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The skin lesion of early Lyme disease, erythema migrans (EM), is so characteristic that routine practice is to treat all such patients with antibiotics. Because other skin lesions may resemble EM, it is not known whether presumptive treatment of EM is appropriate in regions where Lyme disease is rare. We constructed a decision model to compare the cost and clinical effectiveness of three strategies for the management of EM: Treat All, Observe, and Serology as a function of the probability that an EM-like lesion is Lyme disease. Treat All was found to be the preferred strategy in regions that are endemic for Lyme disease. Where Lyme disease is rare, Observe is the preferred strategy, as presumptive treatment would be expected to produce excessive harm and increased costs. Where Lyme disease is rare, clinicians and public health officials should consider observing patients with EM-like lesions who lack travel to Lyme disease-endemic areas.

Small rodents are purported to be enzootic hosts of Yersinia pestis and may serve as sources of infection to prairie dogs or other epizootic hosts by direct or flea-mediated transmission. Recent research has shown that small rodent species composition and small rodent flea assemblages are influenced by the presence of prairie dogs, with higher relative abundance of both small rodents and fleas at prairie dog colony sites compared to grasslands without prairie dogs. However, it is unclear if increased rodent or flea abundance predisposes prairie dogs to infection with Y. pestis. We tracked rodent and flea occurrence for 3 years at a number of prairie dog colony sites in Boulder County, Colorado, before, during, and after a local plague epizootic to see if high rodent or flea abundance was associated with plague-affected colonies when compared to colonies that escaped infection. We found no difference in preepizootic rodent abundance or flea prevalence or abundance between plague-positive and plague-negative colonies. Further, we saw no significant before-plague/after-plague change in these metrics at either plague-positive or plague-negative sites. We did, however, find that small rodent species assemblages changed in the year following prairie dog die-offs at plague-affected colonies when compared to unaffected colonies. In light of previous research from this system that has shown that landscape features and proximity to recently plagued colonies are significant predictors of plague occurrence in prairie dogs, we suggest that landscape context is more important to local plague occurrence than are characteristics of rodent or flea species assemblages.

Sylvatic plague, caused by the bacterium Yersinia pestis, is a flea-borne disease that primarily affects rodents but has been detected in over 200 mammal species worldwide. Mammalian carnivores are routinely surveyed as sentinels of local plague activity, since they can present antibodies to Y. pestis infection but show few clinical signs. In Boulder County, Colorado, USA, plague epizootic events are episodic and occur in black-tailed prairie dogs. Enzootic hosts are unidentified as are plague foci. For three years, we systematically sampled carnivores in two distinct habitat types to determine whether carnivores may play a role in maintenance or transmission of Y. pestis and to identify habitats associated with increased plague prevalence. We sampled 83 individuals representing six carnivore species and found only two that had been exposed to Y. pestis. The low overall rate of plague exposure in carnivores suggests that plague may be ephemeral in this study system, and thus we cannot draw any conclusions regarding habitat-associated plague foci or temporal changes in plague activity. Plague epizootics involving prairie dogs were confirmed in this study system during two of the three years of this study, and we therefore suggest that the targeting carnivores to survey for plague may not be appropriate in all ecological systems.