Lyme disease
Epidemiology
Etiology
Pathophysiology
Clinical features
Stage I (early localized Lyme disease)
Symptom onset occurs 7–14 days after a tick bite.
- Erythema migrans
- Flu‑like symptoms
Stage II (early disseminated Lyme disease)
Symptom onset occurs 3–10 weeks after a tick bite
- Migratory arthralgia; can progress to Lyme arthritis if left untreated
- Early neuroborreliosis
- Lyme carditis
- Cutaneous manifestations
- Multiple erythema migrans lesions
Neuroborreliosis
- Onset
- Early neuroborreliosis: within the first few months after a tick bite; typically has an acute onset
- Late neuroborreliosis: months to years after the initial infection; typically has an indolent onset
- Peripheral neuropathy: weakness, pain, paresthesia
- Cranial neuropathy: most commonly facial nerve palsy (often bilateral)
- Radiculitis, plexopathy, mononeuropathy, or mononeuritis multiplex
- Meningitis: can cause benign intracranial hypertension
- Encephalitis, myelitis, or encephalomyelitis
Lyme arthritis
- Onset: weeks to years after the initial infection
- Prodrome of migratory arthralgia: can occur in early disseminated Lyme disease
- Affects joints at different times; typically involves the bursae and tendons at onset
- Can progress to Lyme arthritis if left untreated
- Lyme arthritis: typically occurs in late disseminated Lyme disease
- Monoarthritis or asymmetric oligoarthritis
- Typically affects the large joints (especially the knee or elbow)
- May be intermittent or persistent