- Early Localized: generalized arthralgias
- Early Disseminated: migratory arthralgias
- Late: mono- / oligo-arthritis
See posting Polyarthralgias.
STAGES OF LYME DISEASE — from time of tick exposure
Early Localized (1-4 wks)- Erythema Migrans (EM) lesion(s) [see pix below]
- Generalized arthralgias, myalgias, fatigue, malaise, “viral syndrome”
- Serology Negative
- Migratory Arthralgias [order serology if any of following Sx]
- Multiple EM lesions *
- Meningeal Sx *
- Cranial Nerve Palsies (esp. facial nerve) *
- Radiculopathy / Peripheral neuropathy *
- Cerebellar Ataxia *
- Carditis (A-V Block, often asymptomatic) *
- Serology: IgM Positive, maybe IgG
- Joint: Mono- / Oligo-arthritis of large joints (esp. knee)
- Neuro: Mild cognitive deficits; radicular pain; neuropathy In Europe: Maybe true ecephalitis; cranial nerve deficits; spastic paraparesis
- Serology: IgG Positive
EPIDEMIOLOGY
Vast Majority of cases: VA (northern tip), MD, DL, NJ, PA, NY (eastern), New England, Wisc, Minn.- Forested areas
- Also suburbs of Boston, NYC, Phila
- Most pts don’t notice tiny nymph ticks
- MUST have typical symptoms / findings
- Serology is supportive
- Serology negative
- If negative = No Lyme Disease
- If positive: confirm with Western Blot IgM and IgG
- If negative = No Lyme Disease
- If positive: confirm with Western Blot IgG
- Serology only useful for specific clinical symptoms
- EM lesions (rash is diagnostic: just Tx)
- Arthralgias / myalgias without other symptoms of Early Disseminated Disease
- Screen asymptomatic people
Erythema Migrans (EM) (Multiple Lesions in ~20% of Pts)
Note characteristic central clearing may evolve slowly; lesion may be simply all red on initial presentation.
Multiple EM Lesions