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Letters |

Accuracy of Tick Identification in a Lyme Disease Endemic Area

Richard C. Falco, PhD; Durland Fish, PhD; Vincent D'Amico, PhD
JAMA. 1998;280(7):602-603. doi:10-1001/pubs.JAMA-ISSN-0098-7484-280-7-jbk0819-m.
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To the Editor.—In areas where Lyme disease is endemic, physicians may routinely be confronted with the problem of arthropod identification and tick-bite management. Because Lyme disease can be difficult to diagnose, history of a bite from the vector tick, Ixodes scapularis (Figure 1), may play a role in diagnosing suspected cases.1 Evidence of a tick bite may result from observations of the patient or the physician. However, the accuracy of identification by persons not trained in entomology is unknown. Consequences of misidentification may lead to misdiagnosis of Lyme disease and unnecessary prophylactic treatment with antibiotics. As part of a tick-bite study in Westchester County, New York,2,3 a Lyme disease endemic area,4 we assessed the accuracy of tick identification by physicians and the public from arthropods submitted for species identification or verification.

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Figure 1

—Clockwise, from left, Dermacentor variabilis female; sesame seed (shown for size comparison, approximately 3 mm in length); Ixodes scapularis, nymph; I scapularis, female; I scapularis, male; I scapularis, larva; poppy seed (shown for size comparison, approximately 1 mm in length. One millimeter measurements are shown on scale on left. (Credit: Dennis White)

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Figure 2

Gibbium aequinoctiale, a common spider beetle. The length is approximately 2.2 mm, exclusive of appendages. One millimeter measurements are shown on scale on left.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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