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A partial list of signs and symptoms* documented to be related to Lyme disease. Click on the name of the symptom to view the source. It is not an all inclusive list, but a work in progress. You do not need to have all of these symptoms to have Lyme disease.
General Symptoms
- Fevers and/or chills
- Headaches- mild to severe (reported in over 90% of children)
- Headache (severe)
- Night and day sweats
- Depression
- Anxiety
- Fatigue- mild (barely noticeable) to severe fatigue (bed ridden) often unrelieved by sleeping
- Fatigue with poor stamina
- Wilting fatigue with some periods of energy in between episodes
- Sore throats- often very painful
- Nausea
- Vomiting
- Abdominal upset and/or pain
- Tiredness
- Loss of appetite
- Anorexia
- Weight loss
- Swelling of ear
- Blue-coloured earlobe
- Painless ear swelling with redness
- Pinna- deformed and floppy
- Enlarged, nontender jugulodigastric node
- Weak gag and cough reflexes
- Problems with schoolwork (not seen previously)
- Dizziness or a floating feeling (vertigo)
- Massive and rapid weight loss
- Vomiting
- Gastroenteritis
- Fever and Chills
- Asthenia (Abnormal Weakness)
- Upper-airway infection
- Excessive thirst
- Pain or sensitivity in teeth
- Restricted mandibular opening (TMJ- Jaw)
- Absence of lip notch
- Tinnitus (Ringing or Buzzing In Ears)
- Forgetfulness
- Stiff neck
- Neck stiffness
- Neck pain
- Weakness
- Inability to think clearly
- Dementia
- Insomnia
- Hypersomnia
- Poor concentration
- Malaise
- Lethargy
- Acute hip pain
- Marrow edema
- Delayed onset of illness
- Organ system involvement
- One or more coinfections
- Asymptomatic Lyme (B. burgdorferi) infection (no visible symptoms)
- Lethargy
- Irritability
- Fatigue without signs of mucous membrane involvement
- Summer flu
- Chronic headache
- Diminishing academic achievements
- 26% had 1 or more complications
- 14% required a change in prescribed antibiotic therapy
- Ten percent of the patients had an adverse drug reaction
- Lyme borreliosis can affect almost all human organs
- Poor frustration management
- Associated with unspecific symptoms
- General unspecific symptoms
- Steroids should not be given
- Subfebrile temperature
- Moderate intoxication
- Nonspecific symptoms such as fatigue, headache, and myalgias are common
- Confusion/drowsiness
- Chronic or recurrent headaches
- Vertigo
- Fatigue syndrome
- Weakness
- Whole body weakness
- Fatigue
- General Comments
- Early diagnosis of borreliosis would result in reduced human suffering and in economic gain.
- Forty six per cent of patients were admitted to hospital
- 34 month old girl- Parvovirus B19, Epstein Barr virus(EBV), Borrelia IgM, and Herpesvirus 6 (HHV-6) DNA were positive
- Lyme neuroborreliosis should be considered in the differential diagnosis of new neurological symptoms in children
- Timely recognition and treatment are imperative in order to facilitate recovery and to prevent long-term sequelae
- Steere diagnosed three-quarters of patients with “fibromyalgia” or “chronic fatigue syndrome”
- Misdiagnosed as "arthralgia-myalgia syndrome,” primary depression, asymptomatic deer tick bites, osteoarthritis, and bursitis.
- Chronic Multisymptom Illness (MUI)- [having] at least one or more chronic symptoms from at least 2 of 3 categories of symptoms including musculoskeletal, fatigue, and mood cognition” that includes fibromyalgia, chronic fatigue syndrome, and Gulf War syndrome.
- In Spain, where the incidence is low, antimicrobial prophylaxis is indicated the after a tick bite
- All symptoms should be treated as early as possible to shorten the duration and prevent progression of the disease
- TBE (tick-borne encephalitis) displayed more long-term complaints (ie, fatigue, headache and irritability) compared to Lyme
- Difficult to diagnose due to vague symptomatology
- Significantly higher frequency of disabilities detected in the TBE (tick-borne encephalitis) children
- The evidence continues to mount that Chronic Lyme Disease (CLD) exists and must be addressed by the medical community
- Despite the evidence, there are physicians who continue to deny the existence and severity of CLD, which can hinder efforts to find a solution.
