This is a characteristic clinical feature of Lyme borreliosis, occurring in approximately 90% of patients infected with Borrelia burgdorferi transmitted to humans by the bite of ticks from the genus Ixodes.
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- Lyme disease occurs in temperate regions of North America, Europe and Asia.
- In some countries of Europe the incidence of Lyme disease has been estimated to be over 100 per 100,000 people a year.
- The characteristic manifestation of early Lyme disease (stage 1) is erythema migrans: a circular rash at the site of the infectious tick attachment, which radiates from the bite, within 2-40 days.
- It starts as a red macule or papule at the site of the tick bite after a 7- to 10-day delay.
- Common areas include the popliteal fossa, groin, the axilla, the thorax and the trunk The hairline and scalp are especially common in children.
- It is associated with other symptoms of infection, including fatigue, myalgia, arthralgia, headache, fever, chills, stiff neck, and regional lymphadenopathy.
- It is also associated with carditis, neurological disease, arthritis, and acrodermatitis chronica atrophicans (a swollen, bluish-red skin lesion on a distal extremity).
- Culture, serology and skin biopsy may be necessary for diagnosis.
Although the rash will resolve spontaneously, antibiotics hasten resolution and help prevent progression to Lyme disease:
- Doxycycline is the antibacterial of choice for early Lyme disease.
- Amoxicillin or cefuroxime are alternatives if doxycycline is contra-indicated.
- Macrolides such as azithromycin or clarithromycin should be reserved as third-line treatment as they are not as effective as the aforementioned antibiotics.
- The duration of treatment recommended is 2-4 weeks.
- Avoid exposure to tick bites.
- Antibiotic prophylaxis can be offered in endemic areas under certain circumstances if the tick bite can be positively identified.
Further reading & references
- Erythema chronicum migrans, DermIS (Dermatology Information System)
- Edlow J; Erythema Chronicum Migrans, eMedicine, May 2010
- British National Formulary
- Wormser GP, Dattwyler RJ, Shapiro ED et al.; The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006 Nov 1;43(9):1089-134. Epub 2006 Oct 2.
|Original Author: Dr Laurence Knott||Current Version: Dr Laurence Knott|
|Last Checked: 20/12/2010||Document ID: 957 Version: 23||© EMIS|
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