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Lyme Disease (cont.)

What Are Signs and Symptoms of Lyme Disease?

Early signs and symptoms of Lyme disease occur from three to 30 days after a tick bite and include the following:

  • Fever
  • Chills
  • Headache
  • Fatigue
  • Muscle and joint aches
  • Swollen lymph nodes
  • General feeling of being unwell (malaise)

The initial infection can occur with minimal or no signs or symptoms. But many people experience a flu-like primary illness or a characteristic rash several days to a few weeks following a tick bite. This rash may feel warm to the touch but is rarely itchy or painful.

The flu-like illness usually occurs in the warm weather months when flu (influenza) does not occur.

The rash is a red rash that grows in size daily. It is called erythema migrans and occurs in about 70%-80% of infected individuals.

The U.S. Centers for Disease Control and Prevention (CDC) defines this rash as a skin lesion that typically begins as a red spot and expands over a period of days to weeks to form a large round lesion, at least 5 cm (about 2 inches) across, and up to 30 cm (12 inches). A red circular spot that begins within hours and is smaller is usually a reaction to the tick bite.

When the rash occurs at the site of the tick bite, it is called a primary lesion. Multiple secondary lesions can occur that are a reaction to the infection and are not due to multiple tick bites. All of these lesions can enlarge to the size of a football. This growth in size of the red spots on the skin is characteristic of Lyme disease.

The red spots may be circular or oval.

As it grows, the rash can remain red throughout, although it often can develop a clear central area. In a minority, it may take on the appearance of a target with multiple rings (alternating red with clear skin), called a bull's-eye lesion.

Symptoms and signs in children are similar, though younger children are more likely to have skin lesions occur on the head or neck and older children on the extremities.

Left untreated, signs and symptoms of the primary illness usually will go away on their own within a few weeks, although the rash may recur.

Days to months later, additional symptoms of Lyme disease may occur. The organs affected later in the course of the disease may lead to the following conditions and complications:

  • Facial palsy (Bell's palsy) is paralysis of the facial nerve that causes the facial muscles to be uneven and droop. This may get better without treatment.
  • Meningitis causes headache, fever, and stiff neck.
  • Nerve inflammation causes pain, numbness, and tingling in the arms or legs.
  • Shooting pains may interfere with sleep and cause insomnia.
  • Muscle weakness
  • Brain swelling (encephalitis) causes learning difficulties, confusion, and dementia.
  • Intermittent episodes of arthritis last about a week and usually involve the knee or wrist. This involves severe joint pain, stiffness, and swelling. These may recur over periods of weeks to months, and if the Lyme disease remains untreated, about 10% of people who have these episodes develop persistent arthritis in the knee. Occasionally, people with Lyme disease can present with an acute arthritis in the knee without a clear history of a rash or other joint complaints.
  • Pain in the tendons, muscles, and bones.
  • Episodes of shortness of breath.
  • Inflammation of the heart (carditis) results in heart palpitations or an irregular heartbeat (Lyme carditis), which can also result in dizziness or passing out.
  • Inflammation of the brain and spinal cord
  • Difficulty with short-term memory

Is Lyme Disease Contagious?

Lyme disease is not contagious and cannot be transmitted from person to person. The only way humans can get Lyme disease is through the bite of an infected blacklegged tick.

What Specialists Treat Lyme Disease?

A primary-care provider (PCP) such as a family practitioner, internist, or child's pediatrician may initially diagnose Lyme disease. In areas where Lyme disease is common, these physicians often treat the illness, as well. However, you may be referred to a specialist for treatment. Rheumatologists specialize in diseases that affect the joints and muscles, including infectious diseases such as Lyme disease. You may also see a neurologist if you experience nerve problems or an infectious disease specialist who can help treat Lyme disease in the later stages.

Medically Reviewed by a Doctor on 8/19/2016

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