]> 2026-07-31T12:14:27+00:00 WBR0777 0 en Bell’s palsy Bell's palsy usually occurs several weeks after the initial tick bite. Third degree heart block AV nodal blocks also occurs several weeks after the initial tick bite. Recurrence of the same rash The same erythema migrans rash can occur within a few weeks after the initial tick bite. Meningitis Meningitis also occurs several weeks after the initial tick bite. Arthritis with severe joint swelling Chronic monoarthritis and migratory polyarthritis is a typical manifestation of late Lyme disease occurring several months to years after the initial tick bite. Lyme disease is a systemic animal-borne illness caused by the spirochete Borrelia burgdorferi transmitted by the Ixodes tick. The disease typically affects the skin, nervous system, musculoskeletal system and heart. The disease is mostly seen in the northeastern United States. The states with the highest incidence of lyme disease include Massachusetts, Pennsylvania, and New York. Classically the disease has 3 phases. The initial phase involves a typical rash known as erythema migrans that expands forming a bull's eye pattern with central clearing. The first stage occurs between 2-20 days after the initial tick bite and inoculation. The second stage is characterized by neurologic manifestations including meningitis, AV nodal block, and Bell's palsy usually occurring several weeks after the inital bite. The final phase, occurring several months to years after the inital exposure, is characterized by chronic monoarthritis and migratory polyarthritis with associated cutaneous manifestations. Treatment is usually with doxycyline or ceftriaxone.<br/> '''Educational Objective:''' Several months after the initial inoculation of Borrelia burgdorferi, the most common clinical manifestation of untreated Lyme disease is chronic monoarthritis and migratory polyarthritis.<br/> '''References:''' Biesiada G, Czepiel J, Leśniak MR, Garlicki A, Mach T. Lyme disease: review. Arch Med Sci. 2012;8(6):978-82. Microbiology Pathophysiology E Infectious Disease 2020-10-28T01:40:53Z 2459150.5700579 WBR0777