Excerpt: The manifestations of Lyme disease have been divided into 3 stages: localized, disseminated, and persistent. The first 2 stages are part of the early infection, while persistent disease is considered late infection. Unlike syphilis, stage 3 disease may occur within 1 year of infection, not many years later. Certain manifestations of Lyme disease are more common in the United States, while others are more common in Europe.

The primary symptoms of stage 1 are erythema migrans and some associated symptoms. The primary symptoms of stage 2 include intermittent arthritis, cranial nerve palsies and radicular symptoms, atrioventricular (AV) nodal block, and severe malaise and fatigue. The primary symptoms of stage 3 include prolonged arthritis; chronic encephalitis, myelitis, and parapareses; and symptoms consistent with fibromyalgia. . . . . . .  . . . Carditis This usually manifests as fever and syncope due to AV block. The level of AV block varies and fluctuates so that the symptoms may be intermittent. The block rarely lasts longer than a week; a temporary pacemaker is rarely required.  Our note: on the side of caution, "rarely" does not mean never.