Lyme disease - secondary or stage 2

Alternative names 
Lyme disease - early disseminated

Secondary Lyme disease is an inflammatory disease characterized by cardiac and neurological symptoms caused by the bacterium Borrelia burgdorferi, which is transmitted by the bite of a deer tick.

Causes, incidence, and risk factors

See Lyme disease for a description of the initial stages of the disease. Secondary Lyme disease develops within days to months after the tick bite, when the infection spreads via the lymph system or bloodstream.

The central nervous system and cardiac system may be affected. Symptoms may be intermittent and may disappear after days, weeks, or months. Involvement of the heart occurs in 8% of people with untreated Lyme disease. Neurologic involvement occurs in 10% of patients with untreated Lyme disease.


  • headache  
  • fatigue  
  • general discomfort, uneasiness, or ill feeling (malaise)  
  • lethargy  
  • muscle pains  
  • stiff neck  
  • joint inflammation in the knees and other large joints  
  • heart palpitations  
  • fainting  
  • blurred vision

Additional symptoms that may be associated with this disease:

  • speech impairment  
  • numbness and tingling  
  • nausea and vomiting  
  • muscle function/feeling loss  
  • movement, dysfunctional  
  • hallucinations  
  • facial paralysis (also called Bell’s Palsy)  
  • eyelid drooping  
  • consciousness, decreased  
  • confusion  
  • abnormal sensitivity to light

Signs and tests

  • a physical examination to reveal signs of neurologic or cardiac involvement  
  • ELISA test to screen for antibodies to Borrelia burgdorferi  
  • Western blot to confirm the presence of antibodies to Borrelia burgdorferi  
  • tests that detect cardiac abnormalities       o ECG (also called EKG)       o chest X-ray may show heart failure       o CSF analysis may show inflammation


The objective of treatment is to eliminate the infection by antibiotic therapy. Penicillin, doxycycline, cefuroxime, and ceftriaxone are frequently used. Ceftriaxone is often used to treat secondary Lyme disease.

Note: Oral doxycycline is usually not prescribed for children until after all the permanent teeth have erupted - it can permanently discolor teeth that are still forming.

Expectations (prognosis)

Symptoms of arthritis may fail to respond to treatment. Other symptoms should improve with treatment.


Calling your health care provider

Call your health care provider if symptoms of this disorder develop.


Early diagnosis and appropriate antibiotic treatment of Lyme disease is the most effective way to prevent secondary Lyme disease.

Johns Hopkins patient information

Last revised: December 5, 2012
by Potos A. Aagen, M.D.

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.