From the Guidelines
Lyme disease symptoms typically occur in stages, beginning with a characteristic bull's-eye rash called erythema migrans at the site of the tick bite in about 70-80% of infected people, accompanied by nonspecific symptoms such as fever, malaise, fatigue, headache, myalgia, and arthralgia 1. The symptoms of Lyme disease can be divided into three stages: early localized, early disseminated, and late disseminated.
- Early localized stage: characterized by the appearance of erythema migrans, a gradually expanding annular lesion >5 cm in diameter, which is often accompanied by fever, lymphadenopathy, myalgias, or arthralgias 1.
- Early disseminated stage: the bacteria may spread hematogenously, causing multiple EM skin lesions, facial palsy, meningitis, or carditis 1.
- Late disseminated stage: characterized by recurrent large-joint arthritis, peripheral neuropathy, encephalopathy, or encephalomyelitis 1. It is essential to note that some people may experience lingering symptoms such as fatigue, pain, and joint and muscle aches even after treatment 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 1. Prompt recognition of symptoms and early antibiotic treatment are crucial to prevent progression to later stages of the disease 1.
From the Research
Symptoms of Lyme Disease
The symptoms of Lyme disease can be divided into several stages, each with distinct clinical manifestations.
- Stage 1: The disease typically begins with a unique skin lesion, erythema chronicum migrans (ECM), which may be accompanied by headache, meningeal irritation, mild encephalopathy, multiple annular secondary lesions, malar or urticarial rash, generalized lymphadenopathy and splenomegaly, migratory musculoskeletal pain, hepatitis, sore throat, non-productive cough, conjunctivitis, periorbital edema, or testicular swelling 2.
- Stage 2: After a few weeks to months, about 15% of patients develop frank neurologic abnormalities, including meningitis, encephalitis, cranial neuritis, motor or sensory radiculoneuritis, mononeuritis multiplex, or myelitis. About 8% of patients develop cardiac involvement, such as AV block, acute myopericarditis, cardiomegaly, or pancarditis 2.
- Stage 3: Months to years after disease onset, about 60% of patients develop frank arthritis, which may be intermittent or chronic 2.
Common Symptoms
Some common symptoms of Lyme disease include:
- Fatigue (54%) 3
- Myalgia (44%) 3
- Arthralgia (44%) 3
- Headache (42%) 3
- Fever and/or chills (39%) 3
- Erythema migrans (EM) rash, which may be pruritic or painful, but generally mild 3
Diagnosis and Treatment
Lyme disease can be diagnosed by its dermatologic manifestations, rapidly changing system involvement, and if necessary, by serologic testing 4. The treatment of Lyme disease typically involves oral antibiotics, such as amoxicillin, doxycycline, or tetracycline, for 3 to 4 weeks 5. In some cases, intravenous antibiotics may be necessary, especially for patients with severe neurologic or cardiac involvement 5.