About Lyme Disease Symptoms

Lyme Disease Symptoms & Signs

Lyme disease symptoms can affect any system in the body and can mimic symptoms of many different diseases.

Lyme disease symptoms

Lyme Disease Symptoms Compiled by the LDA

As listed in the LDA LymeR Primer  Available for online ordering

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Lyme Disease Symptoms Compiled by the LDA

As listed in the LDA LymeR Primer Available for online ordering

Click dropdown arrows for symptoms

Lyme disease symptoms
Lyme disease symptoms


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    chest pain or rib soreness, shortness of breath, heart palpitations, pulse skips, heart block, heart murmur

Lyme disease symptoms

Lyme Rash

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    Only about 9% get the classic bull’s eye rash. Others may get another type of Erythema Migrans (EM) rash or may get no rash at all. Rash at other than bite site may be disseminated disease. Symptoms may occur days or months after a tick bite.
    According to the Centers for Disease Control & Prevention (CDC) surveillance criteria, an erythema migrans (EM) rash in an endemic area, means Lyme disease. In a non-endemic area, a rash requires a positive test. The CDC criteria are for surveillance purposes, not diagnosis.



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    nausea or vomiting, GERD, change in bowel function (constipation, diarrhea), gastritis, abdominal cramping, cystitis, irritable bladder or bladder dysfunction, newly diagnosed irritable bowel syndrome (IBS) 



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    joint/muscle pain in feet, ankle pain, shin splints, joint pain or swelling, stiffness of the joints, neck or back, muscle pain or cramps that migrate, Temporomandibular joint dysfunction (TMJ/TMJD jaw pain), neck creaks & cracks, neck stiffness.

Lyme disease symptoms


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    muscle twitching, headache, tingling, numbness, burning or stabbing sensations, facial paralysis (Bell’s palsy), dizziness, poor balance, increased motion sickness, light-headedness, wooziness, difficulty walking, tremor, confusion, difficulty thinking/concentrating/ reading, forgetfulness, poor short-term memory, disorientation (getting lost, going to wrong place), difficulty with speech, double or blurry vision, eye pain, blindness, increased floaters, increased sensitivity to light or sound, buzzing or ringing in ears, ear pain, decreased hearing, seizure activity, white matter lesions, low blood pressure.



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    mood swings, violent outbursts, irritability, depression, disturbed sleep (too much, too little, early awakening), personality changes, obsessive – compulsive disorder (OCD), paranoia, panic/anxiety attacks, hallucinations.



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    testicular pain/pelvic pain, menstrual irregularity, milk production (lactation), sexual dysfunction or loss of libido.

Lyme disease symptoms

Other Symptoms

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    fever, sweats, or chills, weight change (loss or gain), fatigue, tiredness, hair loss, swollen glands, sore throat, difficulty swallowing, swelling around the eyes, burning in feet, swelling

Lyme Transmission

Lyme Transmission

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    Not all patients recall a tick bite. Studies vary as to how long the tick must be attached in order to transmit Lyme disease. The longer an infected tick is attached, the greater the chance of contracting Lyme disease. Lyme can be transmitted through the placenta.

Lyme disease symptoms

Lyme from Borrelia mayonii
Another strain of Borrelia that causes Lyme

Early symptoms: fever, headaches, rash, neck pain Later: arthritis. Difference from Borrelia burgdorferi may include nausea & vomiting, diffuse rashes, higher concentration of bacteria in blood

Symptoms reviewed by Elizabeth Maloney, MD; President, Partnership for Tick-Borne Diseases Education

Other Tick-Borne Diseases & Conditions:

Patients may also contract other tick-borne diseases (co-infections) from a tick bite along with Lyme disease.

Visit LDA website Other Tick-Borne Diseases page

Other Resources for Lyme Disease Symptoms:

Columbia Lyme Rash Poster

Dr. Joseph Burrascano’s 2005 Lyme Disease Symptom List Chart

En Espanol Enfermedad De Lyme”  Spanish Patient Intake, Printable PDF

LDA Cardiac (Heart) Poster

LDA Lyme Disease Medical Photos  Including Rashes

LDA LymeLiteracy  LDA President’s Blog

LDA “LymeR Primer” Detailed LDA Printable Brochure

ILADS Treatment Guidelines International Lyme & Associated Diseases Society

Columbia Lyme & Tick-Borne Diseases Research Center – Treatment Page Columbia University, Irving Medical Center

© LDA. 2015, 2016, 2020. This website provides practical and useful information on the subject matters covered. It is distributed with the understanding that LDA is not engaged in rendering medical or other professional services. Seek professional services if necessary.




