What Are Its Symptoms?

picture of lyme disease bullseyeAfter infection, many but not all patients develop a characteristic erythema migrans rash that may reach many inches in diameter. It is often asymptomatic and typically develops over days to weeks at the site of the tick bite. At this stage or subsequently, patients develop fever, arthralgia, and malaise with a flu like syndrome, but not in the sense of having an upper respiratory or gastrointestinal illness. Because the tick bite and rash are often asymptomatic, and because both may occur on parts of the body not easily seen, they may go unnoticed. The spectrum of neurological and behavioral disorders ascribed to Lyme disease has been the subject of intense debate. Three clinical syndromes are seen in such increased frequency that their presence alone or together should prompt consideration of Lyme neuroborreliosis in a given patient. They include meningitis, painful polyradiculitis, and cranial neuritis (most commonly a facial palsy). It is important to recognize them and potentially other central, peripheral, and autonomic nervous system manifestations, abbreviated CNS, PNS, and ANS, because they occur early in the infectious illness, lead to a vigorous immune response, and their symptoms resolve more quickly with early institution of antibiotics. There is still debate about encephalopathy, cognitive impairment, and neuropsychiatric involvement in Lyme disease, and the frequency of chronic and late Lyme disease in treated individuals. Notwithstanding, the vigorous immunological response triggered by the Borrelia spirochete infection appears to be a potent factor in the perpetuation of symptoms long after effective treatment has been administered and the infection has been presumably eradicated.

Recognition of the immunological aspects of Lyme infection has already led to the use of immune modulating therapy including intravenous immune globulin (IVIg) and other agents in selected patients.