Symptoms of Lyme disease

The symptoms of Lyme disease in humans occur in three stages.

Stage one (early infection). The early stage of Lyme disease is often characterized by a distinctive, expanding red rash that usually develops at the site of the tick bite. This rash, known as erythema migrans, is seen in 60-80% of infected individuals (it is important to remember that the converse is true: no rash is ever observed in 20-40% of the cases). Spirochetes can be isolated from the leading edge of the rash. Erythema migrans is a red circular patch that appears usually 3 days to 1 month following the bite of the tick. The patch then expands, often to a large size and develops a characteristic "bull's eye" appearance. However, not all rashes that occur at the site of a tick bite are due to Lyme disease. An allergic reaction to tick saliva often occurs at the site of a tick bite. This rash can be confused with the rash of Lyme disease. Allergic reactions to tick saliva usually occur within hours to a few days after the tick bite, usually do not expand, and disappear within a few days. Erythema migrans persists longer, but usually subsides within 3-4 weeks.

The presentation of erythema migrans in Stage 1

Stage two (dissemination stage) occurs days to weeks following infection. At this stage the spirochetes spread hematogenously to additional body tissues. One or more of the following symptoms and signs may be noted:
fatigue
chills and fever
headache
muscle and joint pain
swollen lymph nodes
secondary annular skin lesions

Stage three (persistent infection). Some symptoms and signs of Lyme disease may not appear until weeks, months, or years after a tick bite. Stage three typically involves intermittent episodes of joint pain. Common clinical manifestations at this stage may include meningitis, Bell's palsy, cardiac involvement, and migratory pain to joints, tendons, muscle and bone.

Arthritis is most likely to appear as brief bouts of pain and swelling, usually in one or more large joints, especially the knees.

Nervous system abnormalities can include numbness, pain, Bell's palsy (paralysis of the facial muscles, usually on one side), and meningitis (fever, stiff neck, and severe headache).

Less frequently, irregularities of the heart rhythm occur.

In a minority of individuals (11%) the development of chronic Lyme arthritis may lead to erosion of cartilage and/or bone. Other clinical manifestations associated with stage three Lyme disease include neurologic complications such as depression, disturbances in memory, mood, or sleep patterns, and sensations of numbness and tingling in the hands or feet.

Lyme disease mimics other diseases and pathologies and is highly variable in its presentation. In some persons the rash never forms; in some, the first and only sign of Lyme disease is arthritis, and in others, nervous system problems are the only evidence of Lyme disease. There is an increasing and alarming number of reports of neuropsychiatric effects associated with Lyme Disease.