Skip to main content

Advertisement

Log in

Abstract

Lyme disease (borreliosis) is one of the most common vector-borne diseases worldwide. Its incidence and geographic expansion has been steadily increasing in the last decades. Lyme disease is caused by Borrelia burgdorferi sensu lato, a heterogeneous group of which three genospecies have been systematically associated to Lyme disease: B. burgdorferi sensu stricto Borrelia afzelii and Borrelia garinii. Geographical distribution and clinical manifestations vary according to the species involved. Lyme disease clinical manifestations may be divided into three stages. Early localized stage is characterized by erythema migrans in the tick bite site. Early disseminated stage may present multiple erythema migrans lesions, borrelial lymphocytoma, lyme neuroborreliosis, carditis, or arthritis. The late disseminated stage manifests with acordermatitis chronica atrophicans, lyme arthritis, and neurological symptoms. Diagnosis is challenging due to the varied clinical manifestations it may present and usually involves a two-step serological approach. In the current review, we present a thorough revision of the clinical manifestations Lyme disease may present. Additionally, history, microbiology, diagnosis, post-treatment Lyme disease syndrome, treatment, and prognosis are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Dammin GJ (1989) Erythema migrans: a chronicle. Rev Infect Dis 11(1):142–151

    Article  CAS  PubMed  Google Scholar 

  2. Herrera Lorenzo O, Infante Ferrer J, Ramírez Reyes C, Lavastida Hernández H (2012) Enfermedad de Lyme: historia, microbiología, epizootiología y epidemiología. Rev Cubana Hig Epidemiol 50:231–244

    Google Scholar 

  3. Steere AC, Malawista SE, Snydman DR, Shope RE, Andiman WA, Ross MR et al (1977) Lyme arthritis: an epidemic of oligoarticular arthritis in children and adults in three Connecticut communities. Arthritis Rheum 20:7–17

    Article  CAS  PubMed  Google Scholar 

  4. Burgdorfer W, Barbour AG, Hayes SF, Benach JL, Grunwaldt E, Davis JP (1982) Lyme disease-a tick-borne spirochetosis? Science 216:1317–1319

    Article  CAS  PubMed  Google Scholar 

  5. Mead PS (2015) Epidemiology of Lyme disease. Infect Dis Clin N Am 29:187–210

    Article  Google Scholar 

  6. Gordillo G, Torres J, Solorzano F, Cedillo-Rivera R, Tapia-Conyer R, Munoz O (1999) Serologic evidences suggesting the presence of Borrelia burgdorferi infection in Mexico. Arch Med Res 30:64–68

    Article  CAS  PubMed  Google Scholar 

  7. Gordillo-Pérez G, Torres J, Solórzano-Santos F, Garduño-Bautista V, Tapia-Conyer R, Muñoz O (2003) Estudio seroepidemiológico de borreliosis de Lyme en la Ciudad de México y el noreste de la República Mexicana. Salud Publica Mex 45:351–355

    Article  PubMed  Google Scholar 

  8. Gordillo-Perez G, Vargas M, Solorzano-Santos F, Rivera A, Polaco OJ, Alvarado L et al (2009) Demonstration of Borrelia burgdorferi sensu stricto infection in ticks from the northeast of Mexico. Clin Microbiol Infect 15:496–498

    Article  CAS  PubMed  Google Scholar 

  9. Fang LQ, Liu K, Li XL, Liang S, Yang Y, Yao HW et al (2015) Emerging tick-borne infections in mainland China: an increasing public health threat. Lancet Infect Dis 15:1467–1479

    Article  PubMed  PubMed Central  Google Scholar 

  10. Lopes FA, Rezende J, Silva D, Alves FCG, Oliveira CE, Costa IPD (2017) Molecular evidence of Borrelia burgdorferi sensu lato in patients in Brazilian central-western region. Rev Bras Reumatol Eng Ed 57:641–645

