Clinical Features of second stage of Lyme disease
What clinical manifestations occur in the second stage (disseminated infection) of Lyme disease?
The nervous, cardiac, skin, and musculoskeletal systems are classically involved in the second stage of Lyme disease. Approximately 10% of patients develop neurologic symptoms 1 to 2 weeks into the disease. The most common neurologic manifestations are cranial nerve palsy (especially unilateral or bilateral Bell’s palsy), lymphocytic meningitis, or a motor or sensory radiculoneuritis. Cardiac manifestations occur in <3% of untreated patients during this stage and include varying degrees of atrioventricular block (usually temporary) and myo- or pancarditis. The heart valves are not involved, distinguishing it from acute rheumatic fever. Secondary (satellite) skin lesions are common (50%) and indicate spirochetal dissemination. Migratory arthralgias are common, but transient. Frank arthritis is usually not prevalent until the third stage. Lymphadenopathy, splenomegaly, mild hepatitis, sensorineural hearing loss, iritis/keratitis, and severe fatigue can also occur.