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The Changing Face of Lyme Disease—Rural to Urban

disease is a multisystem, multistage disease caused by the spirochete Borrelia burgdorferi, which is named after Dr. Willy Burgdorferi who discovered this tick-borne spirochete in 1981. 1 B. burgdorferi is transmitted to humans by infected ticks of the Ixodes complex. The primary arthropod vector is I. scapularis in the northeastern and north central parts of United States and I. pacificus in the west. 2 Lyme disease is a rapidly emerging vector-borne infectious disease in the United States and currently accounts for one of the most commonly vector-borne diseases reported. The incidence increased 30-fold between 1982 and 1996 and continued rising rapidly each year. 3 The disease occurs in distinct and geographically limited areas. Most cases in the United States occur in the northeast, north central, mid-Atlantic, and western coastal regions where Ixodes ticks are prevalent. 2–5 The incidence in some of the highly endemic communities may reach 1% to 3% per year. 5 Although cases of Lyme disease have been reported from 49 states and the District of Columbia, 5 significant risk of infection was found in only 165 counties in which 91.6% of the cases occurred. The following case presentation is of a man residing in urban Michigan with no history of travel outside southeastern Michigan and no history of exposure to traditional vectors; however, similar presentations may arise in any US urban area. Incidence of Lyme disease is increasing in the urban setting because of many rodent and bird reservoir hosts for the deer tick, which help in the transmission of this disease to both urban and suburban populations. A 41-year-old man presented with a rash on the anterior aspect of his right leg. The rash started as a small papule and, over a period of about 10 to 15 days, its diameter increased to 3 to 4 in with central clearing. The rash was associated with marked pruritis initially and at the time of presentation had some burning. The patient noticed the rash a few days after he had worked on an outside masonry job. There was no history of a tick bite; however, he did remember being bitten by an insect while in the area. There was no history of travel for 3 years. The patient complained of flu-like symptoms associated with diffused body aches, sore throat, low-grade fever, and malaise accompanied with severe fatigue. He also complained of multiple joint pains for which he had …