    Article  Google Scholar 

  11. Rudenko N, Golovchenko M, Grubhoffer L, Oliver JH Jr (2011) Updates on Borrelia burgdorferi sensu lato complex with respect to public health. Ticks Tick Borne Dis 2:123–128

    Article  PubMed  PubMed Central  Google Scholar 

  12. Stanek G, Reiter M (2011) The expanding Lyme Borrelia complex--clinical significance of genomic species? Clin Microbiol Infect 17:487–493

    Article  CAS  PubMed  Google Scholar 

  13. Salkeld DJ, Leonhard S, Girard YA, Hahn N, Mun J, Padgett KA et al (2008) Identifying the reservoir hosts of the Lyme disease spirochete Borrelia burgdorferi in California: the role of the western gray squirrel (Sciurus griseus). Am J Trop Med Hyg 79:535–540

    Article  PubMed  Google Scholar 

  14. Radolf JD, Caimano MJ, Stevenson B, Hu LT (2012) Of ticks, mice and men: understanding the dual-host lifestyle of Lyme disease spirochaetes. Nat Rev Microbiol 10:87–99

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Borchers AT, Keen CL, Huntley AC, Gershwin ME (2015) Lyme disease: a rigorous review of diagnostic criteria and treatment. J Autoinmun 57:82–115

    Article  Google Scholar 

  16. Miraflor AP, Seidel GD, Perry AE, Castanedo-Tardan MP, Guill MA, Yan S (2016) The many masks of cutaneous Lyme disease. J Cutan Pathol 43:32–40

    Article  PubMed  Google Scholar 

  17. Vasudevan B, Chatterjee M (2013) Lyme borreliosis and skin. Indian J Dermatol 58(3):167–174

    Article  PubMed  PubMed Central  Google Scholar 

  18. Steere AC, Strle F, Wormser GP, Hu LT, Branda JA, Hovius JW, Li X, Mead PS (2016) Lyme borreliosis. Nat Rev Dis Primer 2:16090. https://doi.org/10.1038/nrdp.2016.90

  19. Godar DA, Laniosz V, Wetter DA (2015) Lyme disease update for the general dermatologist. Am J Clin Dermatol 16:5–18

    Article  PubMed  Google Scholar 

  20. Mullegger RR, Glatz M (2008) Skin manifestations of Lyme borreliosis: diagnosis and management. Am J Clin Dermatol 9:355–368

    Article  PubMed  Google Scholar 

  21. Lenormand C, Jaulhac B, Debarbieux S, Dupin N, Granel-Brocard F, Adamski H et al (2016) Expanding the clinicopathological spectrum of late cutaneous Lyme borreliosis (acrodermatitis chronica atrophicans [ACA]): a prospective study of 20 culture- and/or polymerase chain reaction (PCR)-documented cases. J Am Acad Dermatol 74:685–692

    Article  CAS  PubMed  Google Scholar 

  22. Bauvin O, Schmutz JL, De Martino S, Busato T, Cribier B, Barbaud A et al (2017) A foot tumour as late cutaneous Lyme borreliosis: a new entity? Br J Dermatol 177(4):1127–1130

    Article  CAS  PubMed  Google Scholar 

  23. Maraspin V, Nahtigal Klevišar M, Ružić-Sabljić E, Lusa L, Strle F (2016) Borrelial Lymphocytoma in adult patients. Clin Infect Dis 63:914–921

    Article  PubMed  Google Scholar 

  24. Zinchuk AN, Kalyuzhna LD, Pasichna IA (2016) Is localized scleroderma caused by Borrelia burgdorferi? Vector Borne Zoonotic Dis (Larchmont, NY) 16:577–580

    Article  Google Scholar 

  25. Gutierrez-Gomez C, Godinez-Hana AL, Garcia-Hernandez M, Suarez-Roa Mde L, Toussaint-Caire S, Vega-Memije E et al (2014) Lack of IgG antibody seropositivity to Borrelia burgdorferi in patients with Parry-Romberg syndrome and linear morphea en coup de sabre in Mexico. Int J Dermatol 53:947–951

