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Recognition and Treatment of Erythema Migrans: Are We Off Target?

Robert B. Nadelman, MD; and Gary P. Wormser, MD
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Drs. Nadelman and Wormser: New York Medical College; Lyme Disease Diagnostic Center of Westchester Medical Center


Disclaimer: The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the New York State Department of Health.

Grant Support: In part by the Tick-borne Diseases Institute of the New York State Department of Health (C-015088).

Requests for Single Reprints: Robert B. Nadelman, MD, New York Medical College, Division of Infectious Diseases, Munger Pavilion, Second Floor, Valhalla, NY 10595.

Current Author Addresses: Drs. Nadelman and Wormser: New York Medical College, Division of Infectious Diseases, Munger Pavilion, Second Floor, Valhalla, NY 10595.


Ann Intern Med. 2002;136(6):477-479. doi:10.7326/0003-4819-136-6-200203190-00012
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The clinical manifestation most closely associated with Lyme disease is the rash that develops at the site of a bite from an Ixodes scapularis tick. Erythema migrans is present in at least 90% of objective cases of Lyme disease (1). Although it usually resolves spontaneously (that is, without any antimicrobial therapy), it may be the forerunner, in untreated patients, of cardiac, neurologic, or arthritic conditions, causing significant morbidity (12). These sequelae generally respond to antibiotics (13). However, treatment of patients with erythema migrans is usually highly effective in preventing the development of these complications (13).

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