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What Are the 3 Stages of Lyme Disease?

Reviewed on 5/20/2020

What Is Lyme Disease?

Lyme Disease
Symptoms of Lyme arthritis include warmth, swelling from fluid, and limited range of motion.

Lyme disease is an illness transmitted to humans via tick bites from infected ticks of the genus Ixodes (commonly called a deer tick). The tick bite spreads the germ that causes Lyme disease to humans (the spirochete Borrelia burgdorferi).

The type of tick that carries Lyme disease feeds on deer and mice and can only infect a human if it remains attached to a person for at least a day and a half.

What Is the Staging for Lyme Disease?

Lyme disease is categorized into three stages:

  1. Localized: This stage occurs within several days of the tick bite. Symptoms and signs include redness and irritation at the site of the tick bite, along with flu-like symptoms such as fever, chills, and muscle aches.
  2. Disseminated: This stage occurs within weeks of a tick bite. If untreated, the infection spreads to other parts of the body and new symptoms and signs occur.
  3. Persistent: Late infection may occur within months to years after the initial tick bite. Arthritis and neurological symptoms and signs are common in this stage.

What Are the Signs and Symptoms of Lyme Disease?

Symptoms and signs of Lyme disease vary with the stage of the disease. Symptoms of the early stage of Lyme disease include the following:

  • Flulike illness
    • Fever
    • Chills
    • Feeling unwell (malaise)
    • Muscle and joint pains
    • Headache
  • A rash called erythema migrans where the tick bite occurred
    • The rash usually appears within a month of getting bitten.
    • Rash appears red, but the center may be a person's normal skin color.
    • The rash may expand over a few days.
    • The rash may look like a "bull's eye."
  • Swollen glands
  • Neck stiffness
  • Eye redness and tearing

As Lyme disease progresses, symptoms and signs may include the following:

In patients in the late stage of the disease, the most common symptom is arthritis, located mostly in large joints, especially the knee. Symptoms of Lyme arthritis include warmth, swelling from fluid, and limited range of motion.

What Causes Lyme Disease?

Lyme disease is caused by infection with the spirochete Borrelia burgdorferi. In regions of the U.S. where Lyme disease is common, risk factors for getting bitten by a tick include

  • spending a lot of time outdoors and
  • proximity to areas between forest land and lawns, particularly if the area contains low-lying grasses or shrubs.

Ticks can also attach to pets (including dogs and cats) that may bring them into the home. The pet may become infected with Lyme disease. If the tick does not attach to the pet, it can attach to a human and transmit the infection.

How Do Doctors Diagnose Lyme Disease?

In areas where the ticks that carry Lyme disease are found, when a patient comes to a doctor with probable erythema migrans (the rash that appears where the tick bite occurred), blood tests are performed to diagnose the condition, including the following:

  • Step 1: Enzyme immunoassay (EIA) or immunofluorescence assay (IFA) -- total Lyme titer or IgG and IgM titers
  • Step 2: Western blot testing -- only performed if step 1 test results are positive

Other tests that may be indicated include the following:

  • Joint aspiration (fluid is drained from the joints) to see if there is another cause for fluid buildup on the joints
  • Cerebrospinal fluid (CSF) analysis in patients with meningitis
  • Electrocardiogram (ECG) to identify Lyme carditis or arrythmias

What Is the Treatment for Lyme Disease?

Doctors treat early Lyme disease with antibiotics such as doxycycline, amoxicillin, or cefuroxime axetil.

Neurologic manifestations of Lyme disease are treated with IV penicillin, ceftriaxone, cefotaxime, or oral doxycycline.

Late-stage Lyme disease (Lyme arthritis) treatment includes the following:

  • Oral antibiotics for 28 days
  • Re-treatment with oral antibiotics for any residual joint swelling
  • Re-treatment with intravenous (IV) antibiotics for cases that do not resolve with oral antibiotics
  • Oral antibiotics for an additional month in patients with positive PCR of synovial fluid
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with negative PCR, supplemented if necessary, with hydroxychloroquine
  • Arthroscopic synovectomy may be indicated in patients who do not respond to symptomatic treatment

Lyme carditis (heart inflammation) may be treated with either oral or parenteral antibiotic therapy for 2-3 weeks. Patients with severe symptoms of carditis may need to be hospitalized.

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What Are Complications of Lyme Disease?

The main complication of Lyme disease is a condition called post-treatment Lyme disease syndrome (PTLDS) or chronic Lyme disease, in which patients have symptoms that persist more than 6 months after finishing treatment. There is no treatment for PTLDS and it may take many months for patients to recover.

Symptoms of PTLDS include the following:

  • Fatigue that may last for years. May be accompanied by widespread muscle aches and severe headaches.
  • Arthritis and joint pain
  • Problems with short-term memory and thinking
  • Numbness and tingling, or loss of feeling in the extremities
  • Bell's palsy: face muscles and eyelids droop on one side
  • Hearing or vision may be affected
  • Irregular or slow heartbeats
  • Depression and anxiety may be due to the chronic nature of the illness.

How Do You Prevent Lyme Disease?

Prevention of Lyme disease involves preventing ticks from attaching to the skin:

  • Wear protective clothing.
  • Clothing may be pre-treated with permethrin (an insecticide).
  • Use a tick repellent or tick-killing product. Insect repellents containing the active ingredients DEET, IR3535, or picaridin can help prevent tick bites.
  • Inspect clothes and skin for ticks when coming in from the outdoors.
  • Put clothes in a dryer after being outdoors to help kill ticks.
  • Shower immediately after potential tick exposure (within 2 hours).

If you live in an area where the ticks that carry Lyme disease are endemic

  • install a tall fence to keep out deer, who carry the ticks;
  • keep lawns trimmed; and
  • treat the property with products that kill ticks (such as bifenthrin or permethrin).

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Reviewed on 5/20/2020
References
Meyerhoff, John O. "Lyme Disease." Aug. 1, 2019. Medscape.com. <http://emedicine.medscape.com/article/330178-overview>.

United States. Centers for Disease Control and Prevention. "Post-Treatment Lyme Disease Syndrome." Nov. 8, 2019. <https://www.cdc.gov/lyme/postlds/index.html>.

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