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, a fastidious, microaerophilic bacterium that replicates slowly and requires special media to grow in the laboratory (161, 185, 192). Strobino BA, Williams CL, Abid S, Chalson R, Spierling P. Suttorp-Schulten MS, Kuiper H, Kijlstra A, van Dam AP, Rothova A.

Its cell membrane is covered by flagella and a loosely-associated outer membrane. Lyme disease and pregnancy outcome: Prospective study of two thousand prenatal patients. Long-term effects of ceftriaxone treatment on intraocular Lyme borreliosis. Szczepanski A, Furie MB, Benach JL, Lane BP, Fleit HB.

Early localized disease is manifest by the characteristic single round or ovoid rash called erythema migrans (EM), that is observed in approximately 70-80% of infected individuals between 3-30 days [average 7-10 days] after an infected tick bite (182).

In this study, only 31% of individuals directly recalled of a tick bite at the site of their erythema migrans rash. Steere AC, Sikand VK, Meurice F, Parenti DL, Fikrig E, Schoen RT, Nowakowski J, Schmid CH, Laukamp S, Buscarino C, Krause DS.

Favored locations include warmer and moist regions of the body such as in the axillae, the inguinal or popliteal regions, the torso and in women under the breasts though the rash may occur anywhere.

Culture or PCR identification is mostly limited to research laboratories, so clinical determination of a rash as erythema migrans remains the usual method for identification of Lyme disease at this early, localized stage.

If uncertainty exists, options include observing the rash as erythema migrans tends to expand over a period of days, or one can obtain acute and convalescent Lyme serology. Steere AC, Taylor E, Wilson ML, Levine JF, Spielman A.

In the United States most cases of Lyme disease occur in costal and riparian regions of southern New England, southeastern New York, New Jersey, eastern Pennsylvania, eastern Maryland, Delaware, and parts of Minnesota and Wisconsin.

Some infections that occur in northern California and the upper Pacific Northwest are transmitted by I the western black-legged tick. Antibiotic-refractory Lyme arthritis is associated with HLA-DR molecules that bind a Borrelia burgdorferi peptide.

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