3 Distinct Stages - Not all patients suffer all stages, and stages may overlap with remissions between stages
Erythema Chronicum Migrans: Occurs at site of tick bite, beginning with red macule that expands outward. Starts 3-30 days after bite and occurs in 70-80% of cases
Erythema migrans rash more often without central clearing
Fatigue, low grade fever, migrating arthralgia, lymphadenopathy, headache, nausea/vomiting, abdominal pain
Skin- Multiple annular lesions that spare the palm and soles
Nervous System-fluctuating meningoencephalitis, headache, nausea/vomiting, cranial nerve palsies (ie 7th-can be bilateral) peripheral neuropathy, radiculopathy
Cardiovascular: AV blocks, RBBB, dysrhythmias, LV dysfunction
Eye: Conjunctivitis, keratitis, retinal detachment, optic neuritis
Arthritis: Monarticularule outligoarticular asymmetric arthritis (large joints-commonly knee)
Brief episodes separated with complete remission
Migratory pattern may occur
Nervous System: Subtle encephalopathy, fatigue, polyneuropathy
Brief episodes separated with complete remission
Migratory pattern may occur
Lyme disease
Enterovirus
Rabies
Hepatitis
Scarlet fever
Mononucleosis
Plague
Connective tissue disease