The article by Fredrickson et al and accompanying Invited Commentary by Edlow in this issue of the Archives highlight a disease entity that can be difficult to diagnose but easily treated if diagnosed early. Recently, I seem to have had increasingly frequent discussions with colleagues and patients about Lyme disease. In addition to submissions for this series highlighting the cardiac sequelae that are rare, discussions have included whether to treat a rash without a known tick bite from a high-prevalence area and whether a rash that developed within a few hours of a tick bite was due to infection or a hypersensitivity reaction.
There is evidence that suggests that the geographic range of Lyme disease is increasing. This means it is worth updating your knowledge of the prevalence for your area using the Centers for Disease Control and Prevention interactive map (http://www.cdc.gov/lyme/stats/maps/interactiveMaps.html) and current treatment recommendations (http://www.idsociety.org/uploadedFiles/IDSA/Topics_of_Interest/Lyme_Disease/IDSALymeDiseaseFinalReport.pdf). For patients who present with a known tick bite and rash, Lyme disease must be seriously considered, and for patients who present with tick exposure and recent febrile illness in high- prevalence areas, this diagnosis should still be considered, as highlighted in the case by Fredrickson et al.
Tabas JA. Recognition of Lyme in Time: Comment on “Infecting the Electrocardiogram”. Arch Intern Med. 2012;172(21):1627. doi:10.1001/2013.jamainternmed.685