Symptoms of stage 3 (chronic phase)

Further months to years after the infection, various organ disorders may occur. This stage shows regional differences. While in the USA Lyme arthritis is more common in this stage, in Europe neurological diseases and skin symptoms predominate.

Lyme arthritis mainly affects the large joints, usually only one or few joints are affected. Often a constant changeable course can be observed, with completely symptom-free intervals. Neurological symptoms may include hearing loss, increased fatigue, polyneuropathy (disease of several body nerves that supply the periphery (arms, legs) of the body) and encephalomyelitis (inflammation of the brain and spinal cord).

A so-called acrodermatitis chronica atrophicans (ACA) can develop on the skin (also called Herxheimer’s disease). ACA is an atrophy (tissue regression) of the skin, which then turns blue-brown and becomes as thin as “parchment or cigarette paper”. In all stages of Lyme disease spontaneous healing can occur even without therapy. Furthermore, the time between stages and their duration can vary considerably.

Symptoms after years

The third stage of the disease is only reached after months or years. In most cases, the symptoms then manifest themselves as joint inflammation (arthritis), which is caused by the colonisation of the joints with the Borrelia bacteria. The knee joint is often affected.

The inflammation in the knee causes pain that gets worse with movement. In addition, swelling, overheating and redness of the skin in the joint region is noticeable. As the inflammation progresses, the cartilage in the joint is destroyed and the joint becomes increasingly stiff.

Furthermore, the heart can also be affected by the Borrelia infection, if the inflammation of the heart muscle has permanently damaged the heart performance or rhythm in the advanced stages. Heart failure and cardiac arrhythmia can occur. The brain is rarely affected even after years. If the brain is permanently damaged, the cognitive performance decreases. Furthermore, the paralysis from the 2nd stage can persist.

Symptoms child/infant

Especially children often get tick bites when playing in woods and meadows. Therefore, children should be checked for tick bites especially thoroughly after playing. The Lyme disease infection manifests itself in children with similar symptoms as in adults.

Initially, it also occurs, but usually without further symptoms. In children, diseases of the nervous system, i.e. neuroborreliosis, occur particularly frequently in the second stage. Often the nerve that supplies the facial muscles is affected.

This means that the facial muscles can be paralyzed (facial nerve paresis) – a symptom can therefore be the drooping of one half of the face. In addition, meningitis also occurs in children. Facial nerve palsy and meningitis in children are often self-limiting diseases with benign courses.

Joint problems or the infestation of the heart muscle are rather rare complications of a Borrelia infection in children. In the third stage, arthritis (inflammation of the joints) also occurs most frequently in children after years, similar to that in adults. As with pregnant women, children under 10 years of age should not be treated with the antibiotic doxycycline, but should be treated with amoxicillin or cefuroxime.