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It is caused by the spirochete Borrelia burgdorferi transmitted by the deer tick (Ixodes scapularis in the Northeast and Midwest and Ixodes pacificus in the West). By now, most primary care physicians who practice in endemic areas have seen patients concerned about a tick bite or presenting with erythema migrans (EM)—a bull's-eye rash—the most common presentation of early localized disease.
Bites from nymphal deer ticks, which are usually prevalent in early summer, are largely responsible for transmission of the disease. The tick must be attached to the skin for 24 to 36 hours before the spirochete is transmitted; the probability that a nymphal tick bite will lead to Lyme disease is low in patients who have removed the deer tick soon after it has attached...
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