Smith, M.S. Holman, D.H. Persing, A.C. Steere.
Critical revision of the article for important intellectual content: R.P. Smith, D.W. Rahn, V.K. Sikand, J. Nowakowski, D.L. Parenti, M.S. Holman, D.H. Persing, A.C. Steere.
Final approval of the article: R.P. Smith, R.T. Schoen, D.W. Rahn, V.K. Sikand, J. Nowakowski, D.L. Parenti, M.S. Holman, D.H. Persing, A.C. Steere.
Provision of study materials or patients: R.P. Smith, R.T. Schoen, V.K. Sikand, J. Nowakowski, D.L. Parenti.
Statistical expertise: R.P. Smith.
Obtaining of funding: A.C. Steere.
Administrative, technical, or logistic support: R.P. Smith, D.L. Parenti, M.S. Holman, D.H. Persing, A.C. Steere.
Collection and assembly of data: R.P. Smith, R.T. Schoen, V.K. Sikand, J. Nowakowski, D.L. Parenti, M.S. Holman, A.C. Steere.
Smith R., Schoen R., Rahn D., Sikand V., Nowakowski J., Parenti D., Holman M., Persing D., Steere A.; Clinical Characteristics and Treatment Outcome of Early Lyme Disease in Patients with Microbiologically Confirmed Erythema Migrans. Ann Intern Med. 2002;136:421-428. doi: 10.7326/0003-4819-136-6-200203190-00005
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Published: Ann Intern Med. 2002;136(6):421-428.
Lyme disease in the United States is caused by the tick-transmitted spirochete Borrelia burgdorferi sensu stricto (1). This infection is the most common vector-borne disease in the country (2). The illness usually presents with localized infection of the skin, erythema migrans, which is often followed days to a few weeks later by dissemination of the spirochete to multiple sites, particularly to other skin sites, the nervous system, the heart, or the joints (3). Borrelia burgdorferi has been cultured readily from skin biopsy samples of erythema migrans early in the illness (4, 5), but later culture from other sites has been difficult. As a substitute for culture, B. burgdorferi DNA may be detected by polymerase chain reaction (PCR) in most patients with erythema migrans (6, 7) and in the joint fluid of patients with Lyme arthritis (8, 9). However, PCR has had low sensitivity in samples from other sites, including cerebrospinal fluid and blood. Serodiagnosis is not sensitive during the first several weeks of infection, but patients often seroconvert during convalescence (10).
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