From the Guidelines
Lyme disease typically presents with a characteristic rash, known as erythema migrans, accompanied by nonspecific symptoms such as fever, fatigue, and headache, and can progress through three stages if left untreated. The presentation of Lyme disease can vary, but it often begins with early localized disease, which 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 1. This rash expands gradually over days and may be warm but is usually painless. Accompanying symptoms often include:
- Fever
- Fatigue
- Headache
- Muscle and joint aches
- Swollen lymph nodes
Early disseminated disease develops weeks to months later when the Borrelia burgdorferi bacteria spread through the bloodstream, potentially causing:
- Multiple erythema migrans lesions
- Facial palsy (Bell's palsy)
- Meningitis
- Carditis with heart block
- Severe headaches or neck stiffness
Late disseminated disease occurs months to years after infection and primarily manifests as:
- Intermittent or chronic arthritis affecting large joints, particularly the knees
- Neurological complications like peripheral neuropathy or encephalomyelitis
The progression and severity of symptoms vary widely among patients, with some experiencing only mild symptoms while others develop more severe manifestations if left untreated 1. Prompt recognition and antibiotic treatment (typically doxycycline, amoxicillin, or cefuroxime) in early stages can prevent progression to later stages of the disease. It is essential to note that the diagnosis of Lyme disease is often based on clinical presentation, and laboratory testing is necessary to confirm the diagnosis, especially in patients without the characteristic erythema migrans rash 1.
From the Research
Typical Presentations of Lyme Disease
The typical presentations of Lyme disease can vary, but common manifestations include:
- Erythema migrans (EM), a characteristic skin rash that appears at the site of the tick bite, typically within 3 to 30 days of inoculation 2, 3
- Flulike symptoms, such as fatigue, myalgia, arthralgia, headache, and fever and/or chills, which can occur with or without the rash 4, 5, 6
- Disseminated infection, which can involve the nervous system, heart, and joints, and can occur weeks to months after the initial infection 4, 3
Early Disseminated Infection
Early disseminated infection can manifest as:
- Neurological abnormalities, such as meningitis, encephalitis, and radiculopathy 3
- Carditis, which can present as a variable atrioventricular (AV) conduction block, with a high-grade AV block occurring in only 1% of untreated patients 2
- Migratory musculoskeletal pain, hepatitis, and generalized lymphadenopathy and splenomegaly 6
Late Infection
Late infection can manifest as:
- Arthritis, particularly in North America 3
- Acrodermatitis chronica atrophicans, particularly in Europe 3
Diagnosis and Treatment
Diagnosis of Lyme disease is based on recognition of the appropriate signs and symptoms, and can be supported by serological testing 4, 5, 3, 6. All manifestations of the infection can usually be treated with appropriate antibiotic regimens 4, 3.