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There can be either a single erythema migrans rash or multiple rashes without extracutaneous manifestations.

However, fever, malaise, headache, mild neck stiffness, myalgia and arthralgia often accompany EM.

These cases may also have a recent past history of EM lesions (single or multiple) and non-specific low-grade fever, myalgia, and fatigue upon questioning further.

Other manifestations (with or without rash) include an isolated facial nerve palsy, arthritis, heart block (or carditis) or meningitis (severe headache, fever), which is usually lymphocytic predominant.

Figure 5) Two-tiered serological testing for Lyme disease.

Key Words: Lyme disease (LD), a serious disease, is the most common tick-borne infection in Canada and the Northeastern to Midwestern United States, with cases also occurring (with less frequency) on the west coast.

LD is caused by the bacteria spirochete, If a tick is found attached to or feeding on a child, remove it as soon as possible.

The most common presentation is the erythema migrans rash. Some individuals experienced Early, localized (cutaneous) disease: In general, the diagnosis of LD is clinical (see EM, above), supported by a history of potential tick bite in an area where it is known or suspected that black-legged ticks have been established.

However, because tick populations are expanding, it is possible that LD can be acquired outside of currently identified areas.

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