From the transript:

SCHAFFNER: Well, it’s tricky to diagnose because first of all the skin lesion may not be something that you see if it’s in a part of the anatomy that you don’t normally look at. Second, it can be associated with a number of symptoms – not feeling so well, neck pain, headache, a sense of fatigue and then chills and fever. You notice they’re all rather non-specific, and they may not be severe enough to take you to the doctor.

And then, of course, the disease can have in its later phases some other manifestations. You can get more than one skin lesion, and you can have some neurologic effects. You can get a form of meningitis or a paralysis of one of the nerves of the face.

So you can see these are unusual manifestations that both patients and some doctors won’t put together if they are not familiar with the disease.

DANKOSKY: Jared’s in New York City. Hi there, Jared.

JARED: Hi. My daughter had Lyme disease for over a year, and the trouble we had with diagnosing it was, as we later learned, the symptoms show up differently in children than do adults. She didn’t have any skin lesions or any of the fevers, things like that, but she had swollen joints. And so between the episodes of these symptoms occurring, the doctors just didn’t think it was – just didn’t think to check if it was Lyme disease. I just wanted to make that point. I’ll take my response off the air.

DANKOSKY: Thank you very much, Jared. Dr. Schaffner, is that true? Do kids get it differently than adults?

SCHAFFNER: Well, the emphasis may be a little bit different, but Jared is actually right. A later manifestation of Lyme disease can be arthritis of many of the different joints but particularly of the larger joints. And that may not be a diagnosis that comes immediately to mind when you see a child with arthritis.

Here’s a Mayo Clinic article on it.

Click through for discussion of symptoms and other things.