Clinical manifestations of Lyme disease

Early localized disease, occurring a few days to one month after the tick bite^*

Erythema migrans - occurs in the majority of patients

Associated symptoms and signs may include: fatigue, malaise, lethargy, mild headache, mild neck stiffness, myalgias, arthralgias, regional lymphadenopathy

Early disseminated disease^¶, occurring weeks to months after the tick bite^*Δ

Carditis - about 1% of patients reported to the CDC^◊

Manifestations include AV nodal block, mild cardiomyopathy or myopericarditis

Neurologic disease - occurs in approximately 15% of untreated patients^◊

Manifestations include lymphocytic meningitis, cranial neuropathy (most often facial, can be bilateral), peripheral neuropathy; rarely myelitis or encephalitis

Musculoskeletal involvement - occurs in approximately 60% of untreated patients^◊

Manifestations include migratory arthralgias

Skin involvement - multiple erythema migrans lesions^Δ, borrelial lymphocytoma (in Europe)

Lymphadenopathy - regional or generalized

Eye involvement^§ - conjunctivitis, iritis, choroiditis, vitritis, retinitis

Liver disease - liver function test abnormalities, hepatitis

Kidney disease - microhematuria, asymptomatic proteinuria

Late disease^¶, occurring months to years after the tick bite^*

Musculoskeletal symptoms - approximately 60% of untreated patients develop intermittent monoarticular or oligoarticular arthritis; approximately 10% of untreated patients develop persistent monoarthritis, usually affecting the knee

Neurologic disease - incidence has not been established

Peripheral neuropathy or encephalomyelitis (both rare)

Cutaneous involvement - acrodermatitis chronica atrophicans, morphea/localized scleroderma-like lesions (both described only in Europe)

CDC: United States Centers for Disease Control and Prevention.

* Only about 25% of patients with erythema migrans recall the tick bite that transmitted Lyme disease.

¶ Can occur in the absence of any prior features of Lyme disease.

Δ The multiple erythema migrans lesions of early disseminated disease typically occur days to weeks following infection.

◊ Incidence following treated erythema migrans is not known but is very low.

§ Observation based on individual case reports.

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Clinical manifestations of Lyme disease