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

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; and Allen C. Steere, MD
[+] Article and Author Information

From Maine Medical Center, Portland, Maine; Yale University School of Medicine, New Haven, Connecticut; Medical College of Georgia, Augusta, Georgia; Tufts University School of Medicine and New England Medical Center, Boston, Massachusetts; New York Medical College, Valhalla, New York; SmithKline Beecham, Collegeville, Pennsylvania; and Corixa Corporation, Seattle, Washington.


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.


Ann Intern Med. 2002;136(6):421-428. doi:10.7326/0003-4819-136-6-200203190-00005
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During the 20-month study period, which covered two summers of Lyme disease transmission, 1917 of the 10 936 study participants were evaluated for possible Lyme disease (19). Of the 1917 patients, 146 (7.6%) met study criteria for definite Lyme disease, and 118 (6.2%) had microbiological confirmation of this infection by culture or PCR testing of erythema migrans. The mean age of these 118 patients was 51 years (range, 17 to 71 years); 53% were men, and 47% were women. Forty-seven percent were from New England, 51% were from mid-Atlantic states, and 2% were from Wisconsin, reflecting the locations of the study sites. June and July were the peak months of disease onset, which correlated with the expected peak questing period of nymphal Ixodes scapularis ticks. However, cases occurred from March through October, suggesting that adult ticks may also transmit the disease. Vaccine and placebo recipients did not differ in the size of erythema migrans, persistence of symptoms after treatment, and morphologic characteristics of the lesions. In addition, no clinical differences were noted in different geographic areas. Therefore, we present data from vaccine and placebo recipients and from different geographic areas together.

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Figures

Grahic Jump Location
Figure 1.
Erythema migrans with central erythema or central clearing.Top.Bottom.

Bull's-eye lesion, 7 cm in diameter, that had been present for 11 days. 9-cm lesion that had been present for 18 days and exhibits marked central clearing.

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Grahic Jump Location
Figure 2.
Predominantly homogeneous patterns in erythema migrans.Top.Middle.Bottom.

Lesion, 10 cm in diameter, that had been present for 7 days; it has slight vesiculation in the center. Homogeneous lesion, 11 cm in diameter, that had been present for 7 days; no target formation or central clearing is seen. 7-cm lesion, present for 12 days, that has some degree of central erythema.

Grahic Jump Location
Grahic Jump Location
Figure 3.
Central vesiculation of erythema migrans.

An area of intense vesiculation can be seen at the center of this 10-cm lesion, which had been present for 5 days.

Grahic Jump Location

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Summary for Patients

Rashes and Symptoms in Early Lyme Disease

The summary below is from the full report titled “Clinical Characteristics and Treatment Outcome of Early Lyme Disease in Patients with Microbiologically Confirmed Erythema Migrans.” It is in the 19 March 2002 issue of Annals of Internal Medicine (volume 136, pages 421-428). The authors are RP Smith, RT Schoen, DW Rahn, VK Sikand, J Nowakowski, DL Parenti, MS Holman, DH Persing, and AC Steere. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians–American Society of Internal Medicine.

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