What is Lyme disease?
Lyme disease is a multisystem illness caused by infection with the microorganism, Borrelia burgdorferi, and the body’s immune response to its infection. The illness is transmitted from tick bites when the tick regurgitates the microorganism. Lyme disease is known as a “vector-borne disease.” Because the ticks are extremely small and their bites are painless, the biting event very often goes unnoticed.
Prognosis is excellent and most patients recover completely if treated early.
What are the signs and symptoms of Lyme disease?
The signs and symptoms of Lyme disease usually appear one to 30 days after a tick bite, but most commonly between seven to 14 days. The first sign is usually a skin rash and flu-like symptoms.
There are three stages of Lyme disease:
Stage 1: Early localized disease
- Occurs one to 30 days after a tick bite
- Erythema migrans
- Characteristic skin rash of Lyme disease
- Migrating red rash with “bullseye” appearance occurring at or near the site of the tick bite
- Asymptomatic or itches or burns
- Develops around seven days after the tick bite
- Rash expands over a matter of days
- Untreated rash may persist for two to three weeks
- Approximately, half of the early disease patients have flu-like symptoms, which may resolve spontaneously:
- Low-grade fever
- Muscle and joint pain
- Neck stiffness
- Swollen lymph nodes
Stage 2: Early disseminated disease
- Usually develops three to 10 weeks after the initial infection.
- One or more organ systems become involved through blood or lymphatic spread.
- General symptoms:
- Fever and uneasiness (malaise)
- Difficulty breathing
- Chest pain
- Eye manifestations:
- Blurred or double vision
- Eye pain
- Heart manifestations:
- Musculoskeletal manifestations (approximately 60% of patients present with musculoskeletal manifestations:
- Intermittent, migratory inflammatory arthritis which evolves over one to two days, involving single or multiple joints such as knee, ankle and wrist.
- First episode occurs within six months of the erythema migrans lesion
- Untreated, the episodes last approximately one week
- Patients have recurrences and may continue to have them over a 10-year period
- Nervous system manifestations:
- May occur two to 10 weeks after infection
- Encephalopathy (a broad term for any brain disease that alters brain function or structure)
- Meningitis (inflammation of the brain)
- Neck pain or stiffness
- Photophobia (sensitivity to light)
- Nerve paralysis like facial nerve palsy (Bell’s palsy)
- Disturbances in memory, concentration, mood, sleep, personality and/or language
- Skin manifestations:
- Multiple erythema migrans lesions are present
- Borrelial lymphocytoma (uncommon): bluish-red swelling that occurs on the lobe of the ear, scrotum, nose, and extremities.
Stage 3: Late disease
- If untreated, Lyme disease can progress to chronic Lyme disease or stage 3 of Lyme disease. Stage 3 Lyme disease occurs months to years after the initial infection or a period of latency. Most patients presenting with late disease do not have erythema migrans because the rash urges the patient to seek treatment earlier.
- Skin manifestation:
- Acrodermatitis chronica atrophicans: Found almost exclusively in patients of European descent. It commonly affects older women and is characterized by bluish-red discoloration on the back of the hands, feet, knees and elbows.
- Lyme arthritis:
- Typically involves one or a few large joints (knee is involved in 90% of cases).
- Severe inflammation and joint pain
- Nervous system abnormalities:
- Encephalomyelitis (inflammation of the brain)
- Neuropathy nerve paralysis
- Acute spinal disk disease
- Hemiparesis (weakness of one side of the body)
- Ataxia (loss of muscle coordination)
- Bladder dysfunction (loss of urinary control)
- Hearing loss
- Myelitis (inflammation of the spinal cord)
- Paraparesis (paralysis of lower limbs)
- Quadriparesis (paralysis of all limbs)
Can Lyme disease be cured?
Prognosis is excellent and most patients recover completely if treated early. Appropriate oral or intravenous antibiotics can combat infection and provide symptomatic relief. Sometimes a recurrent infection can occur with certain strains, but can be managed well with medication. Co-infection by other organisms transmitted by the same tick bite can also occur which may require treatment. Careful examination of the body, especially hair-bearing areas to remove attached ticks is required.
- Personal and environmental measures to avoid ticks, mice and other insects.
- Removal of attached ticks from self, children and pets.
- Professional management of tick infestation at home.
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