From: Physician reported incidence of early and late Lyme borreliosis
Erythema migrans | Expanding red or bluish-red patch (= > 5 cm in diameter), with or without central clearing. Advancing edge typically distinct, often intensely coloured, not markedly elevated. If <5 cm in diameter a history of tick-bite, a delay in appearance (after the tick bite) of at least 2 days and an expanding rash at the site of the tick-bite is required. |
Disseminated lyme borreliosis | |
Borrelial lymphocytoma | Painless bluish-red nodule or plaque, usually on ear lobe, ear helix, nipple or scrotum. More frequent in children (especially on ear) than in adults. |
Acrodermatitis chronica atrophicans | Long-standing red or bluish-red lesions, usually on the extensor surfaces of extremities. Initial doughy swelling. Lesions eventually become atrophic. Possible skin induration and fibroid nodules over bony prominences. |
Lyme neuroborreliosis | In adults, mainly meningo-radiculitis, meningitis. Rarely encephalitis, myelitis, neuritis, cerebral vasculitis, Bannwarth’s syndrome: painful radiculitis, lymphocytic meningitis with facial nerve palsies. In children, mainly meningitis and facial palsy. |
Lyme arthritis | Recurrent attacks or persisting objective joint swelling in one or a few large joints. Alternative explanations must be excluded. |
Lyme carditis | Acute onset of atrio-ventricular (I–III) conduction disturbances, rhythm disturbances, sometimes myocarditis or pancarditis. Alternative explanations must be excluded. |
Ocular manifestations | Conjunctivitis, uveitis, papillitis, episcleritis, keratitis. |
Persisting symptoms attributed to lyme borreliosis | |
Lyme encephalopathy | Chronic brain syndrome attributed to Lyme borreliosis: impaired memory, concentration, word finding, and sleep; increased fatigue, sensory irritability, emotional lability, headache and depression. |
Persisting symptoms | Persisting symptoms attributed to Lyme borreliosis after treatment, with or without active Borrelia infection. |