From the Guidelines
Lyme disease typically manifests in three stages: early localized, early disseminated, and late disseminated, with clinical manifestations including erythema migrans, fever, lymphadenopathy, myalgias, arthralgias, facial palsy, meningitis, carditis, and recurrent large-joint arthritis.
Clinical Manifestations
- Erythema migrans (EM): a gradually expanding annular lesion >5 cm in diameter, occurring in approximately 70%–80% of persons with Lyme disease 1
- Early disseminated Lyme disease: multiple EM skin lesions, facial palsy, meningitis, or carditis 1
- Late disseminated disease: recurrent large-joint arthritis, peripheral neuropathy, encephalopathy, or encephalomyelitis 1
- Other symptoms: fever, lymphadenopathy, myalgias, arthralgias, headache, fatigue, and malaise 1
Diagnosis
- Clinical diagnosis: possible in patients with a lesion consistent with EM and a compatible epidemiologic and clinical history, without laboratory testing 1
- Laboratory testing: 2-tiered serologic analysis consisting of an enzyme-linked immunoassay or immunofluorescence assay, followed by reflexive immunoblotting, with high specificity (>95%) but low sensitivity (30%–40%) during early infection 1
From the Research
Clinical Manifestations of Lyme Disease
The clinical manifestations of Lyme disease can be divided into several stages, with varying symptoms and presentations.
- Early localized stage: characterized by erythema migrans, a characteristic expanding annular rash, which occurs in nearly 90% of persons with symptomatic infection 2, 3, 4, 5.
- Early disseminated stage: may present with multiple erythema migrans lesions, borrelial lymphocytoma, Lyme neuroborreliosis, carditis, or arthritis 3, 5.
- Late disseminated stage: manifests with acrodermatitis chronica atrophicans, Lyme arthritis, and neurological symptoms 5.
Neurological and Psychiatric Manifestations
Neurological and psychiatric manifestations of Lyme disease are more frequently observed during its secondary phase, including:
- Painful meningoradiculitis
- Encephalomyelitis and encephalitis
- Symptoms of depression 6. In the late stage of the disease, distal axonal polyneuropathy and chronic encephalopathy are the most frequently reported presentations 6.
Other Manifestations
Other clinical manifestations of Lyme disease include:
- Seventh cranial nerve palsy
- Aseptic meningitis
- Arthritis 2, 3. The skin is most frequently involved, and skin manifestations frequently represent clues for the diagnosis 4.
Diagnosis and Treatment
Diagnosis of Lyme disease is usually based on clinical signs and laboratory confirmation, except in the case of typical erythema migrans 3, 4, 5. Treatment is usually with antibiotics for 2 to 4 weeks, and most patients recover uneventfully 3, 5.