Lyme Disease





Clinical Stages of Lyme Disease:
1) Stage 1: Early/Localized Infection: occurs 3-32 days (average 7-10 days) after infection
a) Erythema Migrans (75% of cases): bullseye rash at bite site (usually thigh/groin/axilla) -> progresses to warm (although not often painful) erythema migrans
-Rash may last up to 3-4 wks, although pts usually do not notice the non-pruritic skin lesions
b) Non-Specific Rash:
c) Influenza-Like Illness Without Rash:

2) Stage 2: Disseminated Infection: occurs weeks-months after onset of Erythema Migrans
a) Multiple Annular Skin Lesions:
b) Arthralgias/Myalgias:
c) Malaise/Fatigue:
d) Neuro Involvement (15% of cases/occurs after weeks-months):
–Aseptic Meningitis: LP with lymphocytic pleocytosis (WBC usually around 100)/elevated protein/normal-slightly decreased glucose
–Facial Palsy:
–Neuropathy (see [[Phrenic Neuropathy]])
– Acute/Chronic Hypoventilation (see Acute Hypoventilation, [[Acute Hypoventilation]] and Chronic Hypoventilation, [[Chronic Hypoventilation]])
–Headache: may be severe
e) Cardiac Involvement (8% of cases/occurs after weeks, lasting only a few wks, but may recur):
–Heart Blocks: AV blocks, complete heart block
–LV Dysfunction/CHF:
–Arrhythmias: VT

3) Stage 3: Persistent Infection: occurs months-years after onset of infection
a) Large Joint Oligoarticular Arthritis (60% of cases):
–Lasts wks-months in each joint
–Typically involves the knee
–Arthrocentesis: WBC count 500-110k (average 25k), neutrophil-predominant
b) Neuroborreliosis:
–Subtle Encephalopathy (with abnormal CSF):
–Axonal Polyneuropathy:
–Leukoencephalitis (rare):
c) Chronic Skin Involvement: acrodermatitis chronica atrophicans (mostly in elderly women/more common in Europe)

4) Post-Lyme Syndrome: debilitating chronic illness (fatigue, neurocognitive symptoms, etc.) following Lyme treatment (not due to chronic Lyme infection)
-Randomized trial of antibiotics in tis group showed no improvement
[Klempner, 2001, NEJM]



Steere AC. Lyme Disease (Medical Progress). New Engl J Med 1989; 321(9):586-596
Vlay SC, Dervan JP, Elias J, et al. Ventricular tachycardia associated with Lyme disease. Am Heart J 1991; 121:1558-1660