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Lyme Disease Illustrated Below are photographs and text to help describe the many types of symptoms associated with Lyme Disease. "Stages" are for descriptive purposes only and are not diagnostic or authoritative. Symptoms may overlap or co-mingle in some patients.
Early Lyme Disease: The early stage of Lyme disease is usually marked by one or more of the following symptoms and signs: • Fatigue • Chills and fever • Headache • Muscle and joint pain • Swollen lymph nodes and/or • A characteristic skin rash sometimes in a bulls-eye pattern, called erythema migrans. Note: Additional rashes may occur following the initial bulls-eye rash. These are also related to Lyme and can include multiple lesions that occur anywhere on the body and may or may not be itchy. Erythema migrans (EM) is a red circular patch that appears at the site of the tick bite usually within 3 days to 1 month after the bite of an infected tick. The patch then grows larger. Sometimes many patches appear, in varying shapes and sizes. Common sites are the thighs, groin, trunk, and armpits. The center of the rash may clear as it enlarges, resulting in a “bull’s-eye” appearance. The rash may be warm, but it usually is not painful. Not all rashes that occur at the site of a tick bite are due to Lyme disease, however. An allergic reaction to tick saliva often occurs at the site of a tick bite and may be confused with the “bull’s-eye” rash of Lyme disease. Allergic reactions to tick saliva usually appear within hours to a few days after the tick bite, usually do not expand, and disappear within a few days.
Early Lyme Disease Photos
Red rash surrounding site of tick bite	Rash around tick bite on trunk (Circled in red ink)¹	Typical EM rash²
EM Rash on arm (photo courtesy of CDC)
Late Lyme Disease:
Some symptoms and signs of Lyme disease may not appear until weeks, months, or years after a tick bite: • Arthritis most likely appears as brief bouts of pain/swelling, usually in one or more large joints, especially the knees. • Nervous system abnormalities can include numbness, pain, nerve paralysis (often of the facial muscles, usually on one side), and meningitis (fever, stiff neck, and severe headache), or "frozen shoulder" syndrome, often on one side only. • Sometimes irregularities of the heart rhythm may occur, such as AV node arrythmias, these episodes usually last from days to weeks. Symptoms can include pain in the chest, heart "fluttering", feeling that the heart has skipped a beat, palpitations and fainting or low blood pressure. It is important to see your physician if you experience any of these symptoms. Although the arrythmias are usually non-life threatening, it is not known whether or not if the AV heart block(s) produce long-term damage to the heart. • In some persons, the bull’s eye rash never appears; in some, the first and only sign is arthritis, and in others, nervous system problems are the only evidence of Lyme disease.

Late Lyme Disease Photos
Above image shows inflammation and redness on knee joint (right in photo) Patient's joint was stiff for "no apparent reason" swollen joints	Cranial neuropathy with facial paralysis (Bell's palsy) Patient shown smiling This patient's duration was 9 weeks, and had 20% hearing loss in affected ear, note external swelling and redness of outer ear. Affected patient's vision, taste, smell and function of 2/3 of face. Associated pain ran from top of head on left side, through back and down left arm. Pain described as burning, throbbing, itching, and skin was at times too painful to touch. "It felt like even my hair hurt!"
Lyme Disease and Pregnancy
Rarely, Lyme disease acquired during pregnancy may lead to infection of the placenta and possibly to stillbirth. However, studies of women infected during pregnancy have not proven adverse effects on the fetus when the mother received appropriate antibiotic treatment for her Lyme disease.