Current Lyme Disease Testing Problems

Elizabeth Maloney, MD, explains current Lyme disease testing issues, including the ELISA and Western Blot, sensitivity and specificity of the testing, and the problems associated with the two-tier testing recommended by the CDC. It begins with the general characteristics of diagnostic testing

The Summary states: “Serologic testing for Lyme is inaccurate. While the inadequate sensitivity of ELISA and Western blot tests is the primary problem, imprecision and the lack of clinical validity contribute to the poor performance of two-tier testing in clinical settings. Although the high specificity of the CDC two-tier strategy works well for epidemiologic purposes, the testing sequence reduces the overall sensitivity, thereby limiting its clinical effectiveness. While positive results on two-tier testing in an untreated patient who has symptoms of Lyme disease would confirm the clinical diagnosis (and it would be a mistake to label such results as “false positives”), negative results do not rule out Lyme disease.”

See full article by Elizabeth Maloney, MD here:  Applying Basic Concepts in Laboratory Testing to Serologic Testing for Lyme Disease

See International Lyme & Associated Diseases (ILADS) Controversy & Challenges Page – Issues with Diagnosis & Diagnostics

Lyme disease testing problems by Elizabeth Maloney, MD
ELISA Test: The original whole cell sonicate test

One Health Lyme: ILADS Launches New Research Database

Medical staff discussing over medical reports. Healthcare professionals having discussion in hospital corridor.

The International Lyme and Associated Diseases Society (ILADS) announced they are launching One Health Lyme, a new registry and crowd-solving platform for medical care providers treating Lyme and other Tick-borne diseases (TBD). This repository is exciting news for the Lyme community! 

One Health Lyme is designed to provide valuable resources to clinicians who are treating this patient population. Due to the COVID-19 pandemic, this effort is being pushed forward quickly to provide clinicians the best available resources at this critical time. Clinicians will have a unique opportunity to both track and communicate the impact of COVID-19 on patients with Lyme, allowing important insight from unique immunological legions of these patients to be gathered in the fight against COVID-19. 

Through this platform, data regarding patient experience and treatments will be collected from medical care providers to create a vast repository of information about Lyme that physicians and researchers can use to study and treat it and related diseases.

The platform will also be used to provide educational material and act as a support for crowd-sourcing solutions that face physicians treating this patient population.

ILADS plans to seek a partnership with other organizations such as Lymedisease.org, who have been collecting patient data for years, allowing medical professionals to benefit from both initiatives.

Collaboration with Groopit.co, a crowd solving organization, has provided software that allows for the collection of data in realtime from a vast team which allows for more efficiency.   

The hope is that One Health Lyme will be able to both inform clinicians on how Lyme disease patients are cared for as well as provide potential insight into COVID-19 itself and the public at large.  

*ILADS is a nonprofit, international, multi-disciplinary medical society, dedicated to the diagnosis and appropriate treatment of Lyme and its associated diseases. ILADS promotes understanding of Lyme through research and education and strongly supports physicians and other healthcare professionals dedicated to advancing the standard of care for Lyme and its associated diseases.

For more information, visit: www.ilads.org

CDC Focus on Maternal-Fetal Transmission of Lyme Disease

The Centers for Disease Control (CDC) updated its website to include information regarding  maternal-fetal transmission of Lyme disease.

