{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T03:57:00Z","timestamp":1782273420794,"version":"3.54.5"},"reference-count":11,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2014,3,1]],"date-time":"2014-03-01T00:00:00Z","timestamp":1393632000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Wilderness &amp; Environmental Medicine"],"published-print":{"date-parts":[[2014,3]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p> Lyme disease is the most common vector-borne infectious disease in North America. With nearly 2,500 Appalachian Trail (AT) hikers entering the endemic area for as long as 6 months, exposure to the disease is likely. The characteristic exanthem of erythema migrans (EM) should be a trigger for seeking medical treatment, and its recognition in this relatively isolated environment is important. <\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p> The purpose of this study was to determine the ability of AT hikers to identify EM, the exanthem of Lyme disease. <\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p> Hikers were administered a photographic stimulus in this Internal Review Board\u2013approved pilot study. Historical hiking data, basic demographics, and self-reported treatment and diagnosis were collected. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p> In all, 379 responses were collected by 4 researchers at 3 geographically separate locations at or proximate to the AT from June 2011 to May 2012. Fifty-four percent of respondents (206 of 379) were able to recognize the photographs of EM\/Lyme disease; 46% could not. Of those who did recognize EM, 23 (6%) had seen it either on themselves or on another hiker while on the AT. A total of 37 hikers stated that they had been diagnosed with Lyme disease while hiking, and of these, 89% were treated with antibiotics. Thirteen of these 37 hikers (35%) diagnosed with Lyme disease had visualized an embedded tick. Nine percent of all respondents reported they had been diagnosed with Lyme disease by a healthcare practitioner, whether from EM, symptomatology, or by titer. <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p> This study suggests that hikers are poorly able to recognize the characteristic exanthem of Lyme disease but have a high exposure risk. <\/jats:p><\/jats:sec>","DOI":"10.1016\/j.wem.2013.09.009","type":"journal-article","created":{"date-parts":[[2014,1,14]],"date-time":"2014-01-14T00:01:13Z","timestamp":1389657673000},"page":"24-28","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":8,"title":["Appalachian Trail Hikers\u2019 Ability to Recognize Lyme Disease by Visual Stimulus Photographs"],"prefix":"10.1177","volume":"25","author":[{"given":"Judith M.","family":"Knoll","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Adena Health System, Chillicothe, OH (Dr Knoll)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea C.","family":"Ridgeway","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, York Memorial Hospital, York, PA (Drs Ridgeway and Boogaerts)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine M.","family":"Boogaerts","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, York Memorial Hospital, York, PA (Drs Ridgeway and Boogaerts)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"III","given":"Glenn A.","family":"Burket","sequence":"additional","affiliation":[{"name":"Lake Erie College of Osteopathic Medicine, Erie, PA (Mr Burket)"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2014,3,1]]},"reference":[{"key":"bibr1-jwem201309009","unstructured":"Appalachian Trail Conservancy. Appalachian trail maphttp:\/\/www.appalachiantrail.org\/about-thetrail4. Accessed April 18, 2013."},{"key":"bibr2-jwem201309009","unstructured":"Appalachian Trail Conservancy. 2000 milershttp:\/\/www.appalachiantrail.org\/about-the-trail\/2000-milers. Accessed April 18, 2013."},{"key":"bibr3-jwem201309009","unstructured":"Centers for Disease Control and Prevention. Lyme diseasehttp:\/\/www.cdc.gov\/lyme\/stats\/maps\/map2010.html. Accessed April 13, 2013."},{"key":"bibr4-jwem201309009","doi-asserted-by":"publisher","DOI":"10.1086\/508667"},{"key":"bibr5-jwem201309009","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.1987.36.92"},{"key":"bibr6-jwem201309009","first-page":"960","volume-title":"Wilderness Medicine","author":"Traub S.J.","year":"2011","edition":"6"},{"key":"bibr7-jwem201309009","doi-asserted-by":"publisher","DOI":"10.1086\/514009"},{"key":"bibr8-jwem201309009","unstructured":"Tick identification cardhttp:\/\/www.gundersenhealth.org\/infectious-disease\/ticks\/identification-cards. Accessed April 19, 2013."},{"key":"bibr9-jwem201309009","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200107123450201"},{"key":"bibr10-jwem201309009","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(02)01494-8"},{"key":"bibr11-jwem201309009","unstructured":"Centers for Disease Control and Prevention, National Notifiable Diseases Surveillance System (NNDSS)http:\/\/wwwn.cdc.gov\/nndss\/script\/casedef.aspx?condyrid=752&datepub=1\/1\/2011%2012:00:00%20am. Accessed April 13, 2013."}],"container-title":["Wilderness &amp; Environmental Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1080603213002597?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1080603213002597?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1016\/j.wem.2013.09.009","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1016\/j.wem.2013.09.009","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1016\/j.wem.2013.09.009","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T01:30:23Z","timestamp":1741656623000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1016\/j.wem.2013.09.009"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,3]]},"references-count":11,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2014,3]]}},"alternative-id":["10.1016\/j.wem.2013.09.009"],"URL":"https:\/\/doi.org\/10.1016\/j.wem.2013.09.009","relation":{},"ISSN":["1080-6032","1545-1534"],"issn-type":[{"value":"1080-6032","type":"print"},{"value":"1545-1534","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,3]]}}}