Signs and
symptoms of Early Local Lyme Disease often starts with flu-like
feelings of headache, stiff neck, fever, muscle aches, and fatigue.
About 60% of light-skinned patients notice a unique enlarging
rash, referred to as erythema migrans (EM), days to weeks after
the bite. On dark-skinned people, this rash resembles a bruise.
The rash may
appear within a day of the bite or as late as a month later.
This rash may start as a small, reddish bump about one-half inch
in diameter. It may be slightly raised or flat. It soon expands
outward, often leaving a clearing (normal flesh color) in the
center. It can enlarge to the size of a thumb-print or cover
a persons back.
To be considered
local disease the rash must be at the tick bite site with no
other major organ system involvement. A rash occurring at other
than the bite site in an indication of Disseminated Lyme Disease.
Don't confuse
a local reaction to a tick bite, with signs of infection. A small
inflamed skin bump or discoloration that develops within hours
of a bite and over the next day or two is not likely to be due
to infection - but rather a local reaction to the disruption
of the skin.
Some people
do not notice these early indicators of infection. Early manifestations
usually disappear, and disseminated (other organ system involvement)
infection may occur. General symptoms alone do not indicate Lyme
disease.
GENERAL
Profound fatigue, severe headache, fever(s), severe muscle aches/pain.
BRAIN
Nerve conduction defects (weakness/paralysis of limbs, loss of
reflexes, tingling sensations of the extremities - peripheral
neuropathy), severe headaches, stiff neck, meningitis, cranial
nerve involvement (e.g. change in smell/taste; difficulty chewing,
swallowing, or speaking; hoarseness or vocal cord problems; facial
paralysis - Bell's palsy; dizziness/fainting; drooping shoulders;
inability to turn head; light or sound sensitivity; change in
hearing; deviation of eyeball [wandering or lazy eye], drooping
eyelid), stroke, abnormal brain waves or seizures, sleep disorders,
cognitive changes (memory problems, difficulty in word finding,
confusion, decreased concentration, problems with numbers) and,
behavioral changes (depression, personality changes).
Other psychiatric
manifestations that have been reported in the scientific literature
include: panic attacks; disorientation; hallucinations; extreme
agitation; impulsive violence, manic, or obsessive behavior;
paranoia; schiziphrenic-like states, dementia, and eating disorders.
Several patients have committed suicide.
EYES
Vision changes, including blindness, retinal damage, optic atrophy,
red eye, conjunctivitis, "spots" before eyes, inflammation
of various parts of the eye, pain, double vision.
SKIN
Rash not at the bite site (EM) - This skin discoloration varies
in size and shape; usually has rings of varying shades, but can
be uniformly discolored; may be hot to the touch or itch; ranges
in color from reddish to purple to bruised-looking; and can be
necrotic (crusty/oozy). The rash may develop a bull's-eye rash
or target look. The shape my be circular, oval, triangular, or
a long-thin ragged line.
Other disseminated
skin problems include:
- lymphocytoma,
which is a benign nodule or tumor, and
- acrodermatitis
chronica atrophicans (ACA) which is discoloration/degeneration
usually of the hands or feet.
HEART and
BLOOD VESSELS
Irregular beats, heart block, myocarditis, chest pain, vasculitis.
JOINTS
Pain - intermittent or chronic, usually not symmetrical; sometimes
swelling; TMJ-like pain in jaw.
LIVER
Mild liver function abnormalities.
LUNGS
Difficulty breathing, pneumonia.
MUSCLE
Pain, inflammation, cramps, loss of tone.
STOMACH and
INTESTINES
Nausea, vomiting, diarrhea, loss of appetite, anorexia.
SPLEEN
Tenderness, enlargement.
PREGNANCY
Miscarriage, premature birth, stillbirth, and neonatal deaths
(rare). Congenital LD has been described in medical literature.
It is possible
for the bacterium to pass from mother to fetus across the placenta,
resulting in congenitally acquired LD. A link between LD and
adverse outcomes in pregnancy is under investigation. However,
most studies show that mothers who are promptly diagnosed and
treated appear to have perfectly normal babies.
Nursing women
with LD often call to ask us whether they should continue nursing.
There has been no proved cases of transmission through human
milk. There is research that demonstrates that Bb can
be found in the colostrum of infected cows and mice. Animals
studies have demonstrated that ingestion of Bb can result
in infection. Some physicians recommend nursing mothers discard
breast milk during active infection. Breast feeding can resume
after treatment is completed and the woman becomes symptom-free.
The decision to do so should be discussed with your physician.
For more information
obtain the following information from your local medical library:
Klein (1995) Infectious Diseases of the Fetus and Newborn.
Chapter by Dr. Tess Gardner, "Lyme disease". New York,
NY. Remington-Saunders, p.447-528.