- Chronic Lyme disease has been defined as persistent Borrelia burgdorferi infection requiring months to years of intravenous antibiotic therapy, oral antibiotic therapy, or both.
- TBE (tick-borne encephalitis) and Lyme cause consequences (eg, prolonged convalescence, worries and financial loss) for families
- Adjusted antibiotic treatment led to complete disappearance of symptoms
- Deterioration of general well-being
- Muscles, Bones & Joints
- Migratory pains and stiffness in joints
- Persisting joint involvement
- Acute hip pain
- Marrow edema
- Lumbar rigidity
- Joint swelling
- Arthritis
- Ankle arthritis
- Oligoarthritis
- Monoarthritis
- Monoarticular arthritis
- Pauciarticular arthritis
- Temporomandibular joint effusion- TMJ
- Muscle aches and pain
- Refractory arthritis
- Arthritis of the knee
- Lyme arthritis appearing as septic arthritis or juvenile rheumatoid arthritis
- Myalgia
- Brief attacks of arthritis, particularly affecting the knee
- More likely to have arthritis as sole presenting symptom of disease
- Untreated Lyme arthritis associated with ocular and brain diseases
- Backache
- Leg pain
- Usual and unusual symptoms from patient to patient
- Nocturnal pain in back and legs
- Swollen and/or painful knee
- Swollen knee
- Joint involvement- knee and ankle
- Auricular chondritis
- Similar to relapsing polychondritis
- Deformity of the pinna
- Auricular chrondritis
- Erythema of ipsilateral surrounding face and jaw (Swelling)
- Torticollis (Twisted Neck)
- Torticollis (wryneck)
- Localized marrow edema
- Motoric disturbances
- Morning stiffness
- Antibiotic-refractory arthritis
- Mono- or oligoarthritis
- Transient synovitis
- Continued synovitis
- Hip pain
- Limp
- Refusal to bear weight
- Monoarticular Lyme arthritis of the hip
- Ankle arthritis a year after a tick bite on the dorsum of the foot
- Severe arthritis of ankle joint with necrosis of the talus and deformation of the talocrural and subtalar joints
- Severe arthritis of ankle joint with no history of malaise, fever or systemic symptoms- seronegative for B. burgdorferi
- Suboptimal oral antibiotic treatment hindered the antibody production resulting in severe ankle arthritis
- Suboptimal treatment with oral antibiotics for one week developed in the following months a painless limp
- Acute swelling on the dorsum of foot
- Gradual limping gait
- Almost complete necrosis of the talus
- Calf muscles were atrophic
- Almost no ankle movement
- Equinovarus of the ankle
- Mid-scapular back pain
- Onset of arthritis after a tick bite usually occurs within weeks or months, but as late as five years
- Recurrent synovitis and popliteal cysts
- Synovitis persisted for more than 1 year after 3–4 months of oral doxycycline and intravenous ceftriaxone or penicillin therapy
- Joint fluid and synovial samples obtained at synovectomy had negative PCR results for B. burgdorferi DNA and negative cultures for B. burgdorferi
- Even among patients who meet clinical criteria for antibiotic-refractory LA (Lyme arthritis), patient heterogeneity still exists, and several HLA-DR alleles contribute to disease severity
- Brief, often recurrent episodes of oligoarthritis
- Transient synovitis of the hip
- Pauciarticular arthritis
- Recurrent or persistent arthritis that lasts for up to several years, presumably because of active infection
- Adjacent muscular and soft-tissue edema
- Bilateral & symetrical polyarthritis of big and small joints with fever and cutaneous eruption of trunk
- Popliteal cyst, with or without rupture (Baker's Cyst Behind Knee)
- Upper back pain
- Back stiffness and tenderness to palpation of the spinous processes
- Musculoskeletal complaints
- Tendomuscular pains
- Arthritis of left elbow joint
- Arthritis of left ankle
- Arthritis of knee,shoulder, elbow, ankle, wrist and hip occurring weeks to months after the initial infection
- Neurological Signs and Symptoms- Brain, Spinal Cord, Etc.
