Lyme disease is a tick-borne infection caused by Borrelia burgdorferi, a spirochetal bacterial pathogen [1] [2]. In approximately 80% of cases, cutaneous manifestations of this infection appear, predominantly in the form of erythema chronicum migrans (or erythema migrans), a pathognomonic finding of Lyme disease. It is described as an erythematous papule or macule at the site of the tick bite [3] [4] [5] [6]. The incubation period is variable (3-30 days), but in the majority of cases, erythema chronicum migrans is seen after 1-2 weeks and can occur on virtually any site of the body [1] [2] [5]. However, the waist, the extremities, the groins, the back, and the head and neck in the pediatric population are most frequent sites [4]. The progression of the erythematous macule, which may be asymptomatic, painful, or pruritic, eventually leads to a "target" or "bull's eye" lesion (as a central clearing around the center of the erythematous lesion is observed), with a diameter of > 5 cm, although a diameter as large as 60 cm has been reported [7] [8]. Numerous reports have confirmed that up to 30% of lesions exhibit significant variations [3] [5] [6] [7]. Firstly, multiple lesions can develop, the reason being the dissemination of the infection [3]. Secondly, an increasing number of cases present only with profound erythema and the absence of central clearing, thus the typical "target" lesion is not a mandatory finding in Lyme disease [5] [6]. Moreover, necrosis of the lesion, central hemorrhage, and formation of bullae are less common, but still possible variants of erythema chronicum migrans [1] [8]. It must be noted that numerous symptoms of Lyme disease can accompany erythema chronicum migrans, such as neurological deficits, fever, neck stiffness (suggesting meningitis), cardiac conduction abnormalities and arthritis (a sign of disseminated disease) [1] [2] [5].

• Fatigue

  This condition is often associated with systemic symptoms such as chills, fever, headache, malaise, nausea, vomiting, fatigue, backache, and stiff neck. [profiles.umassmed.edu]

  This condition is often associated with systemic symptoms such as chills, fever, headache, malaise, nausea, vomiting, fatigue, backache, and stiff neck. synonyms Erythema Chronicum Migrans UMLS ECM - Erythema chronic migrans, ECM - Erythema chronicum [dermis.net]

  […] syndrome: severe and debilitating fatigue Multiple sclerosis: leading to problems with muscle control and strength, vision, balance, sensation, and mental functioning Lupus: joint pain, swelling, may affect kidneys, brain and other organs If you suspect [bayarealyme.org]

• Chills

  This condition is often associated with systemic symptoms such as chills, fever, headache, malaise, nausea, vomiting, fatigue, backache, and stiff neck. [profiles.umassmed.edu]

  This condition is often associated with systemic symptoms such as chills, fever, headache, malaise, nausea, vomiting, fatigue, backache, and stiff neck. synonyms Erythema Chronicum Migrans UMLS ECM - Erythema chronic migrans, ECM - Erythema chronicum [dermis.net]

• Malaise

  This condition is often associated with systemic symptoms such as chills, fever, headache, malaise, nausea, vomiting, fatigue, backache, and stiff neck. [profiles.umassmed.edu]

  This condition is often associated with systemic symptoms such as chills, fever, headache, malaise, nausea, vomiting, fatigue, backache, and stiff neck. synonyms Erythema Chronicum Migrans UMLS ECM - Erythema chronic migrans, ECM - Erythema chronicum [dermis.net]

  The syndrome may include advancing erythematous rash stemming from an apparent insect bite, hyperesthesias, myalgias, malaise, fever, lymphadenopathy, and, rarely, meningitis. [ncbi.nlm.nih.gov]

• Fishing

  Erythema chronicum migrans and salmon fishing in Alaska: an enigma resolved by microbiology laboratory. [pagepressjournals.org]

  ISSN 0028-4793. ↑ Fish, Airley E.; Pride, Yuri B.; Pinto, Duane S. (2008). "Lyme Carditis". Infectious Disease Clinics of North America. 22 (2): 275–288. doi:10.1016/j.idc.2007.12.008. ISSN 0891-5520. ↑ Steere AC, Schoen RT, Taylor E (1987). [wikidoc.org]

  Bakken, Franc Strle, Gerold Stanek, Linda Bockenstedt, Durland Fish, J. Stephen Dumler, Robert B. [dermnetnz.org]

• Chronic Infection

  Patients with chronic infections can be treated with a variety of medications, depending on the symptoms they experience. [wisegeek.com]

  Clin Infect Dis. 2006;43(9):1089–1134. 21. Marques A. Chronic Lyme disease: a review. Infect Dis Clin North Am. 2008;22(2):341–360, viiviii. 22. Lipsker D, Lieber-Mbomeyo A, Hedelin G. [web.archive.org]

