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The most common late-stage symptoms are pauciarticular arthritis affecting large joints, especially the knees, which may manifest weeks to months (mean four months) after the tick bite.
Arthritis can occur without a history of earlier stages of illness.
Source: Dr L Robbin Lindsay, Research Scientist, Field Studies (for the Public Health Agency of Canada’s Lyme Disease Surveillance Group).
EM Erythema migrans; Ig Immunoglobulin Reproduced from reference 14 with permission from the American Society for Microbiology.
There can be either a single erythema migrans rash or multiple rashes without extracutaneous manifestations.
However, fever, malaise, headache, mild neck stiffness, myalgia and arthralgia often accompany EM.
Figure 1) The life cycle of black-legged ticks and Lyme disease.
Reproduced with permission from the United States Centers for Disease Control and Prevention (Atlanta, USA): gov/ticks/life_cycle_and_Black-legged tick populations are well established in parts of British Columbia, Manitoba, Ontario, Quebec, New Brunswick and Nova Scotia, and may be expanding.
Macrolides (azithromycin, clarithromycin and erythromycin) have lower efficacy.Two-tiered testing is necessary because the ELISA may yield false-positive results from antibodies directed against other spirochetes, viral infections or autoimmune diseases.Figure 5) Two-tiered serological testing for Lyme disease.EM is usually asymptomatic (although it may produce a burning sensation) but is not painful to the touch, like a cellulitis.EM can be confused with a localized hypersensitivity reaction from a tick or insect bite, which is usually swollen, smaller in size and pruritic).