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In the 14 years since it was named Lyme disease, this illness caused by tick-borne bacteria has become a national concern sometimes verging on obsession. Public-service announcements run on television and in move theaters. People who have been bitten by ticks spend a few days or weeks worrying about getting sick. And an entire subculture has grown up around chronic Lyme disease.

At first, Lyme disease seemed to occur only in certain prime vacation spots: Cape Cod and eastern Long Island in the Northeast, the North Woods of Minnesota and Wisconsin, and less frequently, the northern California coast and Oregon. Although 97% of cases continue to come from only nine states, 46 states in all have reported occurrences to the Centers for Disease Control during the past decade. In 1989, the last year for which statistics are available, the number of new cases reported was 8,552.

Aiming at the bullseye

Diverse symptoms and a variable course make Lyme disease difficult to recognize. The initial event, a tick bite, may not be noticed, in part because the tick itself is no bigger than the size of the period at the end of this sentence. Most patients don't recall being bitten or even seeing the culprit.

If symptoms appear, the best person to consult is one's personal physician, according to Raymond Dattwyler, an expert on Lyme disease and an associate professor of medicine at the State University of New York at Stony Brook. Primary-care physicians are able to diagnose most Lyme infections and give appropriate treatment, and they are in the best position to make referrals, if need be, to reputable specialists in infectious disease or rheumatology.

The most reliable way for a physician to diagnose the illness is to evaluate the patient's physical symptoms andsigns in light of his or her risk of exposure. In 60-80% of cases, the disease announces itself with a so-called bullseye rash, or erythema migrans -- a rim of painless reddened skin expanding around a pale area centered on the site where the tick (by now long gone) originally attached itself. the ring of red must be at least two inches across to meet the standard criterion of erythema migrans. Such a ring can expand to reach 20 inches in diameter, and additional ones may subsequently appear inside it in a targetlike pattern. After a few days similar rashes may show up elsewhere on the body. Fever and flu-like symptoms are often present early in the illness.

# posted by Medical Information : 5:05 AM