Updates from the CDC website:

  • Lyme disease Transmission page under “Are there other ways to get Lyme disease?”: “Untreated Lyme disease during pregnancy can lead to infection of the placenta. Spread from mother to fetus is possible but rare. Fortunately, with appropriate antibiotic treatment, there is no increased risk of adverse birth outcomes. There are no published studies assessing developmental outcomes of children whose mothers acquired Lyme disease during pregnancy.”
  • Lyme Disease FAQ page under “I am pregnant and think I have Lyme disease, what should I do?”: “If you are pregnant and suspect you have contracted Lyme disease, contact your physician immediately. Untreated Lyme disease during pregnancy can lead to infection of the placenta. Spread from mother to fetus is possible but rare. Fortunately, with appropriate antibiotic treatment, there is no increased risk of adverse birth outcomes.* There are no published studies assessing developmental outcomes of children whose mothers acquired Lyme disease during pregnancy.”
  • Pregnancy and Lyme disease poster: information on symptoms, diagnosis, and treatment. Regarding breastfeeding the poster states, “There are no reports of Lyme disease transmission through breast milk.”

LDA President, Pat Smith, said this about the CDC’s recent update, “The maternal-fetal aspect of Lyme disease, mother to baby transmission, has long been known but not well-publicized. The new CDC focus on this Lyme transmission method has been missing in Lyme disease education. A number of advocacy groups, including the LDA, have had information on their websites. LymeHope in Canada has been strongly advocating for wider recognition of this aspect, in particular nurse Sue Faber, who spoke before the HHS TBD Working Group in DC in January 2020. Now it is up to all of us to call attention to this CDC focus to ensure health departments and physicians are aware of the situation and that they take appropriate steps to ensure pregnant women get the necessary care.”

Visit the CDC Lyme disease website.

View the LDA’s Pregnancy, Breastfeeding & Lyme Bibliography.

Pregnancy, Breastfeeding & Lyme Bibliography

Any woman who has Lyme disease and is considering becoming pregnant or who is pregnant, or who is bitten by a tick during pregnancy, should see a Lyme disease doctor, one who understands the serious medical implications of Lyme during pregnancy. The Lyme bacteria, Borrelia burgdorferi, can cross the placenta and can cause death of the fetus. The Lyme Disease Association (LDA) has compiled the following list of articles related to Lyme and pregnancy and Lyme and breastfeeding for informational purposes only, for your review and review by your physician.

NEW in 2020! CDC Focus on Maternal-Fetal Transmission of Lyme Disease

Bale JF, Jr., Murph JR (1992). “Congenital infections and the nervous system.” Pediatr Clin North Am 39(4): 669-90.

Brzostek T. (2004). “[Human granulocytic ehrlichiosis co-incident with Lyme borreliosis in pregnant woman—a case study].” Przegl Epidemiol 58(2): 289-94.

Carlomagno G; Luksa V; Candussi G; Rizzi GM; Trevisan G Acta Eur Fertil 1988 Sep-Oct;19(5):279-81 Dept. of Obstetrics and Gynecology, University of Trieste School of Medicine. Lyme Borrelia positive serology associated with spontaneous abortion in an endemic Italian area.

Donta S, Aberer E, Ziska M. (1996). “Clinical Conference: Chronic Lyme Disease.” Journal of Spirochetal and Tick-Borne Diseases Vol.3 No.3/4 Fall Winter 1996.

Faber S. (2017). “Research findings on Lyme and Pregnancy/Congenital Transmission.” YouTube Video Retrieved from https://www.lymehope.ca/advocacy-updates/sharing-our-research-findings-on-lyme-and-pregnancycongenital-transmission-with-minister-of-health-and-public-health-agency-of-canada   The opinions presented in the video are those of the presenter and not necessarily of the Lyme Disease Association.

Gardner T. (1995). Lyme disease. Infectious diseases of the fetus and newborn infant. J. S. Remington and J. 0. Klein. Philadelphia, Saunders. Chap. 11: 447-528.

Gardner T. (2000) Lyme disease. 66 Pregnancies complicates by Lyme Borreliosis. lnfec Dis Fetus and Newborn Infant. Saunders

Goldenberg RL, Thompson C. (2003). “The infectious origins of stillbirth.” Am J Obstet Gynecol 189(3): 861-73.

Gustafson JM, Burgess EC, et al. (1993). “Intrauterine transmission of Borrelia burgdorferi in dogs.” Am J Vet Res 54(6): 882-90. (dog study)

Harvey WT, Salvato P. (2003) ‘Lyme disease’: ancient engine of an unrecognized borreliosis pandemic? Med Hypotheses. 60(5), 742-59.

