From the Guidelines
Symptoms of undiagnosed Lyme disease can include a characteristic rash (erythema migrans), fever, fatigue, headache, and muscle and joint aches, as well as more severe symptoms such as severe headaches, neck stiffness, and arthritis with severe joint pain and swelling, as noted in a study published in 1999 1. The symptoms of undiagnosed Lyme disease can develop weeks to months after infection if not promptly treated.
- Early symptoms that may have been missed include:
- The characteristic bull's-eye rash (erythema migrans)
- Fever
- Fatigue
- Headache
- Muscle and joint aches As the infection progresses, more serious symptoms can develop, including:
- Severe headaches
- Neck stiffness
- Additional rashes
- Facial palsy (drooping on one or both sides of the face)
- Arthritis with severe joint pain and swelling (particularly in the knees)
- 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
- Nerve pain Some patients may develop Post-Treatment Lyme Disease Syndrome (PTLDS) with persistent symptoms of fatigue, pain, and cognitive difficulties that can last for months even after treatment, as discussed in a study published in 2006 1. If you suspect Lyme disease, seek medical attention promptly as early treatment with antibiotics like doxycycline, amoxicillin, or cefuroxime for 10-21 days is most effective, according to guidelines published in 2006 1. Delayed treatment makes the disease more difficult to eradicate and increases the risk of long-term complications. The most recent and highest quality study on the topic, published in 2006 1, provides evidence to support treatment recommendations for Lyme disease, including the use of oral antibiotics for patients with Lyme arthritis and intravenous antibiotics for patients with neurologic involvement.
From the Research
Symptoms of Undiagnosed Lyme Disease
The symptoms of undiagnosed Lyme disease can be varied and nonspecific, making diagnosis challenging. Some common symptoms include:
- Erythema migrans, a characteristic skin rash 2, 3, 4
- Flu-like symptoms, such as fever, headache, and fatigue 2, 4
- Joint pain and swelling 2, 3, 4
- Neurological symptoms, such as Bell palsy, meningitis, and vertigo 5
- Persistent symptoms, such as arthralgia, after treatment 6, 3
Diagnostic Challenges
Diagnosing Lyme disease can be difficult, especially in the absence of erythema migrans 2, 5. The disease can present with viral-like symptoms, making it easy to misdiagnose 2. Additionally, the lack of biological underpinning makes it difficult to assess which patients' persistent symptoms are related to the previous Lyme disease episode 6.
Delayed Diagnosis
Delayed diagnosis of Lyme disease can lead to late manifestations of the disease, including chronic neurologic impairments 5. Failure to recognize erythema migrans or alternative presentations without a rash can lead to missed or delayed diagnosis, ineffective antibiotic treatment, and the potential for late manifestations 2.
Treatment and Outcome
Both oral doxycycline and parenteral ceftriaxone are effective treatments for acute disseminated Lyme disease 3. However, some patients may experience residual symptoms, such as mild arthralgia, after treatment 3. Early treatment is crucial to prevent late manifestations of the disease 4.