- Brain diseases
- Difficulty learning new material in school
- Facial weakness
- Bilateral facial palsy (BFP)
- Pseudotumor cerebri
- Idiopathic intracranial hypertension
- High cerebrospinal fluid (CSF) levels of mononuclear cells and albumin
- Lyme meningitis characterized by signs/symptoms similar to viral meningitis
- CSF concentration of proteins (more frequent or higher in children with Lyme meningitis)
- Concentration disorder
- Personality changes
- Ataxia
- Cerebellar ataxia
- Meningeal involvement
- Simple partial seizures
- Diffuse leptomeningeal inflammation
- Hyperintense cervical cord lesion
- Hypotonia (Floppy Baby Syndrome)
- Dysarthria (Speech- Motor Disorder)
- Weak gag and cough reflexes
- Hyperintense lesions (Bright spot on MRI)
- Fluid-attenuated inversion recovery sequences on left posterior arm of the internal capsule
- Fluid-attenuated inversion recovery sequences in the medulla oblongata
- Fluid-attenuated inversion recovery sequences on subcortical occipital and parietal region
- Leptomeningeal and root enhancement
- Unexplained neurological symptoms
- Meningoencephalitis
- Meningoradiculitis
- Encephalomyelitis
- Dysarthia (difficult or unclear speech)
- Tourette's syndrome
- Inappropriate laughter
- Disorientation
- Noise sensitivity
- Tingling
- Numbness
- Irritability
- Attention deficit disorder (ADD)
- Attention deficit hyperactivity disorder (ADHD)
- Cognitive Impairments
- Problems with short-term memory
- Word finding problems
- Behavioral changes
- Difficulty thinking or expressing thoughts
- Poor working memory
- Panic attacks
- Depersonalization
- Outbursts- some violent
- Mood swings
- Meningomyeloradiculitis
- Nocturnal pain in back and legs
- Aseptic meningitis
- Night terrors
- Autism spectrum disorder
- Ischemic and hemorrhagic lesions
- Auditory hallucinations
- Diminished reflexes
- Neurologic signs and/or symptoms defined as possible sequelae
- Myelopathy
- Poliomyelitis
- Cranial polyneuritis
- Cranial nerve palsies
- Increased CSF cell count
- Neurodevelopment delay
- Cranial neuropathy
- Transient focal neurological deficits
- Complete hemiparesis
- Paraesthesia
- Recurrent episodes of vertigo
- Seizures
- Partial complex seizure disorder
- Radicular pain
- Facial nerve paralysis
- Bell's palsy
- Peripheral facial palsy
- Trochlear palsy
- Trochlear palsy
- Facial nerve palsies
- Mild facial palsy
- Peripheral neuropathy
- Distal parasthesias
- Spinal cord swelling
- Paraesthesia
- Dysfunctional and cosmetic problems
- Persistent facial nerve palsy
- Altered gait- jerky, uneven, labored, limp
- Transverse myelitis
- Acute myelitis
- Meningitis
- Lymphocytic meningitis
- Opsoclonus-myoclonus
- Myoclonus
- Radiculopathies
- Sensory abnormalities
- Lyme meningitis diagnosed in two-thirds of children with infectious meningitis in Lyme endemic area
- Broad range of neurologic disorders
- Severe acute cerebellar ataxia
- Acute hemiparesis
- Autonomic dysfunction
- Rasmussen Syndrome
- Alice in Wonderland Syndrome
- Seventh nerve palsy
- Multiple sclerosis
- Guillain–Barré syndrome
- Pseudotumor cerebri
- Cerebral vasculitis
- Focal neurological signs
- Lyme disease shares many of the same physical manifestations as Autism Spectrum Disorder (ASD)
- All scores on SAP-O assessment improved after 6 months of antibiotic therapy.
