Fast Five Quiz: Tick Bites

Michael Stuart Bronze, MD


March 11, 2022

Stage 1, early localized Lyme disease, refers to isolated erythema migrans and to an undifferentiated febrile illness. This stage occurs 1-30 days after the tick bite. Erythema migrans, the characteristic skin rash of Lyme disease, occurs in approximately two thirds of patients with Lyme disease and develops at an average of 5-7 days after the tick bite.

Stage 2, early disseminated Lyme disease, usually develops 3-10 weeks after inoculation. Systemic manifestations may include fever and malaise. One or more organ systems become involved as hematologic or lymphatic spread disseminates spirochetes to distant sites. Musculoskeletal and neurologic symptoms are the most common; less common are symptoms from cardiac disturbances, such as dizziness, syncope, dyspnea, chest pain, and palpitations. Ocular manifestations include diplopia secondary to a cranial neuropathy or Bell palsy. Blurred vision and eye pain can occur from keratitis and iritis. Unilateral blindness from panophthalmitis has been reported as well. Cranial neuropathies, especially facial nerve palsy (Bell palsy), develop in as many as 5% of patients with Lyme disease during stage 2.

Stage 3, late or chronic Lyme disease, refers to manifestations that occur months to years after the initial infection, sometimes after a period of latency. Signs and symptoms of chronic Lyme disease are primarily rheumatologic and neurologic. Lyme arthritis is the hallmark of stage 3 Lyme disease. It tends to involve large joints (the knee is involved in most cases). Arthritis must be differentiated from arthralgia, which is common in early disease.

Learn more about the presentation of Lyme disease.


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