Lyme disease most often presents
with a characteristic "bull's-eye" rash, erythema
migrans, accompanied by nonspecific symptoms such as
fever, malaise, fatigue, headache, muscle aches (myalgia),
and joint aches (arthralgia).
The incubation period from infection to onset of
erythema migrans is typically 7 to 14 days but may be as
short as 3 days and as long as 30 days.
Some infected individuals have no recognized illness
(asymptomatic infection determined by serological
testing), or manifest only non-specific symptoms such as
fever, headache, fatigue, and myalgia.
Lyme disease spirochetes disseminate from the site of
the tick bite by cutaneous, lymphatic and blood borne
routes. The signs of early disseminated infection
usually occur days to weeks after the appearance of a
solitary erythema migrans lesion. In addition to
multiple (secondary) erythema migrans lesions, early
disseminated infection may be manifest as disease of the
nervous system, the musculoskeletal system, or the
heart. Early neurologic manifestations include
lymphocytic meningitis, cranial neuropathy (especially
facial nerve palsy), and radiculoneuritis.
Musculoskeletal manifestations may include migratory
joint and muscle pains with or without objective signs
of joint swelling. Cardiac manifestations are rare but
may include myocarditis and transient atrioventricular
blocks of varying degree.
B. burgdorferi infection in the untreated or
inadequately treated patient may progress to late
disseminated disease weeks to months after infection.
The most common objective manifestation of late
disseminated Lyme disease is intermittent swelling and
pain of one or a few joints, usually large,
weight-bearing joints such as the knee. Some patients
develop chronic axonal polyneuropathy, or
encephalopathy, the latter usually manifested by
cognitive disorders, sleep disturbance, fatigue, and
personality changes. Infrequently, Lyme disease
morbidity may be severe, chronic, and disabling. An
ill-defined post-Lyme disease syndrome occurs in some
persons following treatment for Lyme disease. Lyme
disease is rarely, if ever, fatal
Source References:
Bujak DI,
Weinstein A, Dornbush RL. Clinical and neurocognitive
features of the post Lyme syndrome. J Rheumatol
1996;23:1392-1397.
Gaudino EA, Coyle PK, Krupp LB. Post-Lyme syndrome and
chronic fatigue syndrome. Neuropsychiatric similarities
and differences. Arch Neurol 1997;54:1372-1376.
Logigian EL, Kaplan RF, Steere AC. Chronic neurologic
manifestations of Lyme disease. N Engl J Med
1990;323:1438-1444.
Rahn
DW. Natural history of Lyme disease. In: Rahn DW, Evans
J, eds. Lyme disease, Philadelphia: American College of
Physicians, 1998;35-48.
Shadick NA, Phillips CB, Logigian EL, et al. The
long-term clinical outcomes of Lyme disease. Ann Intern
Med 1994;121:560-567.
Steere
AC, Levin RE, Molloy PJ et al. Treatment of Lyme
arthritis. Arthritis Rheum 1994;37:878-888
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