In 1909, in Stockholm, Swedish dermatologist Arvid Afzelius (1910) described a rash (which he labeled erythema migrans) on a female patient following a bite from an Ixodes tick. In 1913 an Austrian physician described a similar lesion on a patient and labeled it erythema chronicum migrans (ECM). Recognition that ECM was associated with systemic symptoms occurred in France in 1922. Investigators described patients with tick bites who developed subsequent erythema migrans and lymphocytic meningoradiculitis (nervous system involvement). In 1934 a German dentist described six patients with erythema migrans and associated joint symptoms. And in 1951 beneficial effects of penicillin in the treatment of a patient with ECM and meningitis suggested a bacterial etiology.

In the United States the first documented case of ECM occurred in a grouse hunter in Wisconsin in 1969. In 1975, two homemakers reported to the Connecticut State Health Department that several children living close together in Lyme, Connecticut, had developed arthritis. A following investigation by Al len C. Steere revealed an associated rash (ECM) in 25 percent of patients. He named the syndrome Lyme disease in honor of the town in which it was first observed.

In 1977 it was observed that an I. dammini tick bite preceded the ECM rash on a human subject. Willy Burgdorfer and his colleagues (1982) isolated a spirochete from the midgut of the I. dammini tick; this spirochete was subsequently named Borrelia burgdorferi. The following year, Steere isolated the spirochete from blood, skin, and spinal fluid from patients with the Lyme disease syndrome and concluded that it was the causative agent. Also, in 1983 in West Germany, H. W. Pfister and his colleagues (1984) concluded that B. burgdorferi isolated in spinal fluid from a patient with lymphocytic meningoradiculitis (Bannwarth's syndrome) was causative, and they implied that the original description of 13 patients provided by A. Bannwarth (1941) may have been due to the same organism. Dermatologist Klaus Weber and his colleagues (1984), working in West Germany, noted an elevation of IgG antibodies in the blood of patients with the skin lesion acrodermatitis chronica atrophicans (AC A). AC A is an uncommon late dermatologic manifestation of Lyme borreliosis. The first description of ACA was given by the German physician Alfred Buchwald (1883), and may have been the first reported case of Lyme borreliosis.

Robert D.Leff

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