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Lyme Disease Progression, Diagnosis, and Prognosis

lyme disease stagesMany Lyme disease patients are healthy, and consider themselves as such, prior to being infected and diagnosed with Lyme disease. The irony is that those who engage in active outdoor pursuits, such as hiking, gardening, horse-riding, hunting, and so forth are more likely to come into contact with ticks and contract Lyme disease than people who do little outdoor physical activity. Patients such as these may then brush off initial symptoms such as a flu-like illness and brief period of joint pain as an isolated incidence of being run down or having overdone the hiking or other activity. As Lyme disease symptoms progress to include cognitive dysfunction and neuropathies, patients may then begin to suspect other factors at work.

Lyme Disease Progression and Testing

Seronegativity on early tests for Lyme disease does not necessarily mean a patient is free of infection as the antibodies detected by such tests take time to build to discernible levels. Symptom progression may be similar between those receiving an early result of seropositivity and seronegativity which makes it all the more difficult for physicians to diagnose the disease accurately. As the condition goes untreated for longer the worse the prognosis for Lyme disease and the greater the possibility of permanent tissue damage. It may be that a patient is prescribed a course of antibiotics, such as doxycycline, for an unrelated acute infection during the time that they have undiagnosed Lyme disease and that they observe a concomitant improvement in symptoms such as joint pain, memory deficit, and other ailments put down to age or other cause. In a number of cases these patients may then be retrospectively diagnosed with an infection such as Lyme disease and serological testing carried out to determine the presence of bacteria in order to continue treatment should it be needed to ensure eradication of the infection.

’Typical’ Lyme Disease Progression

A common sequence of events in Lyme disease progression is a tick bite followed by a localized Lyme disease rash (the bull’s-eye rash) a week or two later, often with an associated flu-like illness and subsequent joint pain, neck pain, and possible facial palsy. These initial symptoms then subside, possibly returning several weeks or months later and are joined by cranial nerve symptoms as the infection spreads to the central nervous system. Dissemination of the bacteria to the rest of the body can lead to inflammation of the heart, abnormal heart-rate, Lyme arthritis, and a number of other symptoms such as fever, swollen glands, musculoskeletal pains, headaches and migraines, and even nausea and gastrointestinal symptoms in some patients (although these can also be an effect of Lyme disease antibiotics).

Psychological symptoms may then occur and intensify as the infection spreads. In older patients the skin in the area of the initial bite may become thin and paper-like, with hair-loss in the area (this is more common in European strains of the Lyme disease bacteria). Lyme arthritis affecting one or more joints (often the larger joints) is more common in North American Lyme disease cases than in Europe and Asia. The particular strain of Borrelia appears to affect the likelihood of patients experiencing specific symptoms and clusters of symptoms but more research needs to be done to create a clearer picture of Lyme disease progression.