What is Lyme disease?

Do you know someone who has been bitten by a tick? How do you remove a tick? Is there a red circular rash? Or do you have flu like symptoms? Are you infected and how do you get tested? Which antibiotics are prescribed and for how long? On this page, you will find general information about Lyme disease, the symptoms, the diagnosis, co-infections and treatment.

Borrelia burgdorferi

Erythema Migrans

Erythema Migrans

Lyme disease is an infectious disease caused by bacteria of the genus Borrelia, in particular, Borrelia Burgdorferi in the United States and Borrelia Afzelii or Borrelia Garinii in Europe. You can get Lyme disease through the bite of a tick. Borrelia is a spirochete. Spirochetes have a corkscrew shaped appearance by which they can be recognized under the microscope.

A distinction is made between Lyme-causing Borrelia bacteria and Relapsing-Fever-causing Borrelia. This distinction is that Lyme Borrelia causes infection in the tissues in low numbers and the Relapsing Fever Borrelia resides in larger numbers in the blood. A well-known Relapsing Fever spirochete is Borrelia Hermsii. A couple of years ago, the Borrelia Miyamotoi was discovered which has features of both the Relapsing Fever Borrelia and the Lyme Borrelia.

In the early phase, a Lyme infection usually causes a typical discoloration of the skin that grows slowly around the bite. This is called an erythema migrans or ‘Bull’s Eye Rash’. The skin rash may occur up to three months after the bite. A skin rash does not appear in all cases.

Symptoms can wax and wane and the disease is easily misdiagnosed as fibromyalgia, chronic fatigue syndrome or various psychiatric illnesses including depression. It is advisable to consult a doctor if you experience symptoms after a tick bite. Lyme disease is also called ‘The Great Imitator’ because it mimics other diseases. Borrelia can infect every organ of the body including the heart, the brain and the nervous system and the muscles and joints.

Lyme disease diagnosis

According to the CDC, Lyme disease is a clinical diagnosis – based on your medical history, symptoms and exposure to ticks. Months or years after the tick bite various symptoms can occur that are difficult to explain. Misdiagnoses are common.

ELISA and WesternBlot blood tests are used to detect antibodies against Borrelia burgdorferi. These tests are very insensitive in the early phase and a negative test result cannot rule out the infection. There are many reasons why someone who is infected with Borrelia tests negative.

In Germany, some laboratories work with an LTT-test or Elispot. This is a blood test that detects a cellular immune response to Borrelia. A study from the Netherlands concluded that this test cannot differentiate between active- and passed infection and specialists advise against its use. The test isn’t validated for Lyme disease. Currently no test can rule out the infection or confirm a cure.

Lyme disease symptoms

Sometime after the tick bite flu-like symptoms can occur (such as headache, fever, chills, sweats, muscle pain, joint pain, fatigue and nausea).

In later stages fainting, shortness of breath, heart palpitations and or chest pain can be suggestive for Lyme carditis.

Cognitive impairments such as brain fog, problems with memory and word finding, anxiety, depression, confusion and/or paranoia, shooting pains, nerve pain, hot/cold sensation, numbness, tingling, insomnia, Bell’s Palsy, headache and stiff neck might suggest neurologic involvement.

Erythema migrans

  • 70% gets a skin rash 7-14 days after the infection (some say only 30% get a skin rash)
  • May be accompanied with flu-like symptoms (but it’s not a requirement)
  • Skin rash can differ from the bull’s-eye shape or doesn’t appear at all

Heart problems

  • Conduction abnormalities
  • AV block
  • Bundle root block
  • Extended QT interval
  • Ventricular tachycardia
  • Fascicular tachycardia
  • Supraventricular tachycardia
  • Myocarditis (rare)
  • Pericarditis (rare)

Joint problems

  • Monoarthritis of major joints (preference for the knee)

Neurological problems

  • Lymphocytic meningitis (self-limiting)
  • Bell’s palsy
  • Meningoradiculitis (Bannwarth syndrome)
  • Meningoencephalitis (Cerebellar syndrome)
  • Peripheral neuropathy
  • Vasculitis, stroke
  • Psychiatric manifestations (psychosis, paranoia, anxiety)

Late neurologic

  • Encephalitis (subtle)
  • Chronic encephalopathy
  • Encephalomyelitis (mimics MS and movement disorders like Parkinson’s)

Case surveillance criteria

For the CDC to recognize a Lyme disease case for surveillance purposes there must be ‘objective’ symptoms such as Bell’s Palsy, monoarthritis, and positive blood tests. These symptoms don’t have to be present for someone to have a late stage ‘chronic’ Lyme infection. The symptom picture can be very subtle. The absence of abnormalities does not rule out the infection and the patient might be suffering tremendously while all tests come back normal. That is why some physicians use treatment response to confirm their clinical diagnosis.


Ticks can carry many different pathogens – bacteria, protozoa, viruses and nematodes and transmit all these infections during a bite at the same time.

Tickborne infections in the United States include Lyme disease, Babesiosis, Anaplasmosis, Ehrlichiosis, Relapsing Fever, Tularemia, Rocky Mountain Spotted Fever (RMSF) and Bartonellosis.

Diagnosis of these co-infections might be difficult. Babesia and Bartonella can be difficult to detect and might resist or persist common treatments. There is very little knowledge about the treatment and diagnosis of some of these co-infections. For some co-infections, there are no commercial tests available. Since the discovery of Lyme disease in 1981, researchers found over 15 tick-borne infections that weren’t known before.

Lyme disease treatment

Lyme disease is divided into 3 stages:

Stage 1: localized infection
Stage 2: disseminated infection
Stage 3: chronic and neurological infection

In the first stage the bacteria are infecting the skin in the area of the tick bite. In the second stage the bacteria are spreading to joints and tissues and in the last stage the infection has spread into the central nervous system.

Treatment depends on the stage of the disease. In stage 1 and 2 oral antibiotics are prescribed varying from  14 days to one month. In the late stage intravenous antibiotics are used in most cases for 14 days to one month.

Chronic Lyme disease

Because there is no test that can tell your doctor whether all bacteria are killed some doctors prescribe the antibiotics for a little longer or repeat the course of antibiotics when symptoms persist. I’ve written an article about what patients call chronic Lyme disease.

What causes these ongoing symptoms is not yet understood by science but some think it is because the Borrelia spirochetes persist. Others think the infection damaged the immune system and the ongoing symptoms are of a post-infectious nature. Currently, there is no way to be sure about which is the case. I have done multiple interviews with doctors and scientists about this issue in which they present their professional opinion about this topic.

Lyme disease articles

Tick bite prevention Chronic Lyme disease Post-Treatment Lyme Disease Syndrome Donating blood