![]() 12,14 Cranial nerve involvement can result in unilateral or bilateral facial palsy, and peripheral nerve involvement can cause radiculoneuropathy that can manifest as numbness, tingling, shooting pain, or weakness in the arms or legs. Neurologic Lyme disease occurs when B burgdorferi infects the peripheral or central nervous system (CNS). 11 Importantly, the CDC recommends that patients with suspected Lyme carditis should be hospitalized for cardiac monitoring and treated with antibiotics prior to laboratory confirmation of Lyme disease. 11 The condition is treated with oral or intravenous antibiotics, with the choice of antibiotic and dosage based on the degree of heart block. Symptoms include light-headedness, fainting, shortness of breath, heart palpitations, and chest pain. 11,14 Carditis can occur any time after the early localized stage and can be fatal. 11,14 The condition manifests as myocarditis and/or atrioventricular nodal conduction abnormalities. Lyme carditis occurs when B burgdorferi infects the heart. Recognized complications of late-stage disease include Lyme carditis, 11 neurologic Lyme disease, 12 and Lyme arthritis. Severe complications include encephalopathy, polyneuropathy, lymphocytic meningitis, and lymphocytoma. Fatigue and prolonged chronic arthritis are common nonspecific symptoms. Late-stage disease is defined as symptoms occurring from months to years after the tick bite. 9 Atrioventricular heart block, sometimes with myopericarditis, can occur. 2,9 Nonspecific symptoms include severe headaches and neck stiffness, facial palsy, arthritis, malaise, fatigue, and migratory pain in joints, bones, and muscles. Annular skin lesions smaller than those of erythema migrans may be the first sign of early disseminated disease however, some individuals with Lyme disease do not develop these additional lesions. ![]() The early disseminated stage of Lyme disease is characterized by symptoms from 2 weeks to months after the tick bite. Image courtesy of the CDC Public Health Library. Erythema migrans of the posterior right shoulder in a patient with Lyme disease. 1 Other tick-borne diseases may be distinguished by geographic distribution, symptoms, and/or laboratory tests (see Sidebar). However, they are also found in Wisconsin, Minnesota and, to a lesser extent, other states in the Great Lakes and Pacific Coastal regions. 1 Cases are heavily centered in New England and the Mid-Atlantic. The geographic distribution of high-incidence Lyme disease areas appears to be expanding. 3 While insurance records may overestimate case numbers owing to pre-emptive treatment of some patients, they highlight the large burden on the healthcare system. 1 However, insurance records suggest that 300,000 to 476,000 Americans may be diagnosed and treated for Lyme disease each year. ![]() 1 In 2019, about 35,000 confirmed and probable cases of Lyme disease were reported to Centers for Disease Control and Prevention (CDC). 2 The exact incidence of Lyme disease is unknown because cases are largely unreported. Lyme disease is most common among children and middle-aged adults.
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