Image: Courtesy of CDC PHIL

Lyme disease signs and symptoms are different for early localized disease, early disseminated disease, and late Lyme disease. Lyme Disease is a tick-borne illness caused by three types of bacteria, Borrelia burgdorferi, Borrelia afzelii and Borrelia garinii. In the United States, the cause of Lyme disease is Borrelia burgdorferi (also known as B. burgdorferi). B. burgdorferi is transmitted through bites of infected blacklegged ticks. In 2013, there were about 275,000 confirmed cases, 95% of which were from 14 states.

Symptoms of Early Localized Lyme Disease

Early localized disease causes erythema migrans (EM) and nonspecific symptoms that resemble a flu or virus infections. Erythema migrans is a rash or skin lesion developed at the site of the tick bite, usually within 7 to 14 days after the bite. EM occurs in approximately 70 to 80% of infected persons. 

Features of erythema migrans:

• Often occurs around the underarm, groin, knee pit, or at the belt line.
• May cause burning or itching, is hot to touch, but not particularly painful.
• May expand gradually over days, reaching up to 12 inches or more,  and may clear as it enlarges and appears like a “bull’s eye”.

Nonspecific symptoms of Lyme disease include:

• Fatigue
• Loss of appetite
• Headache
• Neck stiffness
• Muscle pain
• Joint pain
• Painful and swelling of regional lymph glands
• Fever

Symptoms of Early Disseminated Lyme Disease

Symptoms of early disseminated Lyme disease include neurologic or cardiac complications in addition to multiple EM lesions. 

Neurologic complications include:

• Facial nerve palsy: facial nerve disorder that may affect facial expression.
• Lymphocytic meningitis: inflammations of the brain (meninges)
• Radiculopathy: a nerve disorder causing muscle pain, weakness or difficulty controlling specific muscles. The locations include neck, back and shoulders.
• Peripheral neuropathy: the damage of peripheral nerves normally causes tingling, pain, numbness, or weakness in the feet and hands.
• Mononeuropathy multiplex: damage of nerves outside of brain and spinal cords.

Cardiac complications of early disseminated disease include:

• Abnormal heart rhythm due to atrioventricular heart block
• Lyme Carditis, which is inflammation of the heart and causes light-headedness, fainting.
• Shortness of breath, and chest pain.

Symptoms of Late Lyme Disease

Late Lyme disease occurs months to a few years after the initial infection. Late Lyme disease is associated with arthritis involving with one or more joints, usually at the knees. Approximately 60% of patients develop swelling and painful joints months after the initial infection. A mild neurologic complication called Lyme encephalopathy has been reported in patients with late Lyme disease. The symptoms of Lyme encephalopathy include memory loss, sleep disturbance, fatigue, and depression.

Post-Lyme Disease Syndrome

Post-Lyme disease syndrome, also known as chronic Lyme disease, consists of nonspecific symptoms (e.g., headache, fatigue, and muscle pain) that persist after antibiotic treatment. Post-Lyme disease syndrome is uncommon and the symptoms improve gradually over 6 months to 1 year for most patients.

Treatment Of Lyme Disease

Antibiotics are recommended for patients with Lyme disease. The antibiotics recommended by the Infectious Diseases Society of America include:

• Doxycycline
• Amoxicillin
• Cefuroxime axetil
• Ceftriaxone

Doxycycline, amoxicillin and cefuroxime axetil are oral antibiotics recommended for treatment of early localized or early disseminated Lyme disease. Doxcycline and ceftriaxone are recommended for infected patients with neurologic complications. Ceftriaxone is only available as an intravenous (IV) injection and is for more serious cases.

The duration of treatment varies for different stages of the disease. The treatment duration is 10 to 21 days, depending on choice of antibiotics, for people diagnosed with early localized disease. Patients with early disseminated disease and late Lyme disease may require higher doses and longer duration (up to 28 days) of treatment.

Prevention Of Lyme Disease

There is no vaccine for Lyme disease. According to the Infectious Diseases Society of America the best prevention is to avoid tick-infested areas. People who cannot avoid tick-infested areas should wear protective clothing such as long-sleeved shirt and long pants, and use tick and insect repellent that contain N,N-diethyl-3-methylbenzamide (DEET).

Learn More

Lyme disease by CDC

Mononeuritis multiplex

Post-Lyme Disease Syndrome and Chronic Lyme Disease by CDC