Lyme disease history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ilan Dock, B.S.

Overview

Lyme disease is divided into 3 stages and symptoms are stage specific. Symptoms include "bulls-eye" rash, with accompanying fever, malaise, and musculoskeletal pain (arthralgia or myalgia. It can progress to cardiovascular or neurological complications.

History and Symptoms

The incubation period from infection to the onset of symptoms is usually 1–2 weeks, but can be much shorter (days), or much longer (months to years). Symptoms most often occur from May through September because the nymphal stage of the tick is responsible for most cases.[1] Asymptomatic infection exists, but is uncommon.[2]

Common Symptoms

Less Common

  • Cardiac manifestations (up to 10% of patients may have cardiac manifestations including heart block and palpitations[5])
  • Neurologic symptoms (neuroborreliosis may occur in up to 18%), as well as simple altered mental status as the sole presenting symptom has been reported in early neuroborreliosis.[6]

Chronic Disease

  • Untreated or persistent cases may progress to a chronic form most commonly characterized by meningoencephalitis
  • Cardiac inflammation (myocarditis)
  • Frank arthritis
  • It should be noted, however, that chronic Lyme disease can have a multitude of symptoms affecting numerous physiological systems.
  • The symptoms appear heterogeneous in the affected population, which may be due to innate immunity or variations in Borrelia bacteria.
  • Late symptoms of Lyme disease can appear months or years after initial infection and often progress in cumulative fashion over time.
  • Neuropsychiatric symptoms often develop much later in the disease progression, much like tertiary neurosyphilis.

Chronic neurological disorders

Lyme Carditis

Manifestations of Lyme Disease by Stage

Manifestations of Lyme Disease by Stage[11]
System Stage 1 (Localized Infection) Stage 2 (Disseminated Infection) Stage 3 (Persistent Infection)
Skin Erythema migrans ▸ Secondary annular lesions
Malar rash
▸ Diffuse erythema or urticaria
▸ Evanescent lesions
▸ Lymphocytoma
Acrodermatitis chronica atrophicans
▸ Localized scleroderma-like lesions
Musculoskeletal ▸ Migratory arthralgia
▸ Brief arthritis attacks
Myositis
Osteomyelitis
Panniculitis
▸ Prolonged arthritis attacks
▸ Chronic arthritis
▸ Peripheral enthesopathy
Periostitis or joint subluxations below acrodermatitis
Neurologic Meningitis
▸ Cranial neuritis or Bell's palsy
▸ Motor or sensory radiculoneuritis
Encephalitis
Mononeuritis multiplex
Pseudotumor cerebri
Myelitis
Chorea
Cerebellar ataxia
▸ Chronic encephalomyelitis
▸ Spastic parapareses
Ataxic gait
▸ Mental disorders
▸ Chronic axonal polyradiculopathy
Dementia
Lymphatic ▸ Regional lymphadenopathy ▸ Regional or generalized lymphadenopathy
Splenomegaly
Heart Atrioventricular block
Myopericarditis
▸ Pancarditis
Eyes Conjunctivitis
Iritis
Choroiditis
▸ Retinal hemorrhage or retinal detachment
▸ Panophthalmitis
Keratitis
Liver ▸ Mild or recurrent hepatitis
Respiratory ▸ Nonexudative sore throat
▸ Nonproductive cough
Adult respiratory distress syndrome
Kidney ▸ Microscopic hematuria or proteinuria
Genitourinary Orchitis
Constitutional systems ▸ Minor ▸ Severe malaise and fatigue Fatigue

Adapted from Steere AC. Lyme disease. N Engl J Med. 1989;321:586.

References

  1. Edlow JA (2007-01-25). "Lyme disease". eMedicine. Retrieved 2007-08-21.
  2. Steere AC, Sikand VK, Schoen RT, Nowakowski J (2003). "Asymptomatic infection with Borrelia burgdorferi". Clin. Infect. Dis. 37 (4): 528–32. PMID 12905137.
  3. CDC (2005-07-06). "Lyme Disease Erythema Migrans". Retrieved 2007-08-21.
  4. Donta ST (2002). "Late and chronic Lyme disease". Med Clin North Am. 86 (2): 341–9, vii. PMID 11982305.
  5. Ciesielski CA, Markowitz LE, Horsley R, Hightower AW, Russell H, Broome CV (1989). "Lyme disease surveillance in the United States, 1983-1986". Rev. Infect. Dis. 11 Suppl 6: S1435–41. PMID 2682955.
  6. Chabria SB, Lawrason J (2007). "Altered mental status, an unusual manifestation of early disseminated Lyme disease: A case report". 1 (1): 62. doi:10.1186/1752-1947-1-62. PMID 17688693.
  7. Rosenhall U, Hanner P, Kaijser B (1988). "Borrelia infection and vertigo". Acta Otolaryngol. 106 (1–2): 111–6. PMID 3421091.
  8. Moscatello AL, Worden DL, Nadelman RB, Wormser G, Lucente F (1991). "Otolaryngologic aspects of Lyme disease". Laryngoscope. 101 (6 Pt 1): 592–5. PMID 2041438.
  9. Fallon BA, Nields JA (1994). "Lyme disease: a neuropsychiatric illness". The American journal of psychiatry. 151 (11): 1571–83. PMID 7943444.Hess A, Buchmann J, Zettl UK; et al. (1999). "Borrelia burgdorferi central nervous system infection presenting as an organic schizophrenialike disorder". Biol. Psychiatry. 45 (6): 795. PMID 10188012.)
  10. . doi:10.7326/0003-4819-157-3-20120807-01002. Missing or empty |title= (help)
  11. 11.0 11.1 Steere, AC. (1989). "Lyme disease". N Engl J Med. 321 (9): 586–96. doi:10.1056/NEJM198908313210906. PMID 2668764. Unknown parameter |month= ignored (help)
  12. Fish, AE.; Pride, YB.; Pinto, DS. (2008). "Lyme carditis". Infect Dis Clin North Am. 22 (2): 275–88, vi. doi:10.1016/j.idc.2007.12.008. PMID 18452801. Unknown parameter |month= ignored (help)


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