Stages of Lyme disease

What are the three stages of Lyme disease, and which organ systems are involved in each stage?

• Early localized ECM: skin (ECM), regional lymphadenopathy, flu-like symptoms.

• Disseminated infection: nervous, cardiac, skin, and musculoskeletal systems.

• Persistent infection (late disease): musculoskeletal and nervous systems.

The first stage of Lyme disease, or ECM, occurs days to weeks after inoculation. “Flu-like” symptoms such as headache, fatigue, arthralgias, and fever (15%) often occur, as can regional lymphadenopathy (25%). ECM usually resolves in several days to a few weeks. The second stage, or disseminated infection, occurs weeks to months after ECM occurs and is due to hematogenous spread. The third stage occurs at a mean of 6 months after disease onset (but may occur as soon as days to as late as 2 years after disease onset).


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