• Nausea

  This condition is often associated with systemic symptoms such as chills, fever, headache, malaise, nausea, vomiting, fatigue, backache, and stiff neck. [profiles.umassmed.edu]

  This condition is often associated with systemic symptoms such as chills, fever, headache, malaise, nausea, vomiting, fatigue, backache, and stiff neck. synonyms Erythema Chronicum Migrans UMLS ECM - Erythema chronic migrans, ECM - Erythema chronicum [dermis.net]

• Vomiting

  This condition is often associated with systemic symptoms such as chills, fever, headache, malaise, nausea, vomiting, fatigue, backache, and stiff neck. [profiles.umassmed.edu]

  This condition is often associated with systemic symptoms such as chills, fever, headache, malaise, nausea, vomiting, fatigue, backache, and stiff neck. synonyms Erythema Chronicum Migrans UMLS ECM - Erythema chronic migrans, ECM - Erythema chronicum [dermis.net]

• Myalgia

  General symptoms such as headache, fever, myalgia and/or arthralgia were found in about half of the patients with a disease duration of less than or equal to 3 weeks. Three patients had coexisting lymphadenosis benigna cutis. [ncbi.nlm.nih.gov]

  He denied fever, chill, headache, neck stiffness, myalgia, arthralgia, fatigue, or pruritus. Early Lyme disease was diagnosed on the basis of erythema chronicum migrans and exposure in an endemic area. [jaoa.org]

  Associated symptoms ranged from none to malaise, fatigue, chills and fever, headache, stiff neck, backache, myalgias, nausea, vomiting, and sore throat. Three patients had been bitten by ticks at the site of the… CONTINUE READING [semanticscholar.org]

• Erythema

  This graph shows the total number of publications written about "Erythema Chronicum Migrans" by people in this website by year, and whether "Erythema Chronicum Migrans" was a major or minor topic of these publications. [profiles.umassmed.edu]

  PMID: 6465906 Erythema chronicum migrans of Lyme disease B W Berger. Arch Dermatol. 1984 Aug. Abstract Erythema chronicum migrans (ECM) is the distinctive cutaneous lesion of the multisystem tick-borne spirochetosis, Lyme disease. [pubmed.ncbi.nlm.nih.gov]

  […] migrans, Erythema chronica migrans, Erythema Chronicum Migrans, Erythema, chronicum migrans, Erythema, migrans, chronicum [dermis.net]

• Papule

  The site of the bite is characterized by a red papule that expands peripherally as a nonscaling, palpable band that clears centrally. [profiles.umassmed.edu]

  The histological picture shows a logical localization of a lymphohistiocytic cell infiltrate: deep dermal in the central papule and superficial in the erythematous border. [ncbi.nlm.nih.gov]

• Skin Rash

  The red skin rash is present as a characteristic bull’s eye rash that gradually increases in size. [dovemed.com]

  —Carrie Arnold, Popular Science, 28 June 2020 Typical symptoms include fever, headache, fatigue, and a characteristic skin rash called erythema migrans. [merriam-webster.com]

  Typical symptoms include fever, headache, fatigue, and a characteristic skin rash called erythema migrans. If left untreated, infection can spread to joints, the heart, and the nervous system. [microbiologyinpictures.com]

  Without a telltale skin rash, it can be very hard to diagnose Lyme disease. Many people never recall being bitten. [bayarealyme.org]

• Dermatitis

  […] hypersensivity reaction to Insect Bite Typically Course Onset while tick still attached Starts to resolve within 48 hours Distinguish from Erythema Migrans Mark margins Observe for 48 hours off antibiotics Improvement suggests not a Lyme Disease rash Contact Dermatitis [fpnotebook.com]

  Page Excerpt: Images 10.9.1A: Perivascular and interstitial dermatitis + 10.9.1B: Lymphocytes, plasma cells, and eosinophils = Borreliosis In the United States, the findings pictured here are termed “erythema chronicum migrans” and are considered to be [derm101.com]

  Página 516 - Werner Y, Lindberg M: Transepidermal water loss in dry and clinically normal skin in patients with atopic dermatitis. Acta Derm Venereol (Stockh) 1985;65:102-105. ‎ [books.google.es]

• Pruritus

  2003 Patient details Age Elderly patient Localisation Trunk / abdomen Primary Lesions Excoriation Papule / erythematous Plaque / erythematous Pathophysiology infectious diseases / bacterial infections / Borelliosis / erythema chronicum migrans Symptoms Pruritus [dermquest.com]

  […] reaction to Insect Bite Typically Course Onset while tick still attached Starts to resolve within 48 hours Distinguish from Erythema Migrans Mark margins Observe for 48 hours off antibiotics Improvement suggests not a Lyme Disease rash Contact Dermatitis Pruritus [fpnotebook.com]

