A few days after a summer hiking trip,a 25-year-old man comes to the clinic with a rash.On examination,the nurse notes that the rash is red,macular,with a bull's eye pattern across his midriff and behind his knees.The nurse suspects:

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Lyme disease occurs in people who spend time outdoors in May through September.The first disease state exhibits the distinctive bull's eye and a red macular or papular rash that radiates from the site of the tick bite with some central clearing.The rash spreads 5 cm or larger,and is usually in the axilla,midriff,inguinal,or behind the knee,with regional lymphadenopathy.

A Few Days After a Summer Hiking Trip,a 25-Year-Old Man