What Is Chronic Lyme Disease (Stage 3)?

Stage 1 early localized disease with a red rash with a "bullseye" appearance occurring at or near the site of the tick bite.

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. 

Thus, 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.

The signs and symptoms of Lyme disease usually appear one to 30 days after a tick bite, but most commonly between seven and 14 days. The first sign is usually a skin rash and flu-like symptoms.

There are three stages of Lyme disease, which are outlined below. 

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 a “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 
  • an 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
  • chills
  • muscle and joint pain
  • headache
  • 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)
  • dizziness
  • unconsciousness 
  • difficulty breathing
  • chest pain
  • palpitations
• Eye manifestations:
  • blurred or double vision
  • eye pain 
  • blindness
• Heart manifestations:
  • heart block
  • heart inflammation
  • cardiomyopathy
• 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)
  • headache
  • neck pain or stiffness
  • photophobia (sensitivity to light)
  • nerve paralysis like facial nerve palsy (Bell palsy)
  • disturbances in memory, concentration, mood, sleep, personality, and/or language
  • depression 
  • irritability 
• 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

Stage 3 Lyme disease occurs months to years after the initial infection or during a period of latency. Most patients presenting with the late disease do not have erythema migrans because the rash urges the patient to seek treatment earlier.

Symptoms of Stage 3 Lyme Disease may include the following:

• Skin manifestation:
  • Acrodermatitis Chronica atrophicans: found almost exclusively in patients of European descent. It commonly affects older women with bluish-red discoloration on the back of the hands, feet, knees, and elbows.
• Lyme arthritis:
  • typically involves one or a few large joints (the knee is involved in 90% of cases).
  • severe inflammation and joint pain
• Nervous system abnormalities:
  • encephalopathy 
  • 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)
  • seizures
  • bladder dysfunction (loss of urinary control)
  • hearing loss
  • myelitis (inflammation of the spinal cord)
  • paraparesis (paralysis of lower limbs)
  • quadriparesis (paralysis of all limbs)

Lyme disease is commonly treated in the following ways:

• Treatment with oral and/or intravenous antibiotics to combat infection and medications to provide symptom relief.
• Removal of attached ticks.

Tips to prevent Lyme disease include:

• 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

Prognosis is excellent and most patients recover completely, especially if treated early with appropriate antibiotics. Sometimes a recurrent infection can occur with certain strains, but Lyme disease can be managed well with medication. Co-infection by other organisms transmitted by the same tick bite can occur.