- ASD/Lyme- improved speech, eye contact, sleep behaviors, and reduction of repetitive behaviors after 6 months antibiotic therapy
- Neuropsychiatric impairments
- Sensibility disturbances
- Pain
- Acquired horizontal nystagmus, headaches, and vertigo
- "Pirate Face" (Bell's Palsy)
- Cerebral vasculitis and stroke
- 24 hours of unilateral facial weakness
- Forward neck flexion elicited Lhermitte's sign (electrical sensation down the spine indicative of cervical spinal cord pathology such as inflammation)
- Lower motor neuron facial nerve palsy
- Bilateral increased lower extremity tone
- Muscle power was normal in all muscle groups tested
- Deep tendon reflexes were increased at the knees and ankles
- Left plantar response was extensor
- Reduced sensation to pinprick
- MRI of spine revealed increased T2-weighted signal in the spinal cord, mild spinal cord swelling, and diffuse gadolinium enhancement of the spinal meninges and proximal nerve root
- CSF protein level was elevated and concentration of CSF glucose was reduced
- Meningoradiculitis
- Presumptive diagnosis of transverse myelitis due to Lyme neuroborreliosis
- Banworth's syndrome (lymphocytic meningitis, cranial neuropathy, and painful radiculitis)
- Chronic low-grade encephalitis
- Partial complex seizure disorder
- Children with prior cranial nerve palsy have significantly more behavioral changes (16% vs. 2%), arthralgias and myalgias (21% vs. 5%), and memory problems (8% vs. 1%) an average of 4 years after treatment compared to controls.
- Seizures with regional leptomeningeal enhancement, acute transverse myelitis, meningoradiculitis with pain and paraesthesia and cranial nerve palsies other than facial nerve palsy can be the leading symptoms of children with neuroborreliosis.
- MR of brain- foci of T2 prolongation in the cerebral white matter- one had an enhancing lesion with edema- three demonstrated nerve-root or meningeal enhancement
- Lyme meningitis is difficult to differentiate from other causes of aseptic meningitis
- May develop towards various clinical forms of chronic pathology
- Extensive peripheral nervous deficit
- Mild and moderate residual neurological deficit
- Psychic problems
- Disturbances with sleep
- Psychic concentration, memory & mood
- Lymphocytic meningitis
- Vasculitis syndrome
- Inflammatory CSF changes
- Significant deficits in cognition (short-term visual memory, short-term and delayed verbal memory, all forms of recognition memory)
- Aseptic meningitis
- Meningitis is not always accompanied by meningeal signs
- Worse attendance, grades, and subjective reports of memory problems
- Deficits in visual memory exceeded deficits in verbal memory
- Adolescents with treated Lyme disease are at risk for long-term problems in cognition and school functioning.
- Neuroborreliosis mimicking a space-occupying lesion in the brainstem
- Tumorous lesion
- Peripheral cranial nerves paralysis
- Symptoms of cerebrospinal meningitis
- Unexpectedly swelling, vasogenic oedema of spinal cord predominantly of grey matter compatible with poliomyelitis
- A wide range of neurologic abnormalities
- Ehrlichia meningoencephalitis
- Cranial neuritis
- Lyme-associated pseudo tumor cerebri
- Cerebrospinal fluid pleocytosis consistent with Lyme meningitis
- Subacute meningitis with headache, fever, neck pain or loss of appetite
- Sequelae after confirmed NB occurs
- Skin Related
- Pruritis
- Cervical cellulitis with lymphadenitis
- Acropapular dermatitis
- Misdiagnosed with cellulitis
- Necrotic eschar of scalp
- Thickening of soft tissues with increased echogenicity and hyperemia
- Inflammation of the auricular cartilage
- Mildly tender mass in right pre auricular region- mass became larger, and overlying skin turned purple
- Mass appeared to reduce in size after doxycycline treatment, but then grew and turned erythematous
- Rare erythema (39.5%)
- Paresthesia in leg and toes
- Intense edema of the dermis
- Reticulate and diffuse erythematous discolored skin with doughy turgor of leg
- Multiple oval-shaped whitish atrophic skin changes with erythematous margins present for 18 months
- Sclerotic skin changes were progressive
- Reddish swelling of earlobe present for over 6 months
- Sclerosis multiplex
- Sclerotic skin lesions strongly resembling morphea or lichen sclerosus et atrophicus can beseen in patients with acrodermatitis chronica atrophicans (ACA).
- Highly significant association between morphea, serologic evidence of Borrelia infection, and high-titer antinuclear antibodies when disease onset was in childhood or adolescence.
