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Such a possibility should be considered when assessing patients.

Patients with EM should be diagnosed and treated without laboratory confirmation, Two-tiered serological testing, including an ELISA screening test followed by a confirmatory Western blot test, is used to supplement clinical suspicion of extracutaneous LD (Figure 5).

Early, localized (cutaneous) disease: Erythema migrans (EM) – a rash at the site of a recent tick bite – is the most common presentation in children and adults (Figures 3 and 4).5 cm and mainly flat.

There may be central clearing or some bluish discoloration but a classic bull’s eye is uncommon.

Key Words: Lyme disease (LD), a serious disease, is the most common tick-borne infection in Canada and the Northeastern to Midwestern United States, with cases also occurring (with less frequency) on the west coast.

Clinical manifestations are divided into early, localized (cutaneous) disease, and later (extracutaneous) disease.There can be either a single erythema migrans rash or multiple rashes without extracutaneous manifestations.However, fever, malaise, headache, mild neck stiffness, myalgia and arthralgia often accompany EM.Source: Dr L Robbin Lindsay, Research Scientist, Field Studies (for the Public Health Agency of Canada’s Lyme Disease Surveillance Group).EM Erythema migrans; Ig Immunoglobulin Reproduced from reference 14 with permission from the American Society for Microbiology.

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