Lyme disease classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Lyme disease is classified into three stages. They are localized Lyme disease, disseminated Lyme disease and late disseminated Lyme disease. DUring stage 1, the patient can develop erythema migrans rash. Ten to twenty percent of the patients who has Lyme disease can develop post treatment Lyme disease syndrome.

Classification Based on Clinical Stage

• Stage 1 is called early localized Lyme disease. The infection is not yet widespread throughout the body.
• Stage 2 is called early disseminated Lyme disease. The bacteria have begun to spread throughout the body.
• Stage 3 is called late disseminated Lyme disease. The bacteria have spread throughout the body.

Stage 2: Early Disseminated Lyme disease (Days to Weeks Post-tick Bite)

• Untreated, the infection may spread from the site of the bite to other parts of the body, producing an array of specific symptoms that may come and go, including:

• Additional EM lesions in other areas of the body
• Facial or Bell's palsy (loss of muscle tone on one or both sides of the face)
• Severe headaches and neck stiffness due to meningitis (inflammation of the spinal cord)
• Pain and swelling in the large joints (such as knees)
• Shooting pains that may interfere with sleep
• Heart palpitations and dizziness due to changes in heartbeat

• Many of these symptoms will resolve over a period of weeks to months, even without treatment. However, lack of treatment can result in additional complications.

Bell's (Facial) Palsy

• Loss of muscle tone on one or both sides of the face is called facial or “Bell's” palsy.

Stage 3: Late Disseminated Lyme disease (Months-to-Years Post-tick Bite)

• Approximately 60% of patients with untreated infection may begin to have intermittent bouts of arthritis, with severe joint pain and swelling. Large joints are most often affected, particularly the knees. Arthritis caused by Lyme disease manifests differently than other causes of arthritis and must be distinguished from arthralgias (pain, but not swelling, in joints).
• Up to 5% of untreated patients may develop chronic neurological complaints months to years after infection. These include shooting pains, numbness or tingling in the hands or feet, and problems with short-term memory.

Arthritis

• Pain and swelling in the large joints (such as knees) can occur.

Lingering Symptoms After Treatment (Post-treatment Lyme disease Syndrome)

• Approximately 10-20% of patients with Lyme disease have symptoms that last months to years after treatment with antibiotics. These symptoms can include muscle and joint pains, cognitive defects, sleep disturbance, or fatigue. The cause of these symptoms is not known, but there is no evidence that these symptoms are due to ongoing infection with B. burgdorferi. This condition is referred to as post-treatment Lyme disease syndrome (PTLDS). There is some evidence that PTLDS is caused by an autoimmune response, in which a person's immune system continues to respond, doing damage to the body’s tissues, even after the infection has been cleared. Studies have shown that continuing antibiotic therapy is not helpful and can be harmful for persons with PTLDS.

Classification Based on Causative Organism

• Lyme disease is usually caused by B. burgdorferi. However, B. mayonii has recently been discovered to be also responsible for development of Lyme disease.
• The following table demonstrates key clinical and epidemiological features that distinguish B. burgdorferi from B. mayonii:

	B. burgdorferi	B. mayonii
Transmission	Tick bite	Tick bite
Distribution in the USA	Northeast, Mid-Atlantic, and Midwest regions	Midwest region
Bacteria Concentration in Blood (Spirochetemia)	Lower	Higher
Early Symptoms	Fever, headache, rash, neck pain	Fever, headache, rash, neck pain
Late Symptoms	Arthritis	Arthritis
Nausea / Vomiting?	No	Yes
Rash Characteristics	Bull's-eye target lesion	Diffuse rash
Diagnosis	Serology or PCR	Serology or PCR
Treatment	Doxycycline	Doxycycline

^{Adapted from Pritt BS et al. Identification of a novel pathogenic Borrelia species causing Lyme borreliosis with unusually high spirochaetaemia: a descriptive study. Lancet Infectious Diseases. DOI: http://dx.doi.org/10.1016/S1473-3099(15)00464-8 | Centers for Disease Control and Prevention (CDC). New Lyme-disease-causing bacteria species discovered. URL: http://www.cdc.gov/media/releases/2016/p0208-lyme-disease.html. Retrieved February 9th 2016.}

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