- Specific involvement of B burgdorferi or other similar strains in the development or as a trigger of LS (Lichen Sclerosus)
- Lichen sclerosus shares similarities and common features with acrodermatitis chronica atrophicans (ACA), a chronic form of borreliosis
- Positive association between B burgdorferi infection and LS (Lichen Sclerosus) found evidence of the organism in 10% to 68% of cases
- Epidermis was usually thickened- Borrelia Lichen Sclerosus
- Borrelia Lichen Sclerosus- papillary dermis (early stage) occasionally revealed edema, yet more regularly, early fibrosis with an increase of fibrocytes and fibroblasts
- In later stages of Borrelia Lichen Sclerosus the number of fibrocytes and fibroblasts further increased
- Fibrosis and sclerosis (homogenized bundles of collagen without interposed fibrocytes) increased, whereas the inflammatory infiltrate decreased
- Very late stages- Borrelia Lichen Sclerosus- finally revealed a broad, homogenized eosinophilic band of collagen, ie, sclerosis without significant inflammatory infiltrate
- Borrelia Lichen Sclerosus-fibrosing dermatitis also involved the reticular dermis- simulating features characteristic of morphea at its various stages
- Spirochetes or their degenerative products were frequently located along or in between collagen bundles
- B. burgdorferi sensu lato detected in more than 60% of all LS (Lichen Sclerosus) cases- a significantly higher percentage (P = .001) in early (80%) than in late (33%) LS
- Heart & Circulatory System
- Carditis more likely in children aged >10 years
- Utero transmission of B. burgdorferi during pregnancy resulting in fetal involvement
- Chest pain (at least 70%)
- Shortness of breath
- Palpitations
- Syncope
- Loud opening sound of the mitral valve
- Thickened mitral valve with mild regurgitation
- Stroke
- Myocardial muscle involvement
- Vasculitis
- Atypical location of lymphocytoma cutis
- Cerebral vasculitis
- Myocarditis
- Transient myocardial dysfunction
- Heart block
- Complete antrioventricular block
- Stroke and stroke-like symptoms
- Short stenoses at the branching site of the left middle cerebral artery (MCA)
- Circumscript areas of malperfusion
- Thromboembolic events
- CNS vasculitis
- Stenosis in the left posterior cerebral artery consistent with vasculitic inflammation
- MCA lesions
- Advanced heart block
- Advanced heart block
- Depressed ventricular systolic function
- Cardiopulmonary symptoms
- Carditis
- Cardiac involvement may appear as AV block or carditis
- Tachycardia
- Junctional tachycardia
- Arrhythmia resolved with intravenous ceftriaxone
- Frequent cardiovascular disorders with development of Lyme carditis
- 207 children with early disseminated Lyme disease- 33 (16%) had carditis, 14 (42%) had advanced heart block, including 9 (27%) with complete heart block.
- Four (12%) of 33 patients- children- with carditis had depressed ventricular systolic function, 3 (9%) of whom required mechanical ventilation, temporary pacing, and inotropic support.
- Complete resolution of rhythm disturbances and myocardial dysfunction occurred in 24 (89%) of 27 patients.
- Most children with carditis also had other systemic Lyme involvement.
- Children >10 years of age, those with arthralgias, and those with cardiopulmonary symptomswere more likely to have carditis
- Acute hemiparesis episodes
- Capsulothalamic inflammation and a vasculitis
- Stroke-like episode
- Fetal neurological abnormalities associated with tick-borne diseases
- Bacteriological culture from blood, joint fluid or cerebrospinal fluid is very difficult
- Blood & Lab Related
- There is no “gold standard” diagnostic test for Lyme neuroborreliosis
- Direct culture of Borrelia species and PCR are of low sensitivity
- ELISA, a relatively sensitive, but not specific test
- Western blot, which is specific, but not sensitive
- Sensitivity (tests) may be less than 40% in cases of acute stage 1 Lyme disease
- Increased white cell count
- High level of inflammation (higher in boys studied)
- Lower frequencies of Treg cells (regulatory T Cells)
- Higher expression of activation coreceptors
- Less effective inhibition of pro inflammatory cytokines
- Immune responses excessively amplified
- Elevated CXCL13 levels in CSF
- Pleocytosis in cerebrospinal fluid
- Immune dysregulation
- Negative PCR does not exclude it