    Article  CAS  PubMed  Google Scholar 

  26. Eisendle K, Grabner T, Kutzner H, Zelger B (2008) Possible role of Borrelia burgdorferi sensu lato infection in lichen sclerosus. Arch Dermatol 144:591–598

    Article  PubMed  Google Scholar 

  27. Arvikar SL, Steere AC (2015) Diagnosis and treatment of Lyme arthritis. Infect Dis Clin N Am 29:269–280

    Article  Google Scholar 

  28. Robinson ML, Kobayashi T, Higgins Y, Calkins H, Melia MT (2015) Lyme carditis. Infect Dis Clin N Am 29:255–268

    Article  Google Scholar 

  29. Scheffold N, Herkommer B, Kandolf R, May AE (2015) Lyme carditis--diagnosis, treatment and prognosis. Dtsch Arztebl Int 112:202–208

    PubMed  PubMed Central  Google Scholar 

  30. Marques AR (2015) Lyme neuroborreliosis. Continuum (Minneapolis, Minn). Neuroinfect Dis 21:1729–1744

    Google Scholar 

  31. Halperin JJ (2015) Nervous system Lyme disease. Infect Dis Clin N Am 29(2):241–253

    Article  Google Scholar 

  32. Koedel U, Fingerle V, Pfister HW (2015) Lyme neuroborreliosis-epidemiology, diagnosis and management. Nat Rev Neurol 11:446–456

    Article  PubMed  Google Scholar 

  33. Ogrinc K, Lusa L, Lotric-Furlan S, Bogovic P, Stupica D, Cerar T et al (2016) Course and outcome of early European Lyme neuroborreliosis (Bannwarth syndrome): clinical and laboratory findings. Clin Infect Dis 63:346–353

    Article  CAS  PubMed  Google Scholar 

  34. Zajkowska J, Garkowski A, Moniuszko A, Czupryna P, Ptaszynska-Sarosiek I, Tarasow E et al (2015) Vasculitis and stroke due to Lyme neuroborreliosis - a review. Infect dis (London, England) 47:1–6

    Google Scholar 

  35. Aucott JN (2015) Posttreatment Lyme disease syndrome. Infect Dis Clin N Am 29:309–323

    Article  Google Scholar 

  36. Berende A, ter Hofstede HJ, Vos FJ, van Middendorp H, Vogelaar ML, Tromp M et al (2016) Randomized trial of longer-term therapy for symptoms attributed to Lyme disease. N Engl J Med 374:1209–1220

    Article  CAS  PubMed  Google Scholar 

  37. CDC (1995) MMWR Morbidity and mortality weekly report. Recommendations for test performance and interpretation from the Second National Conference on Serologic Diagnosis of Lyme Disease. https://www.cdc.gov/mmwr/preview/mmwrhtml/00042555.htm .Accesed 10 July 2018

  38. Stanek G, Fingerle V, Hunfeld KP, Jaulhac B, Kaiser R, Krause A et al (2011) Lyme borreliosis: clinical case definitions for diagnosis and management in Europe. Clin Microbiol Infect 17:69–79

    Article  CAS  PubMed  Google Scholar 

  39. Shapiro ED (2014) Lyme disease. N Engl J Med 370(18):1724–1731

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Mygland A, Ljostad U, Fingerle V, Rupprecht T, Schmutzhard E, Steiner I (2010) EFNS guidelines on the diagnosis and management of European Lyme neuroborreliosis. Eur J Neurol 17:8–16

    Article  CAS  PubMed  Google Scholar 

  41. Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MS et al (2006) The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 43:1089–1134

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Oliverio Welsh.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Informed consent

Informed consent was obtained for iconographies.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cardenas-de la Garza, J.A., De la Cruz-Valadez, E., Ocampo-Candiani, J. et al. Clinical spectrum of Lyme disease. Eur J Clin Microbiol Infect Dis 38, 201–208 (2019). https://doi.org/10.1007/s10096-018-3417-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10096-018-3417-1

Keywords

Navigation