Bullseye! Lyme Disease Without the Rash

Lyme disease BullseyeWith the weather finally starting to warm up, if you’re anything like me, you probably can’t wait to get outdoors and get active. However, and with apologies for being a Debbie Downer, we want to remind you that warmer weather also means that ticks become more active and are more likely to bite you, your kids and your pets. Just being outside in the garden could put you at risk of tick-borne diseases such as Lyme.

Should you contract Lyme disease, quick diagnosis and treatment are essential to avoiding long term complications. However, the diagnostic process may be delayed if the skin rash caused by Lyme disease does not have the typical bull’s-eye appearance.

A Research Letter just published in the CDC journal Emerging Infectious Diseases, shows that Lyme disease has been identified in patients with skin lesions that more closely resemble the classic signs of conditions such as contact dermatitis, lupus, insect or spider bites.

Based on these findings they urge doctors to consider Lyme disease when presented with patients complaining of such lesions, particularly when they have been in an area where Lyme disease is endemic.

The research team led by Steven E, Schutzer, MD, Professor of Medicine at the University of Medicine and Dentistry of New Jersey-New Jersey Medical School, studied 14 patients.

borrelia_burgdorferiAn advanced diagnostic technique, based upon polymerase chain reaction (PCR) testing was used to identify Borrelia burgdorferi, the bacterium that causes Lyme disease. Unlike existing methods, the new technique is able to detect evidence of B. burgdorferi early, even in cases where the bacterium is still at low levels in the bloodstream, and sooner than traditional antibody tests, which may require several weeks before becoming positive. It also is able to distinguish between new infections and prior exposure to B. burgdorferi.

Of the patients analyzed, ten were found to have strong microbiologic evidence of Lyme disease, despite the fact that they had presented with skin lesions that differed markedly from the classic bull’s-eye pattern. In fact, not all patients with Lyme disease will even have a rash.

tick biteBased on this finding, Schutzer says, “Doctors who see a rash in a patient who has been in an area where Lyme disease frequently occurs should be alert to the fact that the Lyme disease rash does not have to look like a bull’s-eye, ring-within-a ring. The rash may look different. Doctors should search carefully both for other signs that might suggest Lyme disease, such as flu-like symptoms, and equally for signs that may point towards other conditions. Early diagnosis of most diseases gives the best chance for a cure. This is especially true for Lyme disease.”

So, this summer, make sure your doctor isn’t in a rush to take any rash decisions about ruling out a diagnosis of Lyme Disease.

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