- Serological tests have limited utility for follow-up
- One week oral antibiotics hindered antibody production against B burgdorferi, while not being therapeutic, due to short duration
- Seronegative Lyme arthritis due to early and inadequate antibiotic treatment
- Chronic Lyme disease cannot be excluded by the absence of antibodies against B. burgdorferi
- Dermis with inflammatory infiltrate, lymphocytes,neutrophils and eosinophils, perivascular localisation andtransendothelial migration, and presence of DNA of Borrelia burgdorferi, Parvovirus B19 and EBV
- IL-17 was elevated in CSF in 49% of the patients with confirmed NB
- Significantly higher CSF levels of CXCL10, CCL22 and CXCL8
- Patients with early NB (Neuro-Borreliosis) had a short duration of symptoms and lower CCL22 levels in CSF than did the confirmed NB group
- Cytokine/chemokine levels were not correlated with clinical parameters or to levels of anti-Borrelia-antibodies
- The diagnosis of LNB poses a challenge to clinicians, and improved tests are needed
- CSF CXCL13 levels were significantly elevated in definite and probable acute NB in children
- Serum CXCL13 levels showed great fluctuations and were not significantly elevated
- Antibodies directed to B. burgdorferi exclusively in cerebrospinal fluid
- Observed changes in the cytokine spectrum characterized by INF-gamma high levels
- Presence of ischemic lesions in the pons and cerebellum, with focal stenosis of the basilar artery on magnetic resonance angiography
- Focal gadolinium enhancement of the basilar artery wall
- Oligoclonal bands were present in the CSF, but not serum
- CSF pleocytosis
- There is no objective way to rule out an active infection.
- Intermittent or persistent inflammation over a period of several years
- (PCR) results for B. burgdorferi DNA in synovial fluid (SF) are usually negative after oral and IV antibiotic therapy
- (PCR) results for B. burgdorferi DNA in synovial fluid (SF) are usually negative after cellular and humoral immune responses to B. burgdorferi antigens decline
- Laboratory signs of meningitis were present
- Lymphocytic pleocytosis & raised protein
- Lymphatic System
- Skin Manifestations & Rashes
- Local itching or burning of rash
- Erysipelas may be confused with Lyme EM rash
- Erythema migrans
- Multiple erythema migrans
- Borrelial lymphocytoma
- Acrodermatitis chronica atrophicans
- Acrodermatitis chronica atrophicans
- ALDY- inflammatory disease of skin similar to morphea
- Skin- central paleness, scaling, wrinkling, dermal atrophy, slight pigmentation, and telangiectasia
- Acrodermatitis chronica atrophicans- a late skin manifestation of borreliosis
- Persistent pruritus
- Borrelial lymphocytoma, usually found at earlobes, nipples, or testicular sacks
- Arthrobacter mysorens, a soil bacterium, was isolated from the collected skin (EM rash) and there was a positive serology for an advanced stage of Lyme borreliosis
- Diffuse and patchy bluish red skin changes of different intensity and moderate swelling
- Eyes
- Light sensitivity (indoors or out)
- Iridocyclitis
- Uveitis intermedia
- Abducens palsies
- Optical neuropathy
- Orbital myositis
- Conjunctivitis
- Infestation of eyelashes
- Ocular motor disturbances
- Intracranial hypertension
- Keratitis
- Keratitis
- Nystagmus
- Metamorphopsia (Distorted Vision- looking at straight lines forming a grid pattern)
- Vision loss
- Blindness
- Optic neuritis
- Optic nerve involvement
- Bilateral papilledema along with right sixth cranial nerve palsy
- Photophobia
- Papilledema
- Papilledema caused by raised intracranial pressure
- Ptosis (drooping eye lid)
- Adie's pupil
- Uvetitis
- Eyes may be involved by keratitis, iridocyclitis, or uveitis intermedia
- Lyme borreliosis is difficult to diagnose and should be sought in case of unusual neuro-ophthalmic signs
- Ptosis, conjunctivitis
- Photophobia
- Retinal fibrous scars including the macular area
- Left abducens nerve palsy diagnosed in MRI as a thickened left lateral rectus muscle
- Diagnosis of myositis
- Tick infestation in the eyelid region
- Transientconjunctivitis
- Ears
- Urinary, Bladder- Men, Women & Children's Issues
- Herxheimer Reaction
(*This list above with references is not complete. It is a work in progress.)
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