How Accurate Is a Clinical Diagnosis of Erythema Chronicum Migrans? Prospective Study Comparing the Diagnostic Accuracy of General Practitioners and Dermatologists in an Area Where Lyme Borreliosis Is Endemic

Lipsker, Dan; Lieber-Mbomeyo, A.; Hédelin, Guy

doi:10.1001/archderm.140.5.620

Cited by 30 publications

(14 citation statements)

References 4 publications

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“…4,37 In the present study, the clinical diagnosis was made in accordance with defined criteria 3,4,38 by dermatologists with recognition rates of EM greater than 90%. 39 Furthermore, the clinical diagnosis was substantiated by a typical histopathologic picture, and a positive polymerase chain reaction for B burgdorferi-specific DNA, or cultivation of B burgdorferi in 48% and 57% of these patients for IgG and IgM, respectively. Before therapy, IgG or IgM antibodies to B burgdorferi are lacking in approximately 50% of all patients with EM, particularly in those with shorter disease duration 6,10,32,40 because seroconversion does not occur before 2 to 4 weeks of infection.…”

Section: Commentmentioning

confidence: 95%

Clinical Relevance of Different IgG and IgM Serum Antibody Responses to Borrelia burgdorferi After Antibiotic Therapy for Erythema Migrans

Glatz¹,

Golestani²,

Kerl³

et al. 2006

Arch Dermatol

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Section: Commentmentioning

confidence: 95%

Clinical Relevance of Different IgG and IgM Serum Antibody Responses to Borrelia burgdorferi After Antibiotic Therapy for Erythema Migrans

Glatz¹,

Golestani²,

Kerl³

et al. 2006

Arch Dermatol

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“…While this survey did not target health care professionals, there is some evidence to suggest that physicians are limited in their ability to correctly identify the EM accompanying LD [14]. Another area for future research would be further investigating health provider's ability to accurately identify EM.…”

Section: Discussionmentioning

confidence: 99%

“…However, a review of the published literature on LD has documented both under- and overdiagnosis of the EM rash of LD [12, 13]. Additionally, a study showed that up to 72% of physicians surveyed are not able to correctly identify the EM accompanying LD [14] when shown both EM as well as other rashes common in an ambulatory population. Early diagnosis of LD is dependent on patients seeking evaluation, which depends on patients' ability to recognize rashes or skin lesions that have a high probability of being EM.…”

Section: Introductionmentioning

confidence: 99%

Bull’s-Eye and Nontarget Skin Lesions of Lyme Disease: An Internet Survey of Identification of Erythema Migrans

Aucott

Crowder²,

Yedlin³

et al. 2012

Dermatology Research and Practice

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Introduction. Lyme disease is an emerging worldwide infectious disease with major foci of endemicity in North America and regions of temperate Eurasia. The erythema migrans rash associated with early infection is found in approximately 80% of patients and can have a range of appearances including the classic target bull's-eye lesion and nontarget appearing lesions. Methods. A survey was designed to assess the ability of the general public to distinguish various appearances of erythema migrans from non-Lyme rashes. Participants were solicited from individuals who visited an educational website about Lyme disease. Results. Of 3,104 people who accessed a rash identification survey, 72.7% of participants correctly identified the classic target erythema migrans commonly associated with Lyme disease. A mean of 20.5% of participants was able to correctly identify the four nonclassic erythema migrans. 24.2% of participants incorrectly identified a tick bite reaction in the skin as erythema migrans. Conclusions. Participants were most familiar with the classic target erythema migrans of Lyme disease but were unlikely to correctly identify the nonclassic erythema migrans. These results identify an opportunity for educational intervention to improve early recognition of Lyme disease and to increase the patient's appropriate use of medical services for early Lyme disease diagnosis.

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“…In one study, 72% of the patients with EM were correctly diagnosed in general practice, whereas 23% of patients with other dermatological conditions were given the diagnosis as well. Proper training seemed to improve the clinical diagnosis skills of the GPs [21]. …”

Section: Introductionmentioning

confidence: 99%

Symptom load and general function among patients with erythema migrans: a prospective study with a 1-year follow-up after antibiotic treatment in Norwegian general practice

Eliassen

Hjetland

Reiso³

et al. 2017

Scandinavian Journal of Primary Health Care

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ObjectivePromptly treated erythema migrans (EM) has good prognosis. However, some patients report persistent symptoms. Do patients with EM have more symptoms than the general population? We describe individual symptoms and general function in EM-patients at time of diagnosis and one year after treatment.DesignProspective study with 1-year follow up after treatment. Questionnaires included a modified version of the Subjective Health Complaints Inventory, comprising three additional Lyme borreliosis (LB) related symptoms. General function was assessed using a five-point scale modified from the COOP/WONCA charts.SettingNorwegian general practice.SubjectsA total of 188 patients were included in a randomized controlled trial comparing three antibiotic regimens for EM, of whom 139 had complete data for this study.Main outcome measuresIndividual symptoms, symptom load and general function.ResultsMild symptoms were common, reported by 84.9% at baseline and by 85.6% at follow-up. At baseline, patients reported a mean of 5.4 symptoms, compared with 6.2 after one year. Severely bothersome symptoms and severely impaired general function were rare. Tiredness was the most reported symptom both at baseline and at follow-up. Palsy (other than facial) was the least reported symptom, but the only one with a significant increase. However, this was not associated to the EM.ConclusionThe symptom load was comparable to that reported in the general population. We found an increase in symptom load at follow-up that did not significantly affect general function.Implication: Monitoring patients’ symptom loads prior to treatment reduce the probability of attributing follow-up symptoms to LB.Key pointsErythema migrans has a good prognosis.Patients treated for erythema migrans have a slight increase in symptom load one year after treatment.This increase does not affect general function.The levels of subjective health complaints in patients treated for erythema migrans are comparable to the background population.

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How Accurate Is a Clinical Diagnosis of Erythema Chronicum Migrans? Prospective Study Comparing the Diagnostic Accuracy of General Practitioners and Dermatologists in an Area Where Lyme Borreliosis Is Endemic

Cited by 30 publications

References 4 publications

Clinical Relevance of Different IgG and IgM Serum Antibody Responses to Borrelia burgdorferi After Antibiotic Therapy for Erythema Migrans

Clinical Relevance of Different IgG and IgM Serum Antibody Responses to Borrelia burgdorferi After Antibiotic Therapy for Erythema Migrans

Bull’s-Eye and Nontarget Skin Lesions of Lyme Disease: An Internet Survey of Identification of Erythema Migrans

Symptom load and general function among patients with erythema migrans: a prospective study with a 1-year follow-up after antibiotic treatment in Norwegian general practice

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