Classification of Lyme disease into three stages
Note: The disease manifests itself differently from individual to individual, i.e., it can occur with any of the various early or late manifestations!
Stage |
Designation |
Time (p. i.) |
Description |
I |
Early Lyme disease |
1-5 weeks |
- Erythema migrans (wandering redness) or erythema chronicum migrans (89-95.4%).
- Lymphadenosis cutis benigna Bäfverstedt (Borrelia lymphocytoma) (2%).
|
II |
Intermediate Lyme disease |
Weeks to months |
Disseminated infection (spread through the organism; multiorgan disease):
- Fever, muscle and joint pain, diffuse headache, possibly adenopathy, multifocal erythema;
- Carditis (inflammation of the heart) with cardiac arrhythmias and AV blockages.
- Early neuroborreliosis (acute neuroborreliosis) (Lyme neuroborreliosis): painful meningoradiculitis (meningitis with inflammation of adjacent spinal nerve roots) (synonym: Bannwarth syndrome) (3%)Onset: approximately 3-6 weeks after primary infection with:
- Cranial nerve palsies (cranial nerves): facial nerve palsy with unilateral drooping of the corner of the mouth (bilateral facial nerve palsy is associated with Lyme disease in approximately 96 percent of cases) and abducens nerve
- Radicular (“originating from the nerve roots”) pain, especially at night; often multilocular (“many places”) and migratory
- Inflammatory cerebrospinal fluid syndrome
- Temporary blindness in children due to pressure on the optic nerve (optic nerve).
- Lyme arthritis (joint inflammation; mid to late manifestation) – in the early phase, transient and migratory arthralgia (joint pain); later, the actual Lyme arthritis (as mono- or oligoarthritis/joint inflammation in less than 5 joints); usually large joints such as the knee joint are affected Manifestation: late phase of disease (several weeks to months/possibly up to two years after pathogen transmission).
- Lymphadenosis cutis benigna Bäfverstedt (Borrelia lymphocytoma).
|
III |
Late Lyme disease |
Months to years |
Persistent (continuing) infection:
- Lyme arthrtis (as monoarthritis or oligoarthritis) (5%).
- Late neuroborreliosis (chronic neuroborreliosis):
- Acrodermatitis chronica atrophicans Herxheimer (ACA) – inflammatory skin disease of the ends of the body; triad skin atrophy (thinning of the skin; cigarette paper thin), homogeneous reddish (to livid) coloration of the skin and increased vascular markings (1%).
- Predilection sites (body regions where the disease occurs preferentially): dorsum of hands and feet, elbows and knees.
|