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The 1995 case definition appearing on this page was previously published in the 1990 MMWR Recommendations and Reports titled Case Definitions for Public Health Surveillance [MMWR 1990;39(RR13)] (available at http://www.cdc.gov/mmwr/preview/mmwrhtml/00025629.htm). Thus, the 1990 and 1995 versions of the case definition are identical.
A systemic, tick-borne disease with protean manifestations, including dermatologic, rheumatologic, neurologic, and cardiac abnormalities. The best clinical marker for the disease is the initial skin lesion, erythema migrans, that occurs among 60%-80% of patients.
Confirmed: a case that meets one of the clinical case definitions above
This surveillance case definition was developed for national reporting of Lyme disease; it is NOT appropriate for clinical diagnosis.
Definition of terms used in the clinical description and case definition:
A. Erythema migrans (EM)For purposes of surveillance, EM is defined as a skin lesion that typically begins as a red macule or papule and expands over a period of days to weeks to form a large round lesion, often with partial central clearing. A solitary lesion must reach at least 5 cm in size. Secondary lesions may also occur. Annular erythematous lesions occurring within several hours of a tick bite represent hypersensitivity reactions and do not qualify as EM. For most patients, the expanding EM lesion is accompanied by other acute symptoms, particularly fatigue, fever, headache, mild stiff neck, arthralgia, or myalgia. These symptoms are typically intermittent. The diagnosis of EM must be made by a physician. Laboratory confirmation is recommended for persons with no known exposure.
B. Late manifestations
C. Exposure
Exposure is defined as having been in wooded, brushy, or grassy areas (potential tick habitats) in a county in which Lyme disease is endemic no more than 30 days before onset of EM. A history of tick bite is NOT required.
D. Disease endemic to county
A county in which Lyme disease is endemic is one in which at least two definite cases have been previously acquired or in which a known tick vector has been shown to be infected with B. burgdorferi
E. Laboratory confirmation
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