What Does Lyme Disease Do to a Person?

Early symptoms of Lyme disease can include flu-like illness, a rash, neck stiffness, swollen glands, and eye redness and tearing. As Lyme disease progresses, symptoms may include inflammation of the heart muscle (Lyme carditis), irregular heartbeats (cardiac arrhythmias), nerve damage in the nerves of the brain, and others.

Lyme disease is an illness transmitted to humans via tick bites from infected ticks of the genus Ixodes (commonly called a deer tick). The tick bite spreads the germ that causes Lyme disease to humans (the spirochete Borrelia burgdorferi). 

Deer ticks feed on deer and mice, and can only infect a human if it remains attached to a person for at least a day and a half.

Symptoms of Lyme disease vary with the stage of the illness. Early symptoms of Lyme disease include:

• Flu-like illness
  • Fever
  • Chills
  • Muscle and joint pains
  • Headache 
  • Feeling unwell (malaise)
• A rash where the tick bite occurred
  • Called “erythema migrans”
  • Usually appears within a month of getting bitten
  • Appears red, but the center may be a person’s normal skin color 
  • May look like a “bull's eye”
• May expand over a few days
• Neck stiffness
• Swollen glands
• Eye redness and tearing

As Lyme disease progresses, symptoms may include:

• Inflammation of the heart muscle (Lyme carditis)
• Irregular heartbeats (cardiac arrhythmias)
• Nerve damage in the nerves of the brain
• Symptoms similar to meningitis
  • Headache 
  • Sensitivity to light (photophobia)
  • Nausea,
  • Neck stiffness 
  • Drowsiness
  • Mood changes 
  • Impaired memory and concentration
• Conjunctivitis (uncommon) 

In patients in the late stage of the disease, the most common symptom is arthritis, mostly in large joints, especially the knee. Symptoms of Lyme arthritis include warmth, swelling, and limited range of motion of the joints.

Post-Treatment Lyme Disease Syndrome (PTLDS) or chronic Lyme disease is the primary complication of Lyme disease in which symptoms persist more than 6 months after completing treatment. There is no treatment for PTLDS and it can take many months for patients to recover. 

Symptoms of PTLDS include:

• Fatigue that may last for years
  • May be accompanied by widespread muscle aches and severe headaches
• Arthritis and joint pain
• Problems with short-term memory and thinking
• Numbness and tingling or loss of feeling in extremities
• Irregular or slow heartbeats
• Hearing or vision may be affected
• Face muscles and eyelids droop on one side (Bell’s Palsy)
• Depression and anxiety – may be due to the chronic nature of the illness

In areas where the ticks that carry Lyme disease are endemic, when a patient with probable erythema migrans (the rash that appears where the tick bite occurred) sees a doctor, blood tests are performed to diagnose the condition, including: 

• Step 1: Enzyme immunoassay (EIA) or immunofluorescence assay (IFA) — Total Lyme titer or IgG and IgM titers 
• Step 2: Western blot testing — only performed if step 1 test results are positive

Other tests that may be indicated include: 

• Joint aspiration (fluid is drained from the joints) to see if there is another cause for fluid buildup on the joints
• Cerebrospinal fluid (CSF) analysis (in patients with meningitis)
• Electrocardiogram (ECG) (to identify arrhythmias or Lyme carditis)

When treated early, Lyme disease can be cured and most patients will recover completely. Early Lyme disease is treated with antibiotics such as: 

• Doxycycline
• Amoxicillin
• Cefuroxime axetil

Even when treated in later stages, most patients will respond well to antibiotics, though there may be some chronic damage to the nervous system or joints.

Neurologic manifestations of Lyme disease are treated with: 

• Intravenous (IV) penicillin
• IV ceftriaxone
• IV cefotaxime
• Oral doxycycline

Late-stage Lyme disease (Lyme arthritis) treatment includes:

• Oral antibiotics for 28 days 
• Re-treatment with oral antibiotics for any residual joint swelling 
• Re-treatment with intravenous (IV) antibiotics for cases that do not resolve with oral antibiotics
• Oral antibiotics for an additional month in patients with positive PCR of synovial fluid 
• Nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with negative PCR test, supplemented, if necessary, with hydroxychloroquine 
• Arthroscopic synovectomy may be indicated in patients who do not respond to symptomatic treatment

Lyme carditis (heart inflammation) may be treated with either oral or IV antibiotic therapy for two to three weeks. Patients with severe symptoms of carditis may need to be hospitalized.