To the Editor The Viewpoint on Lyme disease1 contained statements that are not entirely supported by current data. For example, the authors stated that “The vast majority of patients with Lyme disease (≥90%) develop the characteristic skin lesion, erythema migrans.” According to the Centers for Disease Control and Prevention (CDC), only 70% to 80% of patients with Lyme disease reported to its surveillance system have an erythema migrans rash.2 Schutzer et al3 state that erythema migrans may not occur or be recognized in 30% of cases, and studies note uncharacteristic variants of erythema migrans. The general public and even some clinicians find it challenging to decide whether a rash is erythema migrans. Aucott et al4 reported that of 3104 people participating in a rash identification survey, 72.7% correctly identified the classic erythema migrans rash associated with Lyme disease, whereas 24.2% incorrectly identified a tick-bite reaction as erythema migrans. Although 20.5% of participants correctly identified the 4 nonclassic rashes included in the survey, a large percentage of people would be misidentified and potentially not seek prompt medical attention.4 These individuals are at increased risk of developing more severe Lyme disease sequelae, such as posttreatment Lyme disease syndrome, which was not discussed in the article.
Santarella S, Sellati TJ. Controversies About Lyme Disease. JAMA. 2018;320(23):2481–2482. doi:10.1001/jama.2018.17191
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