Clinical Features The clinical manifestations of Lyme disease are variable from person to person. Parallels have been drawn between Lyme disease and syphilis because both are caused by spirochetes, both can involve multiple organ systems at different stages of the infection, and both can mimic other diseases. Common clinical manifestations and typical time courses of the different stages of Lyme disease are described in this monograph. More detailed reviews on the clinical manifestations of this complex disease are included in the references. Conceptually, it is useful to think of Lyme disease in three different stages (Table 1). Alternatively, one can consider stages 1 and 2 as early Lyme disease, and stage 3 as late Lyme disease. Although the clinical manifestations have been divided into stages, each person may have a unique presentation and progression of symptoms.

Fig. 6 Erythema migrans. Courtesy of CDC. Click on the thumbnail for enlarged photo.

Table 1 Major Manifestations of Lyme Disease*
System	Early		Late
*	Stage 1 Localized	Stage 2 Disseminated	Stage 3 Chronic
Skin	Erythema migrans	Secondary annular lesions	Acrodermatitis chronica atrophicans (Europe)
Musculo- skeletal	Myalgias	Migratory pain in joints, bone, muscle; brief arthritis attacks	Prolonged arthritis attacks, chronic arthritis
Neurologic	Headache	Meningitis, Bell's palsy, cranial neuritis, radiculoneuritis	Encephalopathy, polyneuropathy, leukoencephalitis
Cardiac	*	Atrioventricular block, myopericarditis, pancarditis	*
Constitutional	Flu-like symptoms	Malaise, fatigue	Fatigue
Lymphatic	Regional lymphadenopathy	Regional/generalized lymphadenopathy	*
*This table was adapted with permission from: Steere AC. Lyme Disease. N Eng J Med 1989; 321:589