  He denied fever, chill, headache, neck stiffness, myalgia, arthralgia, fatigue, or pruritus. Early Lyme disease was diagnosed on the basis of erythema chronicum migrans and exposure in an endemic area. [jaoa.org]

• Headache

  This condition is often associated with systemic symptoms such as chills, fever, headache, malaise, nausea, vomiting, fatigue, backache, and stiff neck. [profiles.umassmed.edu]

  This condition is often associated with systemic symptoms such as chills, fever, headache, malaise, nausea, vomiting, fatigue, backache, and stiff neck. synonyms Erythema Chronicum Migrans UMLS ECM - Erythema chronic migrans, ECM - Erythema chronicum [dermis.net]

  General symptoms such as headache, fever, myalgia and/or arthralgia were found in about half of the patients with a disease duration of less than or equal to 3 weeks. Three patients had coexisting lymphadenosis benigna cutis. [ncbi.nlm.nih.gov]

• Dizziness

  Intermittent pain in tendons, muscles, joints, and bones Heart palpitations or an irregular heart beat ( Lyme carditis ) Episodes of dizziness or shortness of breath Inflammation of the brain and spinal cord Nerve pain Shooting pains, numbness, or tingling [cdc.gov]

  If left untreated, Lyme disease can cause: joint inflammation and pain irregular heartbeat shortness of breath hand and foot numbness facial palsy (droop or loss of muscle tone on one or both sides of the face) dizziness short-term memory loss If treated [healthline.com]

• Vertigo

  Sleep Apnea Splenomegaly Streptococcal Pharyngitis Stroke Stroke, Hemorrhagic Temporal Arteritis Thoracic Aortic Dissection Upper Gastrointestinal Bleed Urinary Incontinence, Women Urinary Tract Infection, Child Urinary Tract Infection, Women Vaginitis Vertigo [jamaevidence.mhmedical.com]

  Patients may also present with blood behind the tympanic membrane, sensory deafness, and vertigo; the latter two symptoms due to damage to vestibulocochlear nerve and the inner ear. [en.wikipedia.org]

  "Borrelia infection and vertigo". Acta Otolaryngol. 106 (1–2): 111–6. PMID 3421091. ↑ Moscatello AL, Worden DL, Nadelman RB, Wormser G, Lucente F (1991). "Otolaryngologic aspects of Lyme disease". Laryngoscope. 101 (6 Pt 1): 592–5. [wikidoc.org]

  Typical associated findings depend on the nerve affected and can include visual or auditory disturbances, facial paresthesia, and/or vertigo. [emedicine.medscape.com]

• Insomnia

  […] months after treatment patients and controls were asked to complete a written questionnaire asking whether they had had any of 14 nonspecific symptoms (fatigue, malaise, arthralgias, headache, myalgias, pain in the spine, paresthesias, dizziness, nausea, insomnia [clinicaltrials.gov]

  Rarely, late disease may present as a subtle, subacute encephalopathy or axonal polyneuropathy that usually manifests as altered mentation, cognitive impairment, insomnia, or personality changes. 3, 16, 17 Cardiac involvement usually occurs within one [web.archive.org]

The importance of recognizing erythema chronicum migrans lies in the fact that up to 60% of patients have negative serology tests for B. burgdorferi in the first several weeks of the infection [5]. For this reason, a meticulous physical examination supported by data obtained during patient history is the pivotal step in confirming Lyme disease and observing its hallmark lesion [6]. Physicians must inquire whether patients reside in or have recently visited at-risk areas, and note the signs and symptoms that possibly suggest an infectious etiology, while the course and progression of the skin lesion should also be discussed with the patient (if the patient had noticed the lesion etc.). The entire body should be examined in order to exclude multiple erythema chronicum migrans, and a close inspection, as well as palpation of the lesion, is vital for raising clinical suspicion of Lyme disease as a potential diagnosis [1] [2] [4] [7] [8]. Physicians must be aware of the incubation period of erythema chronicum migrans, its variable presentation, and the broad differential diagnosis [4]. In all patients in whom this lesion is suspected, microbiological investigation to confirm Lyme disease is mandatory. As serologic testing may be initially negative, blood cultures, biopsy samples of the lesion and polymerase chain reaction (PCR) testing can be implemented [1] [2] [5] [6]. But because of their limited use and sensitivity/specificity in the absence of erythema chronicum migrans, clinical assessment remains the most important part of Lyme disease workup.

