Lyme Disease Symptoms: Early vs. Late Stage Manifestations

Early Localized Lyme (Days to Weeks Post-Bite)

• Erythema migrans (EM) rash: Expanding "bull's-eye" (central clearing) in 70–80%; may be homogeneous
• Flu-like symptoms: Fever, chills, fatigue, headache, myalgia, arthralgia
• Lymphadenopathy (local or general)

Early Disseminated Lyme (Weeks to Months)

• Multiple EM lesions
• Neurologic: Facial palsy (Bell's), meningitis, radiculoneuritis
• Cardiac: Atrioventricular block, myopericarditis
• Musculoskeletal: Migratory joint/muscle pain

Late Disseminated Lyme (Months to Years)

• Arthritis: Intermittent or persistent mono/oligoarthritis (knee most common)
• Neurologic: Encephalopathy, polyneuropathy, cognitive impairment, sleep disturbance
• Dermatologic: Acrodermatitis chronica atrophicans (European strains)

Key Points

• Not all patients recall tick bite or develop EM rash.
• Serologic testing (two-tier ELISA/Western blot) supports diagnosis after 4–6 weeks.
• Early antibiotic treatment (doxycycline, amoxicillin, cefuroxime) prevents progression.
• Post-treatment Lyme disease syndrome (PTLDS) may persist despite eradication.