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

From the Guidelines

Lyme disease typically presents with a characteristic rash, known as erythema migrans, accompanied by nonspecific symptoms such as fever, malaise, fatigue, headache, myalgia, and arthralgia, usually developing within 3-30 days after the tick bite 1. The disease is caused by the bacterium Borrelia burgdorferi, transmitted through the bite of infected black-legged ticks, and can progress to later stages if left untreated, affecting joints, the heart, and the nervous system. Some key points to consider include:

• 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.
• Approximately 70%–80% of persons with Lyme disease have erythema migrans, which is defined as a gradually expanding annular lesion >5 cm in diameter 1.
• Accompanying signs and symptoms might include fever, lymphadenopathy, myalgias, or arthralgias, and if the infection is not treated, the bacteria might spread hematogenously and cause early disseminated Lyme disease, which can manifest as multiple EM skin lesions, facial palsy, meningitis, or carditis 1.
• The recommended approach for patients with persistent symptoms following standard treatment of Lyme disease is against additional antibiotic therapy, unless there is objective evidence of reinfection or treatment failure 1. Key considerations for diagnosis and treatment include:
• Laboratory testing is necessary to confirm the diagnosis, but proper interpretation depends on symptoms and timing of illness, with a recommended 2-tiered serologic analysis consisting of an enzyme-linked immunoassay or immunofluorescence assay, followed by reflexive immunoblotting 1.
• Early recognition and treatment with appropriate antibiotics like doxycycline, amoxicillin, or cefuroxime for 10-21 days is crucial to prevent progression to later stages 1.

From the Research

Signs and Symptoms of Lyme Disease

The signs and symptoms of Lyme disease can be divided into several stages, including early localized, early disseminated, and late stages.

• The early localized stage is characterized by skin changes, typically erythema migrans (EM), which usually manifests within a month of the tick bite 2.
• The early disseminated stage is marked by numerous EM lesions and/or neurological and/or cardiac manifestations, including meningitis, neuropathy, and motor or sensory radiculopathy 2.
• The late stage is characterized by intermittent or permanent arthritis in one joint or several large joints, and/or more rarely by neurological symptoms such as discrete encephalopathy or polyneuropathy 2.

Common Symptoms

Common symptoms of Lyme disease include:

• Erythema migrans (EM) rash, which is typically not painful but can itch or be warm to the touch 2, 3, 4
• Fatigue, headache, loss of appetite, joint pain, and regional lymphadenopathy 2, 4
• Fever, which can be present in approximately 20% of patients 2
• Migratory musculoskeletal pain in joints, tendons, bursae, muscle, or bone 5
• Neurological abnormalities, including meningitis, encephalitis, cranial neuritis, and motor or sensory radiculoneuritis 5
• Cardiac involvement, including AV block, acute myopericarditis, cardiomegaly, or pancarditis 5

Skin Manifestations

Skin manifestations of Lyme disease can vary and include:

• Erythema migrans (EM) 2, 3, 4
• Borrelial lymphocytoma (BL) 2
• Acrodermatitis chronica atrophicans (ACA) 2
• Livedo reticularis, which can be a possible form of ACA depending on the stage of the disease 2