Hercogova J, Vanousova D (2008). Syphilis and borreliosis during pregnancy. Dermatol Ther. 2008 May-Jun;21(3):205-9.

Jones CR, Smith H, Gibb E, Johnson L (2005) Gestational Lyme Disease: Case Studies of 102 Live Births. Lyme Times. Gestational Lyme Studies 34-36

Jovanovi R, Hajri A, Cirkovi A, et al. (1993) [Lyme disease and pregnancy]. Glas Srp Akad Nauka Med (43), 169-72.

Lakos A, Solymosi N (2010) Maternal Lyme borreliosis and pregnancy outcome. Int J Infect Dis 14(6), e494-8.

Lavoie PE; Lattner BP; Duray PH; Barbour AG; Johnson HC. Arthritis Rheum 1987; Culture positive seronegative transplacental Lyme borreliosis infant mortality. Volume 30, Number 4, 3(Suppl): S50.

Lawrence RM, Lawrence RA (2001). “Given the Benefits of Breastfeeding, What Contraindications Exist?” Pediatric Clinics of North America Volume 48, Issue 1, February 2001

MacDonald A.B. (1989). “Gestational Lyme borreliosis. Implications for the fetus.” Rheum Dis Clin North Am 15(4): 657-77.

MacDonald A.B. (1986). “Human fetal borreliosis, toxemia of pregnancy, and fetal death.” Zentralbl Bakteriol Mikrobiol Hyg [A] 263(1-2): 189-200.

MacDonald A.B., Benach J.L., et al. (1987). “Stillbirth following maternal Lyme disease.” NY State J Med 87(11): 615-6.

Maraspin, V., Cimperman J., et al. (1999). “Erythema migrans in pregnancy.” Wien Klin Wochenschr 111(22 23): 933-40.

Markowitz, L. E., Steere AC, et al. (1986). “Lyme disease during pregnancy.” JAMA 255(24): 3394-6. Because the etiologic agent of Lyme disease is a spirochete, there has been concern about the effect of maternal Lyme disease on pregnancy outcome.

Mikkelsen AL, Pa lie C. Lyme disease during pregnancy. (1987) Acta Obstet Gynecol Scand 66(5), 477-8.

Moro, Manuel H.; Bjornsson, Johannes; Marietta, Eric V.; Hofmeister, Erik K.; Germer, Jeffrey J.; Bruinsma, Elizabeth; David, Chella S.; and Persing, David H. (2001). “Gestational Attenuation of Lyme Arthritis Is Mediated by Progesterone and IL-4,” J Immunol 2001; 166:7404-7409

Mylonas I (2011) Borreliosis During Pregnancy: A Risk for the Unborn Child? Vector Borne Zoonotic Dis. 11:891-8.

Nadal D, Hunziker UA, Bucher HU, et al. (1989) Infants born to mothers with antibodies against Borrelia burgdorferi at delivery. Eur J Pediatr 148(5), 426-7. Abstract

Onk G, Acun C, Kalayci M, Cagavi F, et al. (2005) Gestational Lyme disease as a rare cause of congenital hydrocephalus. J Turkish German Gynecology Association Artemis,6(2), 156-157.

Schlesinger, P. A., Duray PH, et al. (1985). “Maternal-fetal transmission of the Lyme disease spirochete, Borrelia burgdorferi.” Ann Intern Med 103(1): 67-8.

Schutzer SE, Janniger CK, Schwartz RA (1991) Lyme disease during pregnancy. Cutis 47(4), 267-8. Abstract

Silver H. (1997) Lyme Disease During Pregnancy. Inf Dis Clinics of N. Amer. Vol 11, No 1,

Strobino BA, Abid S, Gewitz M (1999) Maternal Lyme disease and congenital heart disease: A case-control study in an endemic area. Am. J. Obstet. Gyn., 180:711-716.

Strobino BA, Williams CL, Abid S, Chalson R, Spierling P (1993)  Lyme disease and pregnancy outcome:  A prospective study of 2,000 prenatal patients. Amer J Ob Gyn, 169:367‑74.

Van Holten J, Tiems J, Jongen VH (1997) Neonatal Borrelia duttoni infection: a report of three cases. Trap Doct 27(2), 115-6.

