While in general three stages of Lyme are mentioned, we at St. Georg Hospital differentiate by symptoms and treatment options. Thus we distinguish between an acute and a chronic stage.

Acute Lyme Disease

The main symptom of the acute phase is the erythema migrans. Days or weeks after the tick bite an erythema forms around the puncture site, which first spreads and later pales centrally, leaving a circular erythema. This occurs in fewer than 50% of the patients.
General symptoms that occur may be flu-like:
▪    fever
▪    myalgia
▪    sore throat
▪    headaches
▪    lymph node swelling
▪    neck aches
▪    fatigue
Rhinitis, sinusitis and cough are not usually present, distinguishing this “flu” from other influenza-like illnesses.
Different countries have different borrelia species and different species may cause different symptoms. For instance, Lyme disease is principally a neurological disease in Australia, whereas in North America single or pauci migratory arthritis with gross swelling predominates.

Chronic Lyme Disease

Weeks or even months after the tick bite, a great variety of symptoms may occur.
Multiple rashes after infection are typical of systemic dissemination to their target tissues and cells. Neck stiffness is rather common for the chronic state of Lyme. Some of the chronic symptoms can in fact be disabling. For instance meningoradiculitis Bannwarth is distinguished by burning radicular pain with or without paralysis. In children, one more often sees meningitis type courses. Cardiac involvement is specified by an atrioventricular blockade grade I-III. The Lymphadenosis cutis benigna Bäfverstedt (borrelia-lymphocytome) is a tumor like manifestation mostly occurring at the earlobe, breast nipple, or scrotum.
Arthralgias primarily involve the large joints (e.g. knees, elbows, hips, shoulders), although smaller joints (e.g. wrists, hands, fingers, toes) may also be involved.
In the late chronic stage, sometimes referred to as stage III, lyme arthritis and acrodermatitis chronica atrophicans Herxheimer (ACA) are typical manifestations. They may develop even years after the infection. ACA leads to an atrophy of the skin.

The symptoms of chronic Lyme are caused by biotoxins & co-factors. For simplification we add a list of the symptoms that may occur with chronic Lyme disease.

▪    can be severe, jumping from joint to joint
▪    can be in the teeth or in the temporal-mandibular joints
▪    can be in the ribs and chest
▪    can be abdominal, testicular or pelvic
▪    paresthesias such as burning, numbness, tingling and itching are frequent; there may be crawling sensations, vibrations, or electric shock-like sensations
▪    there rarely is an actual palsy of the affected areas, making this much more of a neurosensory, rather than a motor disease

▪    headaches,
▪    dysequilibrium
▪    cognitive dysfunction, brain fog
▪    short-term memory loss
▪    tremor
▪    encephalitis or encephalopathy
▪    aseptic meningitis and facial nerve (Bell’s) palsy tend to occur within the first few months following the tick bite, but may also occur as part of a reactivation

▪    anxiety
▪    depression
▪    panic

▪    fevers
▪    sweats
▪    visual dysfunction (described primarily as blurriness, but can include optic neuritis or uveitis, keratitis, episcleritis)
▪    tinnitus, hyperacusis (noise sensitivity), hearing loss
▪    Shortness of breath, palpitations and/or tachycardia
▪    diarrhea or irritable bowel
▪    urinary frequency or urgency

Co-factors associated with chronic Lymes Disease
▪    Infections transmitted with a tick bite (Babesia, Bartonella, Brucella, Chlamydia, Ehrlichia, Mycoplasma, Rickettsiae, Theileria. etc.)
▪    Herpes viruses
▪    Fungus, Candida
▪    Hormonal dysbalance
▪    Toxicity (metals, mold, neuro and biotoxins)
▪    Allergies
▪    Immune system dysfunction
▪    Endocrinal problems (thyroid, Hashimoto, adrenals, etc.)
▪    Mitochondrial dysfunction
▪    cardiac diseases (myocarditis, cadiomyopathy)
▪    Inflammatory reactions, Arthritis
▪    Autonomic nervous system dysfunction
▪    Gastrointestinal problems (colitis, leaky gut, etc.)
▪    Liver and kidney dysfunction
▪    Psychological dysfunction
In our patients we quite often find impaired: Hypophysis-adrenal axis, adrenal fatigue, disturbed sexual function, no periods (menopause-like symptoms in young women), estrogen dominance, hypogonadism, etc.
Typical periods of worsening symptoms alternate with phases of improvement. This occurs cyclically every few weeks. Some patients are more symptomatic than others.
Occasionally a macular or haemorrhagic rash may appear. Generally, these rashes are only slightly irritating or pruritic. This may indicate co-infection.
As symptoms can be diametrically opposite and Lyme disease mimics various other diseases, it becomes clear why diagnosing it is such a difficult task. Therefore, much too often Lyme patients end up in the psychiatric corner.