Bell's palsy is typically seen in which stage of Lyme disease?

• A. Early
• B. Acute disseminated infection
• C. Late
• D. Chronic

Answer: (B)

Bell's palsy from Lyme disease reflects cranial neuritis that occurs when the infection has begun to spread beyond the initial bite. Lyme disease progresses in stages, and the early localized stage is when the erythema migrans rash appears at the bite site, usually without neurologic symptoms. When the infection disseminates, which happens in the early disseminated stage, neurologic manifestations commonly emerge, including facial nerve palsy. That cranial neuropathy is a classic sign of this disseminated phase, whereas late or chronic Lyme disease tends to present with arthritis or other persistent symptoms rather than an isolated facial palsy. So Bell's palsy is best placed in the early disseminated (acute disseminated) infection stage, reflecting spread of the organism to the nervous system rather than a localized initial infection or a later chronic phase.