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  • JAMA June 20, 2007

    Figure 4: Patients With Erythema Migrans

    A, Central portion of rash suggests clearing. B, The presence of multiple descrete lesions on the back indicates hematogenous spread of the spirochete. (Photograph courtesy of Ryan Friedberg, MD.)
  • JAMA June 20, 2007

    Figure 3: Morphology and Approximate Geographic Distribution of Tick Vectors in the Continental United States

    The enlarged tick illustrations are sized according to the same scale shown in each panel. The actual size of the ticks are shown in the circles. Top panel, tick vectors for Lyme disease. The morphology of I pacificus is similar to that of I scapularis (shown). Middle panel, tick vector (A americanum) for southern tick-associated rash illness (STARI). Erythema migrans is a manifestation of both Lyme disease and STARI. The ticks in the bottom panel are included for comparison; these ticks are the major vectors of Rickettsia rickettsii, the causative agent of Rocky Mountain Spotted Fever. The morphology of D andersoni is similar to that of D variabilis (shown). Geographic distributions are approximate and will vary over time. The distribution maps are based on data from the Centers for Disease Control and Prevention (http://www.cdc.gov/ncidod/dvrd). Distribution data for A americanum and D variabilis are updated based on information provided by John F. Anderson, PhD, The Connecticut Agricultural Experiment Station, New Haven (written communication, May 22, 2007).
  • Does This Patient Have Erythema Migrans?

    Abstract Full Text
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    JAMA. 2007; 297(23):2617-2627. doi: 10.1001/jama.297.23.2617
  • JAMA November 24, 1999

    Figure: Western Blot Immunoreactivity From a Patient With Early Seropositive Erythema Migrans (Group 2)

    Top, Immunoreactivity of serum and serum immune complex antibodies to antigens of whole Borrelia burgdorferi B31 sonicates. Lanes 1, 2, and 3 show reactivity using monoclonal antibodies. Lane 1 is the reactivity of monoclonal antibody H3TS to 31-kd outer surface protein A (OspA). Lane 2 is the reactivity of monoclonal antibody H68 to 34-kd outer surface protein B (OspB). Lane 3 is the reactivity of monoclonal antibody H9724 to 41-kd flagellin. Reactivity of the patient's free and immune complexed antibody is represented as follows: lane 4 is free IgG, lane 5 is immune complexed IgG lane 6 is free IgM, and lane 7 is immune complexed IgM. Bottom, OspA antigen detection in the dissociated immune complexes. Isolated and dissociated serum immune complexes were electrophoresed, blotted, and probed with rabbit polyclonal antibody and rabbit anti-OspA. Lane 1 is whole B burgdorferi B31 sonicate, probed with the polyclonal antibody, shown for comparison. Rabbit anti-OspA reactivity is shown in lanes 2 and 3. Lane 2 is the patient's immune complexed antigen. Lane 3 is the recombinant OspA. Molecular weights determined by monoclonal antibodies are indicated on the left.