Lyme disease

Last revised by Rohit Sharma on 2 Jan 2022

Lyme disease, also known as borreliosis, is a condition caused by the bacteria Borrelia burgdorferi, with infection being via the ixodid tick. 

Controversy around Lyme disease centers on chronic infection with some authors doubting its existence 3. There are some terms that help differentiate these patients with non-specific symptoms of fatigue, myalgia, and arthralgia, from those with acute infection 3:

  • post-Lyme disease symptoms: symptoms for <6 months
  • post-Lyme disease syndrome: disabling symptoms lasting for >6 months

Lyme disease is endemic in some areas of North America and Europe. 

Three disease stages have been proposed manifesting after the tick bite 2:

  • stage 1: flu-like illness and enlarging skin lesion (erythema migrans) (2-30 days)
  • stage 2: cardiac and neurological symptoms (1-4 months)
  • stage 3: arthritis and neurological symptoms (many years)

Lyme disease has nonspecific symptoms with multisystemic involvement 1,2:​

Lyme disease caused by the bacteria Borrelia burgdorferi and is transmitted by the bite of the ticks Ixodes scapularis and Ixodes pacificus.

Disease manifestations can be multisystem and nonspecific includes 1,2,4,5:

  • cutaneous: erythema migrans
  • CNS: peripheral neuropathy, radiculoneuropathy, myelopathy, encephalitis, meningitis, facial nerve palsy
  • cardiac: myopericarditis, cardiac arrhythmia
  • musculoskeletal: Lyme arthritis

Intracranial MR imaging findings in patients with Lyme disease are rare 2. Where present, findings include:

  • foci of periventricular / subcortical T2 hyperintensity
  • nerve root enhancement, particularly of the facial nerve 6
  • meningeal enhancement

Treatment is based with antibiotics depending on the stage of the disease and its severity 1. There is no evidence that long-term antibiotic therapy is appropriate for patients with post-Lyme disease symptoms or syndrome 4.

The disease derives its name from the town of Lyme, Connecticut where it was first reported in 1975 2.

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Cases and figures

  • Figure 1: erythema chronicum migrans
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  • Figure 2: deer tick vector
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