Walsh CA, Mayer EW, Baxi LV. (2007). Lyme disease in pregnancy: case report and review of the literature. Obstet Gynecol Surv. 2007 Jan;62(1):41-50.

Williams CL, Strobino BA, Lee A, Curran A, Benach JL, Inamdar S and Cristofaro (1990) Lyme disease in childhood:  Clinical and epidemiologic features of ninety cases. Pediatr. Infect. Dis.,  9: 10‑14.

Williams CL, Strobino BA (1990)  Lyme disease and pregnancy ‑ A  review of the literature.  Contemporary Ob/Gyn, 35:48‑64.

Williams CL, Strobino BA, Weinstein A, Spierling P, Medici F (1995)  Maternal Lyme disease and congenital malformations:  A cordblood serosurvey in endemic and control areas.  Pediatric and Perinatal Epid., 9: 320‑330. 

Weber, K., Bratzke HJ, et al. (1988). “Borrelia burgdorferi in a newborn despite oral penicillin for Lyme borreliosis during pregnancy.”Pediatr Infect Dis J 7(4):286-9.


Schmidt. B. L., Aberer E, et al. (1995). “Detection of Borrelia burgdorferi DNA by polymerase chain reaction in the urine and breast milk of patients with Lyme borreliosis.” Diaqn Microbiol Infect Dis 21(3): 121-8

Altaie. S. S., Mookherjee S, et al. (1996). Abstract # I17 Transmission of Borrelia burqdorferi from experimentally infected mating pairs to offspring in a murine model. FDA Science Forum.

Pregnancy & Breastfeeding

Centers for Disease Control & Prevention (CDC) website

During Pregnancy & While Breastfeeding
“Lyme disease acquired during pregnancy may lead to infection of the placenta and possible stillbirth, however, no negative effects on the fetus have been found when the mother receives appropriate antibiotic treatment. There are no reports of Lyme disease transmission from breast milk.” http://www.cdc.gov/ncidod/dvbid/LYME/ld_transmission.htm




Lyme Rash Poster

A Lyme disease rash may be a symptom of Lyme disease. About 50% of people bitten by a deer tick develop an erythem migrans (EM) rash at the bite site. A classic bull’s eye rash with a central clearing is a type of an EM rash, and only about 9% develop that classic bull’s eye, other EM rashes look different. Some of those who are bitten by a tick do not develop any rash. Rashes at other than a bite site means disseminated diseases. 

The Lyme Disease Association gave a grant to Columbia University to develop and distribute a poster to physicians. With Columbia’s permission, we have made the poster available here for anyone to print and distribute. It must be printed in its entirety.

Click here for printable pdf

LDA LymeRashPoster

1Forrester JD, Meiman J, Mullins J, et al. Update on Lyme carditis, groups at high risk, and frequency of associated sudden cardiac death—United States. MMWR 2014; 63 (43): 982-983.

Ann InternMed 2002 Mar 19;136(6):421-8 Clinical characteristics and treatment outcome of early Lyme disease in patients with microbiologically confirmed erythema migrans.Smith RP, Schoen RT, Rahn DW, Sikand VK, Nowakowski J, Parenti DL, Holman MS, Persing DH, Steere AC. Maine Medical Center Research Institute, Lyme Disease Research Laboratory, 13 Charles Street, Third Floor, Portland, ME

Cardiac (Heart) Manifestations of Lyme & TBD – Updated Poster

Click here for an updated Cardiac Manifestations of Lyme Poster for your use. (PDF)

LDA Heart Poster Small JPEG Not for Print smThe LDA has developed this Cardiac Manifestations of Lyme Poster for your use. You may download it for free and print it out or have it copied at Staples or another office supply store as a large poster for educational use. It must be copied in its entirety. You may NOT sell any material produced from this work. Stores may require a letter from LDA to copy it. Email LDA@LymeDiseaseAssociation.org for the document.

At the LDA/Columbia University 17th Annual CME Lyme Conference on Oct. 15 & 16th, Dr. Elizabeth Maloney presented a cardiac Lyme case and then moved to a broader discussion of Lyme carditis. Dr. Maloney’s presentation traced the evolution of the patient’s clinical picture from multiple erythema migrans lesions to third degree heart block. Click here for Dr. Maloney’s Bio and Talk Summary.



