From the Guidelines
Lyme disease typically presents in three stages with distinct symptoms, including early localized disease characterized by erythema migrans, a bull's-eye rash, and flu-like symptoms, early disseminated disease with neurological and cardiac issues, and late disseminated disease with intermittent or chronic arthritis and neurological complications. The disease progression and severity vary widely among patients, with some experiencing only early manifestations while others develop more serious complications if left untreated 1.
Key Symptoms and Stages
- Early localized disease (Stage 1) occurs 3-30 days after a tick bite and is characterized by:
- Erythema migrans, a bull's-eye rash that appears at the bite site in about 70-80% of patients
- Flu-like symptoms including fever, chills, fatigue, headache, muscle and joint aches, and swollen lymph nodes
- Early disseminated disease (Stage 2) develops weeks to months later and may cause:
- Multiple erythema migrans lesions
- Neurological problems such as Bell's palsy, meningitis, and radiculopathy
- Cardiac issues, particularly AV block
- Severe headaches or neck stiffness
- Late disseminated disease (Stage 3) occurs months to years after infection and primarily manifests as:
- Intermittent or chronic arthritis affecting large joints, especially the knees
- Neurological complications like encephalopathy or peripheral neuropathy
Importance of Early Recognition and Treatment
Early recognition and antibiotic treatment significantly reduce the risk of progression to later stages of the disease 1. It is essential to diagnose and treat Lyme disease promptly to prevent long-term complications and improve patient outcomes.
Diagnostic Approaches
The recommended laboratory test in the United States is 2-tiered serologic analysis consisting of an enzyme-linked immunoassay or immunofluorescence assay, followed by reflexive immunoblotting 1. Patients who have a lesion consistent with erythema migrans and live in or have traveled to Lyme-endemic areas can be given a diagnosis without laboratory testing.
From the Research
Typical Presentations of Lyme Disease
The typical presentations of Lyme disease include:
- Erythema migrans, an expanding erythematous skin lesion that develops days to weeks following an Ixodes species tick bite 2
- Flulike symptoms, such as malaise and fatigue, headache, fever and chills, generalized achiness, and regional lymphadenopathy 3, 4
- Multiple annular secondary lesions, evanescent red blotches or circles, malar or urticarial rash, conjunctivitis, periorbital edema, or diffuse erythema 4
- Meningeal irritation, mild encephalopathy, migratory musculoskeletal pain, hepatitis, generalized lymphadenopathy and splenomegaly, sore throat, nonproductive cough, or testicular swelling 4
- Fatigue, myalgia, arthralgia, headache, and fever and/or chills 5
Clinical Manifestations
Clinical manifestations of Lyme disease can be divided into several stages, including:
- Early stage: characterized by erythema migrans and associated flulike symptoms 3, 2
- Disseminated stage: characterized by involvement of the nervous system, heart, and joints 3
- Late stage: characterized by persistent symptoms, such as arthritis and neurological problems 6
Diagnosis and Treatment
Diagnosis of Lyme disease is based on recognition of the appropriate signs and symptoms, laboratory testing, and serological testing 3, 6. Treatment is usually with antibiotics for 2 to 4 weeks, and most patients recover uneventfully 6.