TY - JOUR
T1 - The presenting characteristics of erythema migrans vary by age, sex, duration, and body location
AU - Rebman, Alison W.
AU - Yang, Ting
AU - Mihm, Erica A.
AU - Novak, Cheryl B.
AU - Yoon, Isaac
AU - Powell, Debra
AU - Geller, Steven A.
AU - Aucott, John N.
N1 - Funding Information:
We would like to thank the physicians of Johns Hopkins Community Physicians, Park Medical Associates, Patient First, and Centennial Medical Group who participated in recruitment for this study. We are grateful to the research participants who contributed their time and effort towards this study. This work was supported by a subagreement from the Johns Hopkins University with funds provided by a Grant Agreement from the Steven and Alexandra Cohen Foundation. Support was also provided from the Global Lyme Alliance (GLA) and the Bay Area Lyme Foundation (BALF). This publication was also made possible by the Johns Hopkins Institute for Clinical and Translational Research (ICTR), which is funded in part by Grant Number UL1 TR003098 from the National Center for Advancing Translational Sciences (NCATS) a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research, and the Johns Hopkins Clinical Research Network (JHCRN). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the Johns Hopkins ICTR, JHCRN, NCATS, NIH, the Steven and Alexandra Cohen Foundation, GLA, or BALF.
Publisher Copyright:
© 2021, Springer-Verlag GmbH, DE part of Springer Nature.
PY - 2021/8
Y1 - 2021/8
N2 - Purpose: The erythema migrans (EM) skin lesion is often the first clinical sign of Lyme disease. Significant variability in EM presenting characteristics such as shape, color, pattern, and homogeneity, has been reported. We studied associations between these presenting characteristics, as well as whether they were associated with age, sex, EM duration, body location, and initiation of antibiotics. Methods: Two hundred and seventy one adult participants with early Lyme disease who had a physician-diagnosed EM skin lesion of ≥ 5 cm in diameter and ≤ 72 h of antibiotic treatment were enrolled. Participant demographics, clinical characteristics, and characteristics of their primary EM lesion were recorded. Results: After adjusting for potential confounders, EM size increased along with increasing EM duration to a peak of 14 days. Male EM were found to be on average 2.18 cm larger than female EM. The odds of a red (vs blue/red) EM were 65% lower in males compared to females, and were over 3 times as high for EM found on the pelvis, torso, or arm compared to the leg. Age remained a significant predictor of central clearing in adjusted models; for every 10-year increase in age, the odds of central clearing decreased 25%. Conclusions: Given that EM remains a clinical diagnosis, it is essential that both physicians and the general public are aware of its varied manifestations. Our findings suggest possible patterns within this variability, with implications for prompt diagnosis and treatment initiation, as well as an understanding of the clinical spectrum of EM.
AB - Purpose: The erythema migrans (EM) skin lesion is often the first clinical sign of Lyme disease. Significant variability in EM presenting characteristics such as shape, color, pattern, and homogeneity, has been reported. We studied associations between these presenting characteristics, as well as whether they were associated with age, sex, EM duration, body location, and initiation of antibiotics. Methods: Two hundred and seventy one adult participants with early Lyme disease who had a physician-diagnosed EM skin lesion of ≥ 5 cm in diameter and ≤ 72 h of antibiotic treatment were enrolled. Participant demographics, clinical characteristics, and characteristics of their primary EM lesion were recorded. Results: After adjusting for potential confounders, EM size increased along with increasing EM duration to a peak of 14 days. Male EM were found to be on average 2.18 cm larger than female EM. The odds of a red (vs blue/red) EM were 65% lower in males compared to females, and were over 3 times as high for EM found on the pelvis, torso, or arm compared to the leg. Age remained a significant predictor of central clearing in adjusted models; for every 10-year increase in age, the odds of central clearing decreased 25%. Conclusions: Given that EM remains a clinical diagnosis, it is essential that both physicians and the general public are aware of its varied manifestations. Our findings suggest possible patterns within this variability, with implications for prompt diagnosis and treatment initiation, as well as an understanding of the clinical spectrum of EM.
KW - Clinical characterization
KW - Erythema migrans
KW - Lyme disease
KW - Sex-based differences
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U2 - 10.1007/s15010-021-01590-0
DO - 10.1007/s15010-021-01590-0
M3 - Article
C2 - 33682067
AN - SCOPUS:85102288788
SN - 0300-8126
VL - 49
SP - 685
EP - 692
JO - Infection
JF - Infection
IS - 4
ER -