Because people travel to Lyme endemic areas and because ticks are expanding their geographic range, cases of Lyme disease have been reported throughout the U.S. Certain parts of the United States, such as the eastern states from Maine extending down the Atlantic and upper mid-western states have the heaviest burden of Bb-infected ticks the Pacific coastal states have also seen a rise in Lyme disease. Certain risk factors will increase the risk of tick attachment these include hiking in the woods or walking through tall grasses or having a pet that might serve as a "tick drag" unwittingly bringing ticks into the house.
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When starting to evaluate a patient, it is important to obtain a full medical history, including exploring whether or not the person has ever lived or vacationed in a Lyme endemic area. only 70-90% sensitive in neurologic Lyme disease), the tests are very helpful in providing additional information to the clinician to help him/her to determine if Lyme disease is the correct diagnosis. While not everyone with Lyme disease will test positive on currently available tests (e.g. With the later disseminated manifestations of Lyme disease, blood tests have a more important role, because by then antibodies will have had time to form. Why? Because it can take two to three weeks before the antibodies develop.
When faced with a patient with an expanding red rash from a Lyme-endemic region, physicians should draw the conclusion that this is most likely an erythema migrans Lyme rash and start antibiotic treatment immediately they should not wait to see the results of a blood test, as in early Lyme disease the test is negative 50-65% of the time.
In early Lyme disease, one can make the diagnosis of Lyme disease with near 100% certainty when the expanding red rash is present. Diagnosis of Lyme disease is made through a clinical decision making process that includes a medical history, physical exam, review of past diagnostic tests and consultations, and results from newly ordered tests.
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