What is Lyme Disease?

Lyme disease is caused by a spiral-shaped bacteria, Borrelia burgdorferi (Bb), or by newly discovered Borrelia mayonii. It is usually transmitted by the bite of an infected tick−Ixodes scapularis in the East, Ixodes pacificus in the West.   

Lyme disease bacterium

How is Lyme disease transmitted?
In the USA, the bacteria are transmitted to people and animals by the bite of an infected tick, Ixodes scapularis, (commonly called the blacklegged or deer tick), and Ixodes pacificus (western blacklegged tick) in the West. Although other types of ticks such as the Dermancentor variabilis (American dog) and some insects have been shown to carry the Lyme bacteria, to date, transmission of Lyme through those vectors has not been proven.  The longer a tick is attached, the greater risk of disease transmission.

The Lyme bacteria has been proven to survive blood banking conditions; however, to date, no transmission has been proven through blood transfusions in humans. Studies have shown transmission through this route in mice in the lab. Note: Other tick-borne diseases have been transmitted through the blood supply.
The bacteria can also be passed through the placenta of a pregnant woman to the fetus—congenital transmission. The DNA of the bacteria has been found in breast milk, but no transmission has been proven to date in humans.
There is no proof to date that Lyme is sexually transmitted, although some preliminary studies have found PCR positives for the DNA of the Lyme bacteria in semen and in cervical tissue. These findings do not prove sexual transmission, but some physicians feel because the Lyme and syphilis spirochete (bacteria) are similar, Lyme may be sexually transmitted.

LDA World Covered in Ticks 2017

Lyme disease is found in approximately 80 plus countries worldwide, and 50 states in the USA, although different types of ticks and different strains of bacteria may be involved. In the USA the number of new cases of Lyme disease contracted each year is approaching 400,000. Many of those cases will include co-infections. 

Lyme Colon Biopsy

Where can Lyme disease be found in the body? 
Lyme is a multi-systemic disease, and the Lyme disease bacterium, Borrelia burgdorferi (Bb), may be found in many different organs, although it is often difficult to test for and to culture. To the left is an image that shows Borrelia burgdorferi (Bb) in the human colon.

Image Borrelia burgdorferi (Lyme disease bacterium) in the Human Colon. Courtesy of Martin Fried, MD.
© LDA.  2015, 2016, 2020. This website provides practical and useful information on the subject matters covered. It is distributed with the understanding that LDA is not engaged in rendering medical or other professional services. Seek professional services if necessary.

Lyme Disease Treatment Guidelines

Doctors discussing patient treatment

Clinical practice treatment guidelines are often used as reference by physicians for Lyme disease treatment and treatment of other tick-borne diseases. The LDA provides some links here for informational purposes only, as LDA does not make specific treatment recommendations. 

The only Lyme disease treatment guidelines that that were posted on the National Guidelines Clearinghouse (NGC), under the auspices of the US Department of Health & Human Services, are those adhering to newly revised National Academy of Medicine (NAM), formerly the Institute of Medicine (IOM), standards for guidelines: the International Lyme & Associated Diseases Society (ILADS) Lyme Guidelines, which address usefulness of antibiotic prophylaxis for tick bite, effectiveness of EM treatment, and antibiotics’ role in treatment of persistent Lyme disease symptoms. Note: Funding to support AHRQ’s NGC contract ended on July 16, 2018. View update here.

You can also checkout our handy infographic for treatment guidelines.

ILADS Guidelines for the Management of Lyme Disease

ILADS press release on the new guidelines

Other Lyme treatment guidelines of note are those developed by one of the most recognized pioneers in Lyme treatment, Dr. Joseph Burrascano, now retired as a treating physician.

Link: Burrascano Diagnostic Hints & Guidelines* (16th edition, 10/2008)

Primary care physicians and other healthcare providers seeking continuing medical education (CME) credits for Lyme disease diagnosis and treatment can now approach the non-profit Partnership for Tick-Borne Diseases Education (PTDE) led by Elizabeth Maloney, MD, a physician with longstanding experience in speaking about tick-borne diseases, organizing Lyme disease conferences, and co-authoring treatment guidelines on Lyme and other tick-borne diseases.

