The Rational Clinical Examination
David L. Simel, Drummond Rennie
Erythema Migrans
David L. Simel
Make the Diagnosis: Erythema Migrans
Topics Discussed:
borrelia lonestari, criterion standard comparisons (diagnostic tests), diagnosis, diagnosis, differential, diagnostic process, erythema migrans, exanthema, likelihood ratio, lyme disease, make the diagnosis, prior probability, reference standards, sensitivity, tick bite, ticks
Excerpt:
"Erythema migrans is a macular or popular erythematous skin lesion
that evolves over days or weeks and expands to form a large, red
lesion. The US Centers for Disease Control and Prevention (CDC)
has defined additional size criteria that are to be used for surveillance
monitoring (when solitary, the lesion must be at least 5 cm in diameter).1 The
European case definition is similar, but it does not specify a particular
size. The lesion is described as having a bluish-red hue with a
distinct advancing edge that is more intensely colored. Because
the clinical evaluation itself defines the presence of erythema
migrans, the prior probability is not known. Complicating these
considerations is that erythema migrans differs geographically...."
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