Systemic symptoms without erythema migrans as the presenting picture of early Lyme disease

The emergence of Lyme disease

“…In the US, the skin lesion is frequently accompanied by flu-like symptoms, such as malaise and fatigue, headache, arthralgias, myalgias, and fever, and by signs that suggest dissemination of the spirochete (28). In about 18% of cases (27), these symptoms are the presenting manifestation of the illness (29). In contrast, EM in Europe is more often an indolent, localized infection, and spirochetal dissemination is less common (30).…”

“…However, if a patient from a highly endemic area has a febrile illness with headache and joint or muscle pain, without respiratory or gastrointestinal symptoms, in the weeks surrounding the summer solstice, antibiotic treatment may be indicated (Figure 4). For such patients, a second-generation serologic test, an IgG ELISA that uses a peptide in the sixth invariant region of the VlsE lipoprotein of B. burgdorferi, may be valuable, since this test typically becomes positive before five IgG bands are present on Western blot (29,95). Although both babesiosis and anaplasmosis are usually asymptomatic, coinfection should be considered in a patient with more severe flu-like symptoms, including high fever, particularly if the patient is very young or old or asplenic (Figure 4).…”

Lyme Disease: A Review

“…Constitutional symptoms, arthralgias, myalgias, and severe fatigue are common, and regional lymphadenopathy also may occur. Erythema migrans may be absent in about 10% of patients with early Lyme disease, and patients may have asymptomatic infection or only nonspecific symptoms [24]. After several days or weeks, the spirochete may spread hematogenously, and patients may develop multiple erythema migrans lesions.…”

Lyme borreliosis in 2005, 30 years after initial observations in Lyme Connecticut

“…Recently, experimental evidence for these differences was demonstrated based on infection of monkeys with commonly used borrelial strains [55]. B. burgdorferi disseminated widely and could be found in heart and muscle and in the peripheral and central nervous systems months after infection, but it did not persist in skin.…”