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NOTE. PR, present report; TMP-SMZ, trimethoprim-sulfamethoxazole. in Missouri and other areas where the disease is not endemic needs review. The national Lyme disease surveillance case definition was developed nearly 10 years ago [3], and a great amount of relevant new scientific evidence regarding Lyme disease and southern tick–associated rash illness has accumulated since that time. The findings of Wormser et al. [6, 9] argue in favor of establishing more rigorous inclusion criteria for patients who present with erythema migrans–like lesions in areas where Lyme disease is not endemic.

Pneumocystis jiroveci Dihydropteroate Synthase Gene Mutations at Codon 171 but Not at Codons 55 or 57 Detected in Germany