What are the symptoms of Lyme disease (Lyme borreliosis)?

From the Guidelines

Lyme disease symptoms typically include a characteristic rash called erythema migrans, accompanied by nonspecific symptoms such as fever, malaise, fatigue, headache, myalgia, and arthralgia, as noted in a study published in 1999 1. The incubation period from infection to onset of erythema migrans is typically 7-14 days but can be as short as 3 days or as long as 30 days, according to the same study 1. Some key points to consider about Lyme disease symptoms include:

• Early symptoms often resemble the flu, including fever, chills, fatigue, body aches, headache, neck stiffness, and swollen lymph nodes.
• If left untreated, the infection can spread to joints, the heart, and the nervous system, causing more severe symptoms, as outlined in a 2006 clinical practice guideline by the Infectious Diseases Society of America 1.
• These severe symptoms may include severe headaches, additional rashes, facial palsy, arthritis with severe joint pain and swelling, intermittent pain in tendons, muscles, joints, and bones, heart palpitations or irregular heartbeat, episodes of dizziness or shortness of breath, inflammation of the brain and spinal cord, and nerve pain.
• Prompt recognition of these symptoms is crucial as early antibiotic treatment can prevent progression to later stages of the disease, with recommended therapies outlined in the 2006 guideline, including doxycycline, amoxicillin, or cefuroxime for 10-21 days 1. The recommended treatment duration may vary depending on the stage and severity of the disease, as well as the patient's response to treatment, with some cases requiring longer treatment durations or alternative therapies, as noted in the guideline 1. It is essential to note that some people may experience asymptomatic infection or only nonspecific symptoms, making prompt diagnosis and treatment critical to preventing long-term complications, as emphasized in a 1999 study 1.

From the Research

Lyme Disease Symptoms

The symptoms of Lyme disease can be divided into three stages: early localized infection, early disseminated infection, and late disseminated infection.

• Early localized infection is characterized by:
  • Erythema migrans (a skin rash) 2, 3
  • Fever 2, 3
  • Malaise 2
  • Fatigue 2
  • Headache 2
  • Myalgias (muscle pain) 2
  • Arthralgias (joint pain) 2
• Early disseminated infection occurs days to weeks later and is associated with:
  • Neurologic symptoms 2, 3
  • Musculoskeletal symptoms 2
  • Cardiovascular symptoms 2
  • Multiple erythema migrans lesions 2
• Late disseminated infection is characterized by:
  • Intermittent swelling and pain of one or more joints (especially knees) 2
  • Neurologic manifestations (neuropathy or encephalopathy) 2

Diagnosis and Treatment

Diagnosis of Lyme disease is usually made clinically 2, 3, and treatment is typically accomplished with antibiotics such as doxycycline or amoxicillin 2, 4.

• Alternative treatment options include:
  • Cefuroxime axetil 2, 4
  • Erythromycin 2
  • Azithromycin 4
  • Phenoxymethylpenicillin 4
• In cases of late or severe disease, intravenous ceftriaxone or penicillin G may be necessary 2.
• Single-dose doxycycline (200 mg orally) can be used as prophylaxis in selected patients 2.