Lyme Disease

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Signs and Symptoms

Lyme disease may be asymptomatic or may produce symptoms that develop in three stages. The first stage causes flu-like symptoms (e.g., fever, headache, malaise, muscle pain) and the characteristic "bull's eye" rash, typically within 7 to 14 days of infection. These symptoms often resolve without treatment.

The rash begins as a red area at the site of the tick bite and gradually expands, often with central clearing, which produces the bull's eye. It can last from a few hours to several weeks and varies in size. Other types of rash have been noted, some of which resemble hives, eczema, sunburn, poison ivy, and flea bites. Dark-skinned people may develop a rash that resembles a bruise.

The rash may itch, disappear, and then return weeks later. In some cases, a single bite can cause rash to occur on several areas of the body.

The second stage develops in approximately 10% of patients and occurs weeks to months after infection. The bacteria spread throughout the body via the bloodstream and the lymphatic system, causing arthritis, rash, and eye inflammation. Second stage Lyme disease may also affect the heart and the central nervous system. This stage also may resolve without treatment.

Third stage Lyme disease can develop months to years after infection. This stage affects the musculoskeletal, ophthalmologic, cardiovascular, and central nervous systems. Symptoms include the following:

• Blockage in the chambers of the heart (atrioventricular block)
• Brain dysfunction resulting in memory loss (encephalopathy)
• Damage to nerves in the head (cranial neuropathy)
• Inflammation of the brain and spinal cord (encephalomyelitis) or membranes surrounding the brain (meningitis)
• Inflammation of the cornea causing decreased vision and eye pain (keratitis)
• Inflammation of heart muscle (myocarditis) or the membrane that surrounds the heart (pericarditis)
• Inflammation of joints causing pain, swelling, and structural changes (arthritis)
• Multiple rashes
• Rapidly progressive motor neuron paralysis involving inflammation of several peripheral nerves (radiculoneuritis)

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