Signs and Symptoms of Lyme Disease

Lyme disease occurs in three stages: early localized, early disseminated and late disseminated. Symptoms can occur anywhere from 3 to 30 days after the bite and can be wide-ranging, depending on the stage of the infection. In some cases, symptoms can appear months after the bite.

Early localized stage: The early signs and symptoms of Lyme disease is a “bulls-eye” rash also known as erythema migrans. This rash starts at the site of the tick bite after a delay of 3 to 30 days and spreads gradually over a period of days reaching a diameter of 12 inches or more (30cm). It doesn’t itch and it isn’t painful but may be warm to touch. This rash is said to be typical of Lyme disease, it occurs in approximately 70 to 80 percent of infected individuals and may appear on any part of the body.

Early disseminated stage: Infected persons in early disseminated stage present with flu-like symptoms such as fever, headache, sore throat, chills, visual problems or inflammation of the eye, muscle and joint aches, fatigue and swollen lymph nodes near the site of a tick bite.

Late disseminated Lyme disease: If left untreated, later signs and symptoms of Lyme disease might manifest and can occur weeks, months or years after the tick bite. This stage is characterized by;

  • Irregular heart rhythm or palpitations. Rarely last more than a few days or weeks.
  • Encephalitis (Inflammation of the brain)
  • Neck stiffness with severe headaches caused by inflammation of the tissues surrounding the brain
  • Loss of muscle tone or droop on one or both sides of the face (Paralysis of facial muscles)
  • Diffuse erythema migrans rashes on other areas of the body,
  • Bouts of severe pain affecting the muscles, joints, tendons, and bones.
  • Arthritis affecting the knees and other large joints in the body, with severe pain and swelling. (Lyme arthritis)
  • Numbness or tingling in the hands or feet with shooting pains
  • Inflammation of the liver (hepatitis).
  • Difficulty concentrating
  • Short-term memory loss
  • Visual problems or inflammation of the eye.
  • Loss of consciousness or shortness of breath.
  • Problem with sleep.


What is the best way to treat Lyme disease

The first-line of treatment for adults diagnosed with Lyme disease is doxycycline, a tetracycline antibiotic. Other antibiotics that have activity against Borrelia include the cephalosporin Ceftin and the penicillin-like antibiotic amoxicillin. In children under the age of 12, amoxicillin is preferred to doxycycline because of the possible side effects of doxycycline in small children. The mainstay of treatment is with oral (pill) antibiotics, but intravenous antibiotics are sometimes indicated for more difficult to treat cases such as meningitis, late Lyme arthritis, or neurologic-Lyme disease.

For early disseminated Lyme disease, which may occur when a Lyme infection goes untreated, oral antibiotics are recommended for symptoms such as facial palsy and abnormal heart rhythm. Intravenous antibiotics are recommended if a person has meningitis, inflammation of the lining of the brain and spinal cord, or more severe heart problems.

In late-stage Lyme disease, a patient may receive oral or intravenous antibiotics. Patients with lingering arthritis would receive standard arthritis treatment.

For patients who are not able to tolerate either of amoxicillin, doxycycline, or cefuroxime, the macrolides azithromycin, clarithromycin, or erythromycin may be used instead. Although they have a lower efficacy compared to the latter.

Just like every other medication, antibiotics have possible side effects. They can cause symptoms such as skin rash and itchy skin. Sometimes, symptoms worsen first few days when antibiotic therapy is initiated. This is known as Herxheimer reaction and occurs within the first 24 to 48 hours when the antibiotics start to attack the bacteria. These dead bacteria stimulate the host immune system to release chemokines and inflammatory substances that mediate inflammatory response such as fever, aches and skin rashes. This reaction is always mild and usually resolves between a day or two after initiation of antibiotic therapy.

The Food and Drug Administration warns against the use of Bismacine also known as Chromacine, a chemical substance containing high levels of bismuth. It is usually prescribed by some alternative medicine practitioners to treat Lyme disease. It is not approved for use in injectable form or as a treatment for Lyme disease as it can cause bismuth poisoning, which may lead to heart and kidney failure. However, bismuth is safely used in oral medications for treating stomach ulcers

The general outcome after treatment of Lyme disease is generally favorable. Majority of people return to their normal daily activities after being treated with antibiotics. The prognosis is best when Lyme disease is diagnosed and treated quickly and unfavorable when diagnosis and treatment are delayed. However, a subset of the patient still has lingering symptoms even after standard antibiotic therapy. This condition is known as Post-Treatment Lyme Disease Syndrome (PTLDS)

Post-treatment Lyme Disease Syndrome: Post-treatment Lyme Disease Syndrome (PTLDS) refers to a group patient who remains seriously ill despite standard antibiotic therapy for Lyme disease. PTLDS is characterized by a collection of symptoms that includes sleep disturbance (insomnia), depression, severe fatigue, muscle and bone pain, and cognitive disorders such as the problem with short-term memory, performing simple task or multi-tasking. PTLDS has proven difficult to diagnose among medical experts, and its existence as a syndrome still remains controversial. But recent studies and research shows that strict patient evaluation, when combined with appropriate diagnostic testing, can reliably diagnose patients with typical symptoms pattern of Post-Lyme Disease Syndrome. The study also shows that PTLDS can severely impair patients daily functioning and quality of life.

Factors which predispose to Post-Treatment Lyme Disease Syndrome include a delay in diagnosis of Lyme infection, the presence of neurologic symptoms and increased severity of initial illness.



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Sigal, L. (1998). Pitfalls in the diagnosis and management of Lyme disease. Arthritis & Rheumatism41(2), 195-204. doi: 10.1002/1529-0131(199802)41:2<195::aid-art3>;2-y