Abstract:
Lyme disease is the most common vector-borne infectious disease in North America. With nearly 2500 Appalachian Trail (AT) hikers entering the endemic area for up to 6 months, exposure to the disease is likely. The characteristic exanthem of erythema migrans (EM) should be a trigger for seeking medical treatment, and it’s significance in this relatively isolated environment is critical. Objective: Determine AT hikers ability to recognize EM as a surrogate marker for Lyme disease. Methods: Hikers were administered a photographic stimulus in this IRB approved, non-validated study. Historical hiking data, basic demographics, and self-reported treatment/diagnosis were collected. Results: 379 responses were collected by 4 researchers at three geographically separate locations at or proximate to the AT from June 2011 to May 2012. 54% (206/379) respondents were able to recognize the photographs of EM/Lyme disease, 46% could not. Of those who did recognize EM, 23 (6%) had seen it either on themselves or another hiker while on the AT. 37 hikers stated that they had been diagnosed with Lyme disease while hiking, and of these 89% were treated with antibiotics. 13 out of 37 (35%) hikers diagnosed with Lyme disease had visualized an embedded tick. 9% of all respondents reported they had been diagnosed with Lyme disease by a healthcare practitioner, whether from EM, symptomatology, or by titer. Conclusions: This study suggests that hikers are poorly able to recognize the characteristic exanthem of Lyme disease but have a high exposure risk.
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