• Borrelia Burgdorferi

  Borrelia japonica B. Borrelia burgdorferi C. Borrelia andersonii D. Borrelia recurrentis Correct answer : B. Borrelia burgdorferi Erythema chronicum migrans Erythema chronicum migrans is a rash often seen in the early stages of Lyme disease. [pgblazer.com]

  LABC 31 1988 Complete heart block in a dog seropositive for Borrelia burgdorferi. Similarity to human Lyme carditis. AV 32 1987 Early detection and persistence of antibodies to Borrelia burgdorferi in persons with Lyme disease. [allie.dbcls.jp]

  Cited by A systematic review of Borrelia burgdorferi morphologic variants does not support a role in chronic Lyme disease. Lantos PM, Auwaerter PG, Wormser GP. Lantos PM, et al. Clin Infect Dis. 2014 Mar;58(5):663-71. doi: 10.1093/cid/cit810. [pubmed.ncbi.nlm.nih.gov]

  ELISA for Borrelia burgdorferi was performed, with serological testing being negative for antibodies against B. burgdorferi. [symbiosisonlinepublishing.com]

  Lyme disease is a tick-borne infection caused by Borrelia burgdorferi, a spirochetal bacterial pathogen. [symptoma.com]

[…] received a recommended treatment and in 1 of the 3 patients who received other treatments. [ncbi.nlm.nih.gov]

Antibiotic Treatment of Multiple Erythema Migrans migrans Lyme borreliosis ceftriaxone treatment doxycycline treatment outcome subjective symptoms Additional relevant MeSH terms: Layout table for MeSH terms Erythema Erythema Chronicum Migrans Glossitis [tripdatabase.com]

Annals of the New York Academy of Sciences 1988 Between June 1981 and July 1987 the efficacy of antibiotic treatment of 215 patients with erythema chronicum migrans of Lyme… (More) Bernard W. [semanticscholar.org]

These patients had uneventful recoveries following treatment with systemic antibiotics. Thirty-four skin biopsy specimens were obtained from the ECM lesions of 30 patients. [pubmed.ncbi.nlm.nih.gov]

The prognosis in most patients with Lyme borreliosis is excellent. [ncbi.nlm.nih.gov]

Babesia microti Prognosis the rash typically self-resolves without treatment untreated Lyme disease can result in arthritis excellent prognosis with early antibiotic treatment Presentation Symptoms early localized stage erythema migrans (7-14 days post-tick [step2.medbullets.com]

Similar articles Diagnosis, treatment, and prognosis of erythema migrans and Lyme arthritis. Feder HM Jr, Abeles M, Bernstein M, Whitaker-Worth D, Grant-Kels JM. Feder HM Jr, et al. [pubmed.ncbi.nlm.nih.gov]

These results suggest an etiologic role for the Ixodes ricinus spriochete in European erythema chronicum migrans disease. [ncbi.nlm.nih.gov]

ELISA 38 1986 [Etiology of acrodermatitis chronica atrophicans and erythema chronicum migrans]. [allie.dbcls.jp]

ELISA, IFA, Ig 33 1987 Epidemiology of borrelia infections in Austria. [allie.dbcls.jp]

Weekly Epidemiological Record = Relevé épidémiologique hebdomadaire, 62 (‎51-52)‎, 386 - 387. https://apps.who.int/iris/handle/10665/226543 Журнал Weekly Epidemiological Record = Relevé épidémiologique hebdomadaire, 62 (‎51-52)‎: 386 - 387 [apps.who.int]

Lyme disease can present with neurologic abnormalities without diagnostic extraneural features, can be suspected on clinical and epidemiologic grounds, and can be diagnosed serologically. [ncbi.nlm.nih.gov]

[…] erythema chronicum migrans Member Rated 0 Patient case no. 4085 Date added 27 July 2003 Patient details Age Elderly patient Localisation Trunk / abdomen Primary Lesions Excoriation Papule / erythematous Plaque / erythematous Pathophysiology infectious [dermquest.com]

Erythema Annulare Centrifugum (Overview) Erythema Annulare Centrifugum: Background, Pathophysiology, Etiology Edition: No Results No Results Please confirm that you would like to log out of Medscape. [tripdatabase.com]

The symptoms of EPC have been interpreted to be due to cortical hyperexcitability, but the exact pathophysiology is poorly understood due to a high degree of variability. [ncbi.nlm.nih.gov]

Prevention Avoid exposure to tick bites. Remove ticks as soon as possible. Ticks take some time to transmit infection, so this may be prevented if removed quickly. [patient.info]

Abstract The efficacy of antibiotic treatment of 117 patients with erythema chronicum migrans of Lyme disease was evaluated in terms of the necessity for retreatment and the prevention of the late manifestations of Lyme disease. [ncbi.nlm.nih.gov]

The Centers for Disease Control and Prevention (CDC) definition is “erythema migrans (EM), the initial skin lesion that occurs in 60%–80% of patients. [doi.org]

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7. Schutzer SE, Berger BW, Krueger JG, Eshoo MW, Ecker DJ, Aucott JN. Atypical Erythema Migrans in Patients with PCR-Positive Lyme Disease. Emerg Infect Dis. 2013;19(5):815-817.
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