Clinical features

Lyme disease is a multisystemic disorder with cutaneous, joint, neurological, cardiac, and occasional ocular involvement (1).

Like other spirochaetal diseases such as leptospirosis and syphilis the disease divides into 3 stages, although there is considerable overlap between the stages.

• stage 1 - early/localised infection
• stage 2 - early/disseminated infection
• stage 3 - late/persistent infection (2)

Thirty-three percent of patients remember the red macule or papule left by the nymphal tick bite.

Infection with B. burgdorferisensu lato (sl) can sometimes go unremarked, with mild symptoms that are ignored by the person (3)

• when symptoms occur, this is called Lyme disease
• many people may not notice or remember a tick bite
  • a tick bite can be followed by an 'erythema migrans' rash, which is sometimes mistaken for cellulitis or ringworm, and effective treatment is delayed
  • if there is no erythema migrans or it is unnoticed, diagnosis can be difficult because the same symptoms may be caused by many other conditions as well as Lyme disease.

Reference:

• (1) Centers for Disease Control and Prevention. Lyme Disease (accessed 29/5/2020)
• (2) Brouqui P et al. Guidelines for the diagnosis of tick-borne bacterial diseases in Europe. Clin Microbiol Infect 2004;10:1108–1132
• (3) NICE (April 2018).Lyme disease