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Lyme disease

Last reviewed: 14 Apr 2025
Last updated: 07 Feb 2025

Summary

Definition

History and exam

Key diagnostic factors

  • erythema migrans
  • constitutional symptoms
Full details

Other diagnostic factors

  • facial palsy
  • arthritis or arthralgia
  • regional lymphadenopathy
  • stiff neck
  • lymphocytoma cutis
  • acrodermatitis chronica atrophicans
  • atrioventricular (AV) block or myopericarditis
  • radiculoneuropathy
  • encephalomyelitis, peripheral neuropathy, encephalopathy
Full details

Risk factors

  • exposure to infected ticks
  • outdoor activities
  • tick bite duration
Full details

Diagnostic tests

1st tests to order

  • enzyme immunoassay or immunofluorescence assay
Full details

Tests to consider

  • Lyme-specific IgM and IgG (immunoblot assays)
  • skin biopsy culture
  • polymerase chain reaction (PCR)
  • ECG
Full details

Treatment algorithm

INITIAL

known high risk tick bite

ACUTE

erythema migrans

cardiac involvement

neurologic disease

arthritis

ONGOING

recurrent or persistent arthritis

Contributors

Authors

Janak Koirala, MD, MPH, FACP, FIDSA
Janak Koirala

Professor of Medicine and Infectious Diseases

Division of Infectious Diseases

Southern Illinois University School of Medicine

Springfield

IL

Disclosures

JK declares that he has no competing interests.

Acknowledgements

Dr Janak Koirala would like to gratefully acknowledge Dr Tin Han Htwe and Dr Cristian A. Spiel, previous contributors to this topic.

Disclosures

THH and CAS declare that they have no competing interests.

Peer reviewers

Raymond J. Dattwyler, MD

Professor of Medicine and Microbiology/Immunology

Chief of Allergy, Immunology and Rheumatology

New York Medical College

Valhalla

NY

Disclosures

RJD declares that he has no competing interests.

Ionita Catalina, MD

Assistant Professor of Neurology and Neurosurgery

SUNY at Buffalo

Stroke/Neurocritical Care

Millard Fillmore Gates Hospital - Kaleida Stroke Center

Buffalo

NY

Disclosures

IC declares that she has no competing interests.

Graham Fry, MB, FRCSI, DTM&H

Lecturer in Tropical Medicine

University College Dublin

Medical Director

Tropical Medical Bureau

Ireland

Disclosures

GF declares that he has no competing interests.

Andras Lakos, MD, PhD

Physician

Centre for Tick-Borne Diseases

Budapest

Hungary

Disclosures

AL is an author of a reference cited in this topic.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Lantos PM, Rumbaugh J, Bockenstedt LK, et al. Clinical practice guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 guidelines for the prevention, diagnosis and treatment of Lyme disease. Clin Infect Dis. 2021 Jan 23;72(1):e1-48.Full text  Abstract

Centers for Disease Control and Prevention. CDC Yellow Book 2024: health information for international travel. Section 5: travel-associated infections & diseases - Lyme disease. May 2023 [internet publication].Full text

Mead P, Petersen J, Hinckley A. Updated CDC recommendation for serologic diagnosis of lyme disease. MMWR Morb Mortal Wkly Rep. 2019 Aug 16;68(32):703.Full text  Abstract

Mygland A, Ljøstad U, Fingerle V, et al; European Federation of Neurological Societies. EFNS guidelines on the diagnosis and management of European Lyme neuroborreliosis. Eur J Neurol. 2010 Jan;17(1):8-16;e1-4.Full text  Abstract

National Institute for Health and Care Excellence. Lyme disease. Oct 2018 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Lyme disease images
  • Differentials

    • Local inflammatory reaction to tick bite
    • Tickbite allergy
    • Cellulitis
    More Differentials
  • Guidelines

    • CDC Yellow Book: health information for international travel - Lyme disease
    • 2020 guidelines for the prevention, diagnosis and treatment of Lyme disease
    More Guidelines
  • Patient information

    Lyme disease

    More Patient information
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