Erythema migrans rash
It is widely recognized that there are three stages of Lyme disease, and a good basic understanding of the symptoms that present in these stages can help you to identity the presence of this condition so that you can seek treatment as soon as possible. If you have been exposed to ticks by traveling in high risk areas such as woodland edges and grasslands then you should monitor your health for a few weeks following this exposure and note down any symptoms you may experience for your physician.
Early Stages
There are two main stages after the initial Lyme disease infection, and these are known as ‘early localized’ and ‘early disseminated’. These first two stages present different symptoms such as:
- Early localized – one of the key characteristics of Lyme disease is the skin rash known as Erythema migrans (EM). This occurs in two thirds of patients between 3 to 30 days after the initial infection and manifests as a red mark on the skin (at the site of the tick bite). This mark gradually expands in a circular fashion, rather like a bull’s eye and can be hot and sore to touch and multiple lesions can form in other areas of the body. Typically EM rashes fade after around four weeks, but this does not mean the infection is gone, but instead that it has moved onto the next stage.
- Early disseminated – once the Lyme bacteria begins to spread through the body (via blood and lymph systems) then other symptoms can begin to manifest. This typically includes a flu-like state, with symptoms such as fatigue, chills, fever, stiff joints, and a general feeling of being unwell, which can last for weeks. The generic symptoms can be difficult to diagnose when they manifest without the characteristics EM rash, and many patients are incorrectly diagnosed. At this stage some patients may experiences fibromyalgia, which cause symptoms such as muscle pain and joint stiffness and this can develop into Lyme arthritis if left untreated. Neurologic abnormalities have been known to develop in around 10-15% of patients during the early disseminated stage of Lyme disease and this can result in conditions such as cranial neuritis (typically Bell’s palsy), and an inflammation of the brain known as meningoencephalitis (which resembles meningitis).
Late Stage
The late stage of Lyme disease occurs when the infection is left to spread throughout the system unchecked. This stage can begin months or years after the initial infection and one of the most common symptoms is Lyme arthritis, which develops in around 60% of patients. Lyme arthritis can be a painful and debilitating condition, and although it can be cleared up with antibiotics, long term exposure can lead to permanent damage to the lining of joints, and in particular the knees. Chronic fatigue can also characterize the late stages of Lyme disease infections, and further neurologic abnormalities can develop including a variety of brain problems which can seriously affect mood, memory and sleep.
Treating Lyme Disease
Oral antibiotics such as doxycycline, amoxicillin and cefuroxime axetil can be effective at treating Lyme disease in the early stages, but once the condition has progressed then intensive intravenous antibiotic treatment may be required to target the widespread bacteria. Most patients respond well to antibiotic treatment, although some may find that symptoms can persist for months or even years before they are fully recovered.