SYMPTOMS & EARLY DIAGNOSIS
Early Lyme Disease is Easy to Treat & Does Minimal Damage
Early-stage Lyme disease, in most cases (80%), seems to be fairly easy to treat with a typical course of antibiotics, & can present with a subset from a multitude of signs & symptoms including:
Symptoms may occur days or months after a tick bite. Studies are not sufficiently conclusive as to how long the tick must be attached in order to transmit Lyme disease. The transmission times for other tick-borne diseases (called co-infections) are even less well documented. One can only conclude that the longer an infected tick is attached, the greater the chance of contracting Lyme disease & various co-infections.
Tick paralysis is a rare disease thought to be caused by a toxin in tick saliva. The symptoms include acute, ascending, flaccid paralysis that is often confused with other neurologic disorders or diseases (e.g., Guillain-Barré syndrome or botulism). Within 24 hours of removing the tick, the paralysis typically subsides.
According to the Centers for Disease Control & Prevention (CDC) surveillance criteria, an erythema migrans (EM) rash appearing on a patient in a tick-endemic area is a definitive diagnosis of Lyme disease and a patient should be treated immediately without further serological testing needed. This is because the rash is actually caused by the spread of the Lyme disease bacteria spreading under the skin; not the bite itself. Patients may suffer from a diffuse rash all over their body instead of the typical EM bull’s-eye rash (& have nausea and vomiting), depending on the strain of Lyme disease bacteria.
In a non-endemic area, a rash should be confirmed by a positive serological test, because the cause of the patient's rash may not necessarily be from a tick bite & could be from another source. According to the CDC, a rash does not occur in about 30% of cases, but an EM (erythema migrans), an expanding rash with or without a central clearing, often develops at the bite site. Note that a rash may occur in the patient's scalp if that is where the tick attached, and may never be seen. Rashes anywhere other than the bite site may be a sign of already disseminated disease. Sometimes, the classic bull’s-eye rash - a subset of the EM rash - occurs, but only in about 9% of cases. Other studies suggest that only 50% of patients may exhibit any kind of rash with Lyme disease. Genetic variations of the bacteria determine if a patient gets a rash or not.
In the cases where a rash is present, it could appear as a circular red mark that spreads outwards. This rash is usually not itchy. As it spreads over the skin, it may become lighter in the area near the center of the bite. This pattern is characteristic of a bull’s-eye rash compared to other EM rashes. In people of color, the rash may appear more like a bruise. In many cases, the rash could be mistaken for a spider bite.
NO LONGER EARLY LYME
Clinical Symptoms Progress
After Lyme disseminates, a patient may develop additional symptoms characteristic of late-stage Lyme disease, which can manifest more widely in a variety of systems throughout the body. At this time, a patient may exhibit multiple rashes, develop weakness of the facial muscles (Bell’s palsy), experience other peripheral neuropathies, & have cardiac problems.
Late-stage Lyme disease symptoms may already be present when a patient is diagnosed, since the patient may have had Lyme disease symptoms which were not previously recognized or were not attributed to Lyme disease. The course of Lyme disease treatment with antibiotics depends on the duration of illness, the severity of symptoms, & the presence of co-infections. Below is a list of possible Lyme disease symptoms & signs:
Musculoskeletal: joint pain or swelling or stiffness, muscle pain, shin splints, neck or back stiffness, migrating muscle pain or cramps, TMJ, neck creaks & cracks, tender soles, Baker's cysts.
Reproductive: testicular pain/pelvic pain, menstrual irregularity, unexplained milk production (lactation), sexual dysfunction or loss of libido.
Cardiac/Pulmonary: heart block, chest pain or rib soreness, shortness of breath, heart palpitations, pulse skips, slow pulse, heart murmur, valve prolapse, heart tissue damage, pulmonary disease.
Neurological: muscle twitching, headache, tingling, numbness, burning or stabbing sensations, facial paralysis (that looks like Bell’s palsy - may be bilateral), low blood pressure, dizziness, poor balance, increased motion sickness, light-headedness, wooziness, difficulty walking, tremor, involuntary limb jerks, confusion, difficulty thinking/concentrating/reading, forgetfulness, poor short-term memory, disorientation (getting lost, going to wrong place), difficulty with speech, double or blurry vision, eye pain, blindness, increased floaters, increased sensitivity to light or sound or smell, phantom smells, buzzing or ringing in ears, ear pain, decreased hearing or deafness, difficulty swallowing, seizure activity, white matter lesions - brain tissue damage, lymphocytic meningitis, cranial neuritis, radiculoneuropathy, encephalomyelitis.
Neuropsychiatric: mood swings, irritability, depression, disturbed sleep (too much, too little, early awakening), personality changes, obsessive-compulsive disorder (OCD), violent outbursts, paranoia, panic/anxiety attacks, hallucinations.
Gastrointestinal: nausea or vomiting, loss of appetite, GERD, change in bowel function (constipation, diarrhea), gastritis, abdominal cramping, cystitis, irritable bladder or bladder dysfunction, newly diagnosed irritable bowel syndrome (IBS).
Other: fever, sweats, or chills, weight change (loss or gain), fatigue, tiredness, hair loss, swollen glands, sore throat, difficulty swallowing, swelling around the eyes, & swelling in feet.
Bacon RM. Kugeler K, Mead PS. MMWR 2008 57(SS10); 1-9
Stonehouse A, Studdiford JS, Henry CA. An update on the diagnosis and treatment of early Lyme disease: "focusing on the bull's eye, you may miss the mark". J Emerg Med. 2010 Nov;39(5):e147-51. Epub 2007 Oct 18.
Centers for Disease Control and Prevention