Diagnosing Lyme
Many symptoms of Lyme disease are similar to those of other diseases. The fever, muscle aches, and fatigue of Lyme disease can be mistaken for viral infections, such as influenza or infectious mononucleosis. Joint pain can be mistaken for other types of arthritis, such as rheumatoid arthritis, and neurologic signs can mimic those caused by other conditions, such as multiple sclerosis. On the other hand, other infections, arthritis, or neurologic diseases can be misdiagnosed as Lyme disease. Along with Lyme disease, ticks can transmit other diseases like: Tick Paralysis, Tularemia, Rocky Mountain Spotted Fever, Colorado Tick Fever, Masters Disease, STARI (southern tick associated rash illness) and there seems to be a connection between Lyme disease and Morgellon's disease. Diagnosis of Lyme disease should take into account the following factors: • Patient’s history of possible exposure to ticks in areas where Lyme disease is known to occur. • Symptoms and signs of the illness and CLINICAL HISTORY OF SYMPTOMS • The results of blood tests used to detect whether the patient has antibodies to the Lyme disease bacterium (B. burgdorferi). The proper interpretation of test results & proper testing by reputable labs educated in the proper testing methods cannot be stressed enough here. Laboratory tests for Lyme disease must be interpreted in relation to the patient’s clinical assessment. Both false-positive (the test results read positive, but the patient is not infected with Lyme disease-causing bacteria) and false-negative test results (the results read negative, but the patient is infected with Lyme disease-causing bacteria) may occur. In 1995, recommendations were made to standardize testing for Lyme disease. Two tests that measure the body’s production of antibodies to the Lyme disease bacterium are recommended: (1) an enzyme-linked immunosorbent assay (ELISA) or indirect immunofluorescence assay (IFA), followed by (2) a Western immunoblot of samples that tested positive or equivocal by ELISA or IFA. These tests do not detect an infection until the body begins to produce measurable levels of antibodies to the Lyme disease bacterium, usually 2-4 weeks after the bite of an infected tick. IF YOU FEEL YOU HAVE LYME DISEASE OR YOUR DOCTOR IS INSUFFICIENTLY INFORMED ABOUT LYME: Contact your local Lyme support group or one of the links on this web site to be referred to a Lyme-literate physician in your area. Send your doctor to the ILADS web site: www.ilads.org and ask him or her to register and get more information.
What Lyme Looks Like Borrelia Bergdorferi (Bb) spirochete Below A & B: Active Borrelia Bergdorferi Spirochetes A B Below C: Bb spirochete with cysts, D: T. Macrodentium cyst showing spirochetes coiled inside C & D
Bartonella Quintana (trench fever) & Bartonella Henselae (cat scratch disease) Bartonella can manifest in a many symptoms and is also carried by cats. Infections of Bartonella are more difficult to cure and can be chronic in duration. Most often the symptoms are more neurologically oriented. Infection usually beings with swollen glands, flu symptoms and sometimes a rash. Migraines, long-term fatigue, seizures, dimentia, neurological disorders, brain fog, joint aches and pains and arthritis can also occur. Bartonella Quintana is known as trench fever and Bartonella Henselae is referred to as cat scratch disease because it can also be transmitted by cats. Many doctors are unaware that Bartonella exists as a tick-borne illness. A: Bartonella Quintana 1 B: Bartonella Quintana 2
Babesiosis, Erlichiosis and all the rest...
Babesiosis is caused by a parasite that invades red blood cells and causes malaria-like symptoms one to nine weeks after exposure. The disease affects those over 50 years of age and the immunocompromised the most severely. Babesiosis can also be transmitted by a blood transfusion. Symptoms: Babesiosis generally produces only mild to moderate flu-like symptoms in healthy children and adults. Some people exhibit no symptoms at all, so proper testing is essential in treating this infection, caused by a protozoan. Anti-malarial drugs are often prescribed. A gradual onset of malaise, loss of appetite, and fatigue generally occur, followed by intermittent fever with temperatures as high as 104 degrees. Usually one or more of the following occur: shaking chills, sweats, headache, muscle aches and anemia. Physicians should consider babesiosis in a person presenting with a high fever and anemia, particularly in spring and early summer, in tick areas. More About Babesiosis Ehrlichiosis (anaplasma): Ehrlichiosis is a group of bacteria that invades the white blood cells. There are two main forms of ehrlichiosis, human granulocytic ehrlichiosis (HGE), also known as human anaplasmosis, and human monocytic ehrlichiosis (HME). Most cases of HGE are reported in the northeastern, mid-atlantic, and north central states where Lyme disease is endemic. It is transmitted by the bite of an infected deer tick. Symptoms of Ehrlichiosis: Symptoms usually occur 5-10 days after the tick bite. Symptoms are flu-like but may include the following: • fever, chills, malaise, and/or • headache, muscle and joint pain, and/or • nausea and vomiting Most patients show a decrease in white blood cell and platelet counts, and have elevated liver enzymes. Physicians should consider ehrlichiosis in the diagnosis of a patient with flu-like symptoms with altered blood values and liver enzymes, particularly if exposure to ticks is likely. *Patients with Lyme disease should be tested for co-infections.* HME is transmitted by the lone star tick (above) primarily in the southeastern and south central states. (photo courtesy of wwhd.org Target Lyme Disease site) More about Ehrlichiosis
For More Info about Rocky Mountain spotted fever For More Info about Southern Tick Associated Rash Illness

Thanks to Dawn B.¹ and the New York Medical College² for providing some of the rash images above
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