Early/disseminated infection

Dissemination of the infection may occur through the skin, lymph or blood vessels (1). Weeks or months later if the rash is untreated:

• 8% develop cardiac features:
  • myopericarditis, often in young males
  • and/or conduction defects - a PR interval of greater than 0.3 ms may herald complete heart block
• 15% get neurological manifestations (neuroborreliosis), which usually occur within four weeks of the initial illness and resolve over 3 months. It is the most common complication of lyme disease in UK and may include (2):
  • meningoradiculoneuritis (Bannwarth's syndrome)
  • meningitis
  • cranial neuritis - usually VII, with palsy - very hard to distinguish from Bell's palsy
  • radicular neuritis
• 60% get brief attacks of arthritis, and oligoarticular arthritis usually of the large joints, particularly the knee, may occur there can be migratory joint or muscle pain, with or without joint swelling (3).

Other stage II features include:

• secondary erythema chronicum migrans (3)
• eye disorders - conjunctivitis, iridocyclitis, choroiditis, optic neuropathy with papilloedema
• hepatomegaly
• hepatitis
• very rarely, a dry cough or testicular swelling

Reference:

• (1) Centers for Disease Control and Prevention. Lyme Disease (accessed 29/5/2020)
• (2) Health Protection Agency (HPA). Diagnosis and Treatment of Lyme borreliosis
• (3) Bratton R.L. et al. Diagnosis and treatment of Lyme disease. Mayo Clin Proc. 2008;83(5):566-71