This Lyme disease rash, called erythema migrans, starts out as a red blotch and spreads over a period of a few days to form a central red spot with a wider area of paler red skin around it. In some cases there is a clear ring of skin between the inner indurated spot and outer red ring. The rash is not usually painful or itchy but may be warm to the touch and the spreading of the redness indicates the steady dissemination of the infection across the body. Headaches, malaise, migratory and intermittent joint pain, and fatigue may also occur in the initial localized infection stage. The flu-like symptoms of early localized Lyme disease commonly last around two to three weeks.
A brief period of remittance may then occur as the spirochaetes migrate steadily into the bloodstream and start to affect the skin, nervous system, heart, and joints. Sometimes symptoms develop rapidly within just a few days of the initial bite and other times they may only arise weeks afterwards after any initial rash has cleared. The early disseminated stage indicates the progression of the infection into the peripheral nervous system and may be indicated by the erythema migrans rash having spread to other areas far away from the original tick bite. Multiple bull’s eye lesions occur in around 40% of patients, with the reappearance of the original rash occurring in around 20% of patients. Headaches, neck stiffness, fever, chills, and more severe joint pain may follow along with paraesthesia, cardiac irregularities, and lymph node inflammation.
Around a third of patients with erythema migrans display no further manifestations of the disease however, whereas the rest suffer progressive infection. Cranial nerve palsy leading to facial paralysis (commonly bilateral) can also occur in both the early disseminated stage and late stage Lyme disease. This facial palsy may last for around two months without treatment and could reoccur. Patients who remain untreated may experience heart palpitation, dizziness, and neurological problems in the early disseminated stage although the central nervous system is not yet impacted.
Over months, or even years in rare cases, late stage Lyme disease may occur with around 5% of patients developing further neurological symptoms and around 60% of those in North America commonly experiencing arthritis, joint pain and swelling. Two-thirds or so of affected patients will experience arthritis pain lasting for around a week within six months of the rash first appearing. This pain may then reoccur and resolve intermittently until successful antibiotic treatment is given. Patients may develop symptoms related to the infection’s presence in the central nervous system and the destruction of both white and grey matter. Cognitive abilities can be adversely affected, mood swings, anxiety, and even acute psychosis may arise. Patients suffering symptoms of the most progressive of the Lyme disease stages may develop difficulties in both their professional and personal lives due to impaired mental health and cognition along with physical disability.