Early Lyme Disease (Erythema Migrans) and Its Mimics (Southern Tick-Associated Rash Illness and Tick-Associated Rash Illness).

Erythema migrans, an expanding erythematous skin lesion that develops days to weeks following an Ixodes species tick bite, is the most common clinical manifestation of Lyme disease. Presentations in the United States differ somewhat from that in Europe, presumably because of the different etiologic agents. Diagnosis is based on the appearance of the skin lesion, rather than on laboratory testing. After treatment with an appropriate oral antibiotic for 10 to 14 days, the prognosis is excellent. Two conditions that cause a similar skin lesion following a tick bite, but are of unknown cause, are Southern tick-associated rash illness in the United States and tick-associated rash illness in Japan.

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Disclosure G.P. Wormser reports receiving research grants from the Institute for Systems Biology and Pfizer, Inc. He has been an expert witness in malpractice cases involving Lyme disease and is an unpaid board member of the American Lyme Disease Foundation. He is coowner of US Patent No. 11230728 entitled: Differentiation of Lyme disease and Southern Tick-associated rash illness; issue Date: 1/25/22. F. Strle served on the scientific advisory board for Roche on Lyme disease serologic diagnostics, on the scientific advisory board for Pfizer on Lyme disease vaccine, received research support from the Slovenian Research Agency [grant numbers P3-0296, J3-1744, and J3-8195] and is an unpaid member of the steering committee of the ESCMID Study Group on Lyme Borreliosis/ESGBOR.