Silver-stained skin lesion with spirochetes and systemic symptoms in the northeastern United States; which disease is diagnosed?

Silver-stained skin lesion with spirochetes and systemic symptoms in the northeastern United States; which disease is diagnosed?

• A. Lyme disease
• B. Plague
• C. Rabbit fever
• D. Relapsing fever

Answer: (A)

Recognizing a spirochete infection presenting with an expanding skin lesion in the northeastern United States points to Lyme disease. The agent, Borrelia burgdorferi, is a spirochete that can be visualized in tissue or lesions with silver staining, and the northeast is a classic endemic area where Ixodes scapularis ticks transmit the pathogen. The hallmark early lesion, erythema migrans, is often expanding and may resemble a bull’s-eye as the infection disseminates, leading to systemic symptoms such as fatigue, headache, meningitis, facial nerve palsy, or arthritis as the disease progresses. The combination of a silver-stain-detectable spirochete in a skin lesion and the regional epidemiology makes Lyme disease the best fit. Plague involves Yersinia pestis with buboes and septicemia; tularemia presents with an ulcer at the site and regional lymphadenopathy; relapsing fever shows recurrent fevers from different Borrelia species but lacks the characteristic northeastern U.S. exposure and typical erythema migrans pattern.

Recognizing a spirochete infection presenting with an expanding skin lesion in the northeastern United States points to Lyme disease. The agent, Borrelia burgdorferi, is a spirochete that can be visualized in tissue or lesions with silver staining, and the northeast is a classic endemic area where Ixodes scapularis ticks transmit the pathogen. The hallmark early lesion, erythema migrans, is often expanding and may resemble a bull’s-eye as the infection disseminates, leading to systemic symptoms such as fatigue, headache, meningitis, facial nerve palsy, or arthritis as the disease progresses. The combination of a silver-stain-detectable spirochete in a skin lesion and the regional epidemiology makes Lyme disease the best fit. Plague involves Yersinia pestis with buboes and septicemia; tularemia presents with an ulcer at the site and regional lymphadenopathy; relapsing fever shows recurrent fevers from different Borrelia species but lacks the characteristic northeastern U.S. exposure and typical erythema migrans pattern.