Stages of Lyme Disease

Untreated Lyme disease (infection with the bacteria B. burgdorferi sensu lato) progresses over time through three clinical stages that can present with skin, cardiac, nervous system, and musculoskeletal manifestations. Diagnosing Lyme disease can be challenging, as the initial characteristic skin lesion, erythema migrans, is highly variable, and may present as a single or multiple lesions. Erythema migrans is also not always visible. Patients may initially present with non-specific symptoms such as fever, fatigue, and malaise. All non-erythema migrans manifestations require a positive two-tier serology to confirm the diagnosis. The majority of second stage early disseminated cases are neurologic in nature and may present with any combination of cranial nerve palsy, radiculoneuritis, and meningitis, whereas the majority of late disseminated cases are musculoskeletal in nature. Persistent symptoms may occur after treatment of any stage of Lyme disease, and may be due to a number of potential mechanisms still under study.