An August case in New England with spirochetes seen on silver-stained skin biopsy has which diagnosis?

An August case in New England with spirochetes seen on silver-stained skin biopsy has which diagnosis?

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

Answer: (A)

Spirchetes seen on a silver-stained skin biopsy in an August case from New England point to infection with Borrelia burgdorferi, the agent of Lyme disease. In this region and season, Lyme disease is highly likely because Ixodes ticks are active in summer, and the characteristic skin lesion (erythema migrans) can yield visible borrelial spirochetes on tissue staining. The silver stain visualizes these slender, corkscrew-shaped bacteria within the lesion, which is a classic microscopic clue for borrelial infection. The other options are caused by different organisms and do not fit this combination of geographic timing, skin biopsy findings, and presentation.

Spirchetes seen on a silver-stained skin biopsy in an August case from New England point to infection with Borrelia burgdorferi, the agent of Lyme disease. In this region and season, Lyme disease is highly likely because Ixodes ticks are active in summer, and the characteristic skin lesion (erythema migrans) can yield visible borrelial spirochetes on tissue staining. The silver stain visualizes these slender, corkscrew-shaped bacteria within the lesion, which is a classic microscopic clue for borrelial infection. The other options are caused by different organisms and do not fit this combination of geographic timing, skin biopsy findings, and presentation.