 In terms of the clinical manifestations, really the most common is the everything on my brand's rash, which is seen in 70% of patients followed by arthritis, and then some of the neurologic complications like facial palsies, neuropathy, and meningitis. Carditis is fairly uncommon, but we do see it. And it's important to look for it. So in the early phase of Lyme disease, really we're looking at flu-like symptoms. So somebody who comes in with fevers, chills, fatigue, muscle, joint aches after a tick bite, especially in the spring and summer months, we really do want to think about Lyme disease. Erythema migrants is considered pathopneumonic for Lyme disease. However, I want to point out some exception. So not everybody who has Lyme disease will have an Erythema migrants rash or a rash at all. It's typically described as a target or bullseye lesion, but sometimes the rashes don't look that way. Some of the good characteristics to keep in mind, to differentiate them from other things is that they're usually not itchy or painful. It's pretty much a rule. If the lesion is less than five centimeters in size, it's not going to be related to Lyme disease. So it's more likely to be a bug bite or something like this, but almost all of the Lyme rashes are greater than five centimeters in size. So that's a very important feature. It's also important if you see somebody early on in disease, they may have a small lesion, but it may expand over the next couple of days. So it's always important to tell patients, if your lesion is expanding, please let us know. So this just shows you various patients who have differing rashes related to Lyme disease. So the first one is the classic target or bullseye lesion, where you see like the central red area and then a clearing and then another ring. Here's other ones. So this one has irregular borders and kind of a central kind of area there. This is a patient who has disseminated erythema migraines, but you can see that she has a bluish kind of hue in the center. Sometimes you won't see anything in the middle, you'll just see a clearing and then you'll see this ring. But by far, the most common is this last one where you have this slightly raised oval confluent erythema. That's the most common rash that's seen with Lyme disease. So important to just be aware of it because so many of the Lyme diagnosis really come from the EM rash. This is a rash that is related to another tick born on this called starry or Southern tick associated rash illness. And it can have a central clearing just like Lyme disease. So it's important to keep this in mind. You may have patients who report a tick bite and then have a Lyme appearing rash. So again, it's called Southern tick associated rash illness. The bacteria or the agent that causes it is unknown. Typically patients just get the early symptoms so they can get a rash fever, myelogist fatigue, but they typically don't go on to have arthritis, neurologic disease or chronic symptoms. It's associated with this lone star tick and sometimes patients can tell you, yes, I pulled up a tick, it's bigger than the Xodes scapularis tick and it has this distinctive white dot on its back. So we talked about early Lyme disease now, just the manifestations for early disseminated disease, which can happen weeks to months. So for the neurologic manifestations, they're gonna occur in 15% of patients who are untreated and they present typically with meningitis, cranial policies or some kind of radiculopathy. A bilateral cranial nerve policy, very few things do that and one of them is Lyme disease. So if you see this in the summer, Lyme disease should be very high up on the differential. In terms of cardiac manifestations, most commonly varying degrees of AV block and sometimes you can also see ocular manifestations but this is not as common. The late disease can happen months to years after the initial infection and about 50 to 60% of people who don't get treated with that half Lyme disease will go on to develop this late Lyme arthritis and the folks that are treated about 10% will have persistent arthritic symptoms despite getting one or two courses of antibiotic therapy. So this is one of the primary reasons why we treat Lyme disease is to prevent this from happening. So sometimes people will worry about the neurologic manifestations, they're somewhat rare to see and the clinical diagnosis can be difficult. So it's a little bit hard sometimes to really distinguish, many patients will come thinking that they have late neurologic Lyme disease but again, it's fairly rare and it's just fairly rare to see this.