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Late disease manifestations

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Late disease manifestations occur months or years later if the rash has been untreated. These include (1):

  • erosive arthritis:
    • rare in UK-acquired infection, common if the disease was acquired in North America or some parts of Europe (2)
    • mono- or oligoarticular
    • usually affects the knee (2)
    • intermittent or chronic
  • acrodermatitis chronica atrophicans
    • most common cutaneous manifestation seen in Europe
    • start off as an initial red or bluish-red discolouration which is followed by atrophic skin changes
    • usually seen on the extensor surfaces of the hands (3)
  • chronic progressive encephalitis and encephalomyelitis (rare). Lyme encephalitis can be differentiated from multiple sclerosis because of the presence of a specific antibody in the CSF and a higher cell count.
  • other features include cardiac involvement
    • during early disseminated infection, acute cardiac involvement may occur, characterized by atrioventricular conduction defects in varying degrees
    • less common cardiac manifestations include:
      • acute myopericarditis or,
      • more rarely, a dilated cardiomyopathy
    • Lyme carditis is potentially fatal if untreated (4)
  • and a dermatomyositis-like syndrome

Reference:

  • (1) European Union Concerted Action on Lyme Borreliosis (EUCALB). Lyme borreliosis
  • (2) Health Protection Agency (HPA). Diagnosis and Treatment of Lyme borreliosis
  • (3) National Travel Health Network and Centre (NaTHNaC) 2007. Travel Health Information Sheets: Lyme disease
  • (4) Kullber BJ et al. Lyme borreliosis: diagnosis and management.BMJ 2020;369:m1041

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