Lyme disease natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Lyme disease is effectively managed by prompt treatment. Prognosis is affected by failure to treat in a timely manner as well as simultaneous infections with other tick-borne diseases. Lyme disease can cause neurological complications such as facial paralysis and carditis.
Natural History
Stage 1: Early Localized Lyme disease (3-30 Days Post-tick Bite)
- Red, expanding rash called erythema migrans (EM)
- Fatigue, chills, fever, headache, muscle and joint aches, and swollen lymph nodes
- Some people may get these general symptoms in addition to an EM rash, but in others, these general symptoms may be the only evidence of infection.
- Some people get a small bump or redness at the site of a tick bite that goes away in 1-2 days, like a mosquito bite. This is not a sign that you have Lyme disease. However, ticks can spread other organisms that may cause a different type of rash. For example, Southern tick-associated rash illness (STARI) causes a rash with a very similar appearance.
- EM resolves in approximately 28 days in untreated patients.[1]
Erythema Migrans (EM) or "Bull's-eye" Rash
- Rash occurs in approximately 70-80% of infected persons and begins at the site of a tick bite after a delay of 3-30 days (average is about 7 days).
- Rash gradually expands over a period of several days, and can reach up to 12 inches (30 cm) across. Parts of the rash may clear as it enlarges, resulting in a “bull's-eye” appearance.
- Rash usually feels warm to touch but is rarely itchy or painful.
- EM lesions may appear on any area of the body.
Stage 2: Early Disseminated Lyme disease (Days to Weeks Post-tick Bite)
- Untreated, the infection may spread from the site of the bite to other parts of the body, producing an array of specific symptoms that may come and go, including:
- Additional EM lesions in other areas of the body
- Facial or Bell's palsy (loss of muscle tone on one or both sides of the face)
- Severe headaches and neck stiffness due to meningitis (inflammation of the spinal cord)
- Pain and swelling in the large joints (such as knees)
- Shooting pains that may interfere with sleep
- Heart palpitations and dizziness due to changes in heartbeat
- Many of these symptoms will resolve over a period of weeks to months, even without treatment. However, lack of treatment can result in additional complications.
Bell's (Facial) Palsy
- Loss of muscle tone on one or both sides of the face is called facial or “Bell's” palsy.
Stage 3: Late Disseminated Lyme disease (Months-to-Years Post-tick Bite)
- Approximately 60% of patients with untreated infection may begin to have intermittent bouts of arthritis, with severe joint pain and swelling.[2]
- Intermittent attack of Lyme arthritis ranges from 3 days to 11.5 months with a mean of 3 months.[3]
- Large joints are most often affected, particularly the knees. Arthritis caused by Lyme disease manifests differently than other causes of arthritis and must be distinguished from arthralgias (pain, but not swelling, in joints).
- Up to 5% of untreated patients may develop chronic neurological complaints months to years after infection. These include shooting pains, numbness or tingling in the hands or feet, and problems with short-term memory.
Arthritis
- Pain and swelling in the large joints (such as knees) can occur.
Lingering Symptoms After Treatment (Post-treatment Lyme disease Syndrome)
- Approximately 10-20% of patients with Lyme disease have symptoms that last months to years after treatment with antibiotics. These symptoms can include muscle and joint pains, cognitive defects, sleep disturbance, or fatigue. The cause of these symptoms is not known, but there is no evidence that these symptoms are due to ongoing infection with B. burgdorferi. This condition is referred to as post-treatment Lyme disease syndrome (PTLDS). There is some evidence that PTLDS is caused by an autoimmune response, in which a person's immune system continues to respond, doing damage to the body’s tissues, even after the infection has been cleared. Studies have shown that continuing antibiotic therapy is not helpful and can be harmful for persons with PTLDS.
Complications
Stage 3, or late disseminated, Lyme disease can cause long-term joint inflammation (Lyme arthritis) and heart rhythm problems. Brain and nervous system problems are also possible, and may include:
- Decreased concentration
- Memory disorders
- Nerve damage
- Numbness
- Pain
- Paralysis of the face muscles
- Sleep disorders
- Vision problems
Prognosis
For early cases, prompt treatment is usually curative.[4] However, the severity and treatment of Lyme disease may be complicated due to late diagnosis, failure of antibiotic treatment, simultaneous infection with other tick-borne diseases including Ehrlichiosis, Babesiosis, and Bartonella, and immune suppression in the patient.
A meta-analysis published in 2005 found that some patients with Lyme disease have fatigue, joint and/or muscle pain, and neurocognitive symptoms persisting for years despite antibiotic treatment.[5] Patients with late stage Lyme disease have been shown to experience a level of physical disability equivalent to that seen in congestive heart failure.[6]
Though rare, Lyme disease can be fatal.[7][8][9][10]The first CDC recognized death from Lyme disease was Amanda Schmidt, age 11.[11]
References
- ↑ Steere AC, Bartenhagen NH, Craft JE, Hutchinson GJ, Newman JH, Rahn DW; et al. (1983). "The early clinical manifestations of Lyme disease". Ann Intern Med. 99 (1): 76–82. PMID 6859726.
- ↑ Wormser, Gary P. (2006). "Early Lyme Disease". New England Journal of Medicine. 354 (26): 2794–2801. doi:10.1056/NEJMcp061181. ISSN 0028-4793.
- ↑ Steere AC, Schoen RT, Taylor E (1987). "The clinical evolution of Lyme arthritis". Ann Intern Med. 107 (5): 725–31. PMID 3662285.
- ↑ Krause PJ, Foley DT, Burke GS, Christianson D, Closter L, Spielman A (2006). "Reinfection and relapse in early Lyme disease". Am. J. Trop. Med. Hyg. 75 (6): 1090–4. PMID 17172372.
- ↑ Cairns V, Godwin J (2005). "Post-Lyme borreliosis syndrome: a meta-analysis of reported symptoms". Int J Epidemiol. 34 (6): 1340–5. PMID 16040645.
- ↑ Klempner MS, Hu LT, Evans J; et al. (2001). "Two controlled trials of antibiotic treatment in patients with persistent symptoms and a history of Lyme disease". N Engl J Med. 345 (2): 85–92. PMID 11450676.
- ↑ Kirsch M, Ruben FL, Steere AC, Duray PH, Norden CW, Winkelstein A (1988). "Fatal adult respiratory distress syndrome in a patient with Lyme disease". JAMA. 259 (18): 2737–9. PMID 3357244.
- ↑ Oksi J, Kalimo H, Marttila RJ; et al. (1996). "Inflammatory brain changes in Lyme borreliosis. A report on three patients and review of literature". Brain. 119 (Pt 6): 2143–54. PMID 9010017.
- ↑ Waniek C, Prohovnik I, Kaufman MA, Dwork AJ (1995). "Rapidly progressive frontal-type dementia associated with Lyme disease". J Neuropsychiatry Clin Neurosci. 7 (3): 345–7. PMID 7580195.
- ↑ Cary NR, Fox B, Wright DJ, Cutler SJ, Shapiro LM, Grace AA (1990). "Fatal Lyme carditis and endodermal heterotopia of the atrioventricular node". Postgrad Med J. 66 (772): 134–6. PMID 2349186.
- ↑ "First Lyme Disease Death Told". Los Angeles Times. 1990-09-26.