Late Lyme Disease (stage 3) Symptoms

Late Lyme Disease Symptoms may include; inflammation, joint pain/stiffness, and sometimes neurological symptoms. Symptoms of late Lyme disease occur months to years after a tick bite.

Muscle and joint symptoms —  may occur in 80% of individuals with Lyme disease who have not been treated with antibiotics.  20% of individuals experience joint pain, 50% experience intermittent episodes of arthritis (joint inflammation), and  fewer than 10% experience persistent arthritis of a single joint (usually a knee) or a few joints.

Neurologic symptoms — chronic pain, difficulty with memory, slowed thought processes, and odd sensations, such as numbness or tingling. However, late neurologic manifestations can include; anxiety, depression, or personality/mood changes. These symptoms are more rare and are usually caused by something other than Lyme disease.

Skin symptoms —  may include skin nodules, swelling, thinning of patches of skin, which usually occurs on the hands, feet, knees, or elbows.

Post-Late Lyme disease syndrome— nonspecific symptoms, such as headache, fatigue, and joint pain, may linger for months after the treatment of Lyme disease has ended. However, these symptoms gradually resolve, and there is no evidence that antibiotics improve or speed up the resolution of post-Lyme disease symptoms.

Encephalopathy

Patients may develop cognitive problems from Lyme disease after the initial infection.  The cognitive problems most commonly include problems with short-term memory, decreased verbal fluency, slowed word retrieval, and slower speed of thinking.  Patients typically report that they experience a feeling of “brain fog”.  On a practical level, adults may have difficultly in following the normal speed of conversations, children may find it difficult to write down the homework assignments quickly enough or even forget whether or not they did a task or not. Rarely the encephalopathy may manifest as dementia in the elderly.

Encephalomyelitis

  Encephalomyelitis may be characterized by confusion and/or severe psychiatric disorders, jerking movements, decreased coordination, and/or seizures. Patients may have a combination of these symptoms that appear quite similar to the manifestations of multiple sclerosis.

Neuropsychiatric Lyme Disease

Neuropsychiatric symptoms can emerge either early or late in the dissemination phase of infection. These symptoms commonly appear as cognitive symptomspresenting as irritability, easy tearfulness, anxiety, and depression. Rarely, patients with undetected Lyme disease may present with obsessive compulsive disorder (OCD), paranoia, auditory/visual hallucinations, or full blown mania.  Sleep disturbances are also common in Lyme disease with patients more often reporting a need for many hours of sleep or feeling tired more often. Increased sensory sensitivity occurs in about 50% of patients with later stage neurologic Lyme disease.  These patients may resort to wearing earplugs, sound protectors, and/or sunglasses indoors.  Normal sensory stimulation may over-stimulate, causing confusion.  While psychiatric problems can arise during the course of Lyme disease, it is critical to remember that most psychiatric disorders have nothing to do with Lyme disease.  It is also important to note that when patients with Lyme disease experience a psychiatric disorder, treatment for the psychiatric disorder should not be delayed.

The late neurologic symptoms consist primarily of a mild to severe encephalopathy, a polyneuropathy, and profound fatigue. Encephalopathy is thought to occur in 9 out of 10 patients and is often characterized by subtle disturbances in mood, memory, and sleep. In ruling out subacute encephalopathy, psychiatrists will have their greatest diagnostic challenge, for these patients may be irritable, tearful, depressed, and have poor concentration and sleep. A diagnostic tip in favor of Lyme disease as the cause of the depression and irritability might be concomitant memory loss, word finding problems, or a concomitant polyneuropathy.

Case reports have linked a variety of neurologic syndromes to late Lyme disease, including blindness , progressive demyelinating-like syndromes (mimicking Multiple sclerosis or Amyotrophic lateral sclerosis , Guillian-Barre, progressive dementias, seizure disorders , strokes , and extrapyramidal disorders). Encephalomyelitis is characterized by spastic paraparesis, ataxia, cognitive impairment, bladder dysfunction, and cranial neuropathy . Finally, neonatal death has been linked with Lyme borreliosis based on culture positive frontal cortex specimens .

References: http://www.columbia-lyme.org/patients/ld_lyme_symptoms.html

http://www.uptodate.com/contents/lyme-disease-symptoms-and-diagnosis-beyond-the-basics

http://www2.lymenet.org/domino/file.nsf/bbf2f15334c1f28585256613000317cc/87e8dfed931381b7852567c70012001f?OpenDocument