Prospective clinical evaluation of patients from Missouri and New York with erythema migrans-like skin lesions

Abstract

Background. The most common and most recognizable feature of Borrelia burgdorferi infection (Lyme disease) is the skin lesion erythema migrans (EM). An illness associated with an EM-like skin lesion, but which is not caused by B. burgdorferi, occurs in many southern states in the United States (southern tick-associated rash illness [STARI], also known as Masters disease). Methods. Clinical features of 21 cases of EM-like skin lesions in 21 patients from Missouri were compared in a prospective study with those of 101 cases in 97 patients with EM-like skin lesions from New York. Results. Among Missouri cases, the peak incidence of EM-like skin lesions occurred earlier in the year than it did among New York cases (P < .001). Case patients from Missouri were more likely to recall a tick bite than were case patients from New York (85.7% and 19.8%, respectively; P < .001), and the time period from tick bite to onset of the skin lesion was shorter among Missouri case patients (6.1 ± 4.2 days and 10.4 ± 6.1 days, respectively; P = .011). Missouri case patients were less likely to be symptomatic than were New York case patients (19.0% and 76.2%, respectively; P < .001), more circular in shape (P = .004), and more likely to have central clearing (76.2% and 21.6%, respectively; P < .001). After antibiotic treatment, Missouri case patients recovered more rapidly than did New York case patients (P = .037). Conclusion. Cases of EM-like skin lesion in patients from Missouri and New York have distinct clinical presentations. © 2005 by the Infectious Diseases Society of America. All rights reserved.