Partnership for Tick-Borne Diseases Education, CME for Doctors

*In order to download this file, you will need Adobe Acrobat Reader 5.0 or greater. Please feel free to download the latest version for FREE. 

How CDC Surveillance Criteria Impact Lyme Treatment
The Centers for Disease Control & Prevention (CDC) has a case definition for Lyme disease which is developed by the Council of State & Territorial Epidemiologists (CSTE). This definition is meant to be used for surveillance purposes only, not for diagnosis. Surveillance is the collection, analysis and interpretation  of data for public health, e.g., comparing case numbers in different states: In 2015, PA is number one in Lyme case numbers, NJ is number two, etc. Below, is the current case definition used for surveillance.
Depending upon what state you live in, surveillance reporting of cases might be mandatory.  Some states require doctors to report cases that meet this surveillance criteria to the State, and some also require laboratories to report these Lyme cases or maybe only labs who do electronic reporting.
Doctors are not supposed to use the surveillance criteria to diagnose so Lyme treatment should not be based on surveillance criteria. Insurance companies should not base their payment on surveillance criteria.
Click here: Lyme Disease | 2017 Case Definition

DISCLAIMER: The LDA is not a medical organization. The LDA does not make specific recommendations for treatment. Whenever medical advice is needed, the services of a qualified medical provider should be sought. The guidelines on the web sites above are the products of the guidelines’ authors who are solely responsible for their content.

Bransfield Article on Neuropsychiatric Lyme Published

bransfieldRobert C. Bransfield, MDRobert C. Bransfield, MD, Department of Psychiatry, Rutgers-RWJ Medical School, published an article on 8-25-18, which demonstrates an association between Lyme borreliosis and neuropsychiatric impairments — considered a major advance in psychiatry. Entitled Neuropsychiatric Lyme Borreliosis: An Overview with a Focus on a Specialty Psychiatrist’s Clinical Practice, the article was published in a special issue of Healthcare – Lyme Disease: The Role of Big Data, Companion Diagnostics and Precision Medicine, with guest editor, Raphael B. Stricker, MD.

According to Dr. Bransfield, “Lyme borreliosis, possibly with other interactive infections in the body can evade and suppress the immune system and cause immune effects and biochemical changes in the brain causing neuropsychiatric symptoms.” The results can include developmental disorders, autism spectrum disorders, schizoaffective disorders, bipolar disorder, depression, anxiety disorders (panic disorder, social anxiety disorder, generalized anxiety disorder, post-traumatic stress disorder, intrusive symptoms), eating disorders, sleep disorders, decreased libido, addiction, opioid addiction, cognitive impairments, dementia, seizure disorders, suicide, violence, anhedonia, depersonalization, dissociative episodes, derealization and other impairments.

Dr. Bransfield is a member of the Lyme Disease Association’s Scientific & Professional Advisory Board.


There is increasing evidence and recognition that Lyme borreliosis (LB) causes mental symptoms. This article draws from databases, search engines and clinical experience to review current information on LB. LB causes immune and metabolic effects that result in a gradually developing spectrum of neuropsychiatric symptoms, usually presenting with significant comorbidity which may include developmental disorders, autism spectrum disorders, schizoaffective disorders, bipolar disorder, depression, anxiety disorders (panic disorder, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder, intrusive symptoms), eating disorders, decreased libido, sleep disorders, addiction, opioid addiction, cognitive impairments, dementia, seizure disorders, suicide, violence, anhedonia, depersonalization, dissociative episodes, derealization and other impairments. Screening assessment followed by a thorough history, comprehensive psychiatric clinical exam, review of systems, mental status exam, neurological exam and physical exam relevant to the patient’s complaints and findings with clinical judgment, pattern recognition and knowledgeable interpretation of laboratory findings facilitates diagnosis.Psychotropics and antibiotics may help improve functioning and prevent further disease progression. Awareness of the association between LB and neuropsychiatric impairments and studies of their prevalence in neuropsychiatric conditions can improve understanding of the causes of mental illness and violence and result in more effective prevention, diagnosis and treatment.

Click here for full journal article