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Diagnosis of Lyme disease

Linden Hu, MD
Section Editor
Allen C Steere, MD
Deputy Editor
Jennifer Mitty, MD, MPH


Lyme disease is a tick-borne illness caused by three pathogenic species of the spirochete Borrelia burgdorferi sensu lato. B. burgdorferi is the sole cause of the disease in the United States, whereas all three pathogenic species, including Borrelia afzelii and Borrelia garinii, are found in Europe, and the latter two species have been identified in Asia. There is a broad spectrum of manifestations, and severity of disease is due, in part, to differences in the infecting species.

The diagnosis of Lyme disease will be reviewed here. The diagnosis of Lyme arthritis and neurologic Lyme disease, as well as the microbiology, epidemiology, immunopathogenesis, clinical manifestations, and treatment of Lyme disease are discussed separately; the evaluation of a tick bite for Lyme disease is also presented elsewhere. (See "Musculoskeletal manifestations of Lyme disease", section on 'Laboratory testing' and "Nervous system Lyme disease", section on 'Diagnosis' and "Epidemiology of Lyme disease" and "Microbiology of Lyme disease" and "Immunopathogenesis of Lyme disease" and "Clinical manifestations of Lyme disease in adults" and "Treatment of Lyme disease" and "Evaluation of a tick bite for possible Lyme disease".)


The clinical manifestations of Lyme disease can generally be divided into three phases: early localized, early disseminated, and late disease (table 1). However, the clinical features of each stage can overlap, and some patients present in a later stage of Lyme disease without a history of prior signs or symptoms suggestive of earlier Lyme disease:

Early localized disease is characterized by the appearance of the characteristic skin lesion, erythema migrans (EM), with or without constitutional symptoms (picture 1). EM usually occurs within one month following the tick bite.

Early disseminated disease is characterized by multiple EM lesions (that typically occur days to weeks after infection) and/or neurologic and/or cardiac findings (that typically occur weeks to months after infection). Some of these patients have no history of antecedent early localized Lyme disease.


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Literature review current through: Sep 2016. | This topic last updated: Mar 20, 2015.
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