Rash Decisions: Lyme Disease, or Not?

porting, ∼20,000 cases are now recorded annually in the United States [4]; much larger numbers of patients are treated presumptively for the disease, often with only tenuous support for the diagnosis. Diagnostic uncertainties can result because of the complex natural history Lyme disease, its varied and often nonspecific manifestations, and difficulties in obtaining laboratory confirmation in the early stages of infection, when most patients first seek medical attention. The decision to treat is, therefore, most often made empirically on the basis of clinical presentation and epidemiological or ecological context [5, 6]. Ready confirmation or rejection of diagnosis by routine laboratory testing is still problematic during the early stages of infection, when most patients seek medical attention, and the decision to treat is most often made empirically on the basis of clinical presentation and epidemiological and/or ecological context.