Borreliosis (Lyme Disease)

Description of the Disease

Lyme disease (borreliosis) is the most common tick-borne disease in Europe, the United States, and Canada. It is transmitted by ticks of the Ixodes ricinus and Ixodes persulcatus species. The causative agents are Borrelia bacteria that inhabit the tick’s intestinal tract. Of the 11 known Borrelia species, three are pathogenic to humans: Borrelia burgdorferi sensu stricto, Borrelia garinii, and Borrelia afzelii, with B. afzelii being the predominant species in the Baltic countries. The risk of infection is greatest if the tick remains attached for at least 48 hours.

Symptoms

Approximately 90% of infected individuals develop an infection limited to the skin. A characteristic rash, known as erythema migrans, may appear anywhere on the body but is most commonly found on the face, neck, or ears in children. The rash is typically larger than 5 cm in diameter, painless, and ring-shaped. It may disappear from one area and reappear in another before resolving completely.

In some individuals, the infection spreads throughout the body and affects the joints, heart, eyes, skin, and nervous system. These complications may develop weeks, months, or even years after the initial infection.

Manifestations may include:

• Acrodermatitis chronica atrophicans: Bluish-violet skin lesions, usually on the hands, feet, or buttocks, often accompanied by swelling. Over time, the affected area may become painful and tender, with enlarged nearby lymph nodes and sensory disturbances. In later stages, the skin becomes thin, and superficial blood vessels become visible.
• Neuroborreliosis: Usually develops within the first six months after infection. One characteristic presentation is Garin-Bujadoux-Bannwarth syndrome, which may include meningitis with severe headache, nausea, and vomiting, inflammation of the spinal nerve roots (radiculitis), and facial nerve palsy. The pain is often severe, persistent, and worse at night. Facial nerve involvement may cause facial weakness, drooping of the corner of the mouth, drooling, inability to close the eye completely, or difficulty moving facial muscles. Hearing loss, eye movement disorders, and balance problems may also occur.
• Lyme arthritis: Most commonly affects the knees or elbows, causing swelling, pain, redness, and warmth. In approximately 10% of patients, acute arthritis progresses to chronic arthritis.
• Eye involvement: Symptoms may include redness, eye pain, and sensitivity to light.
• Cardiac involvement: Lyme disease may affect the heart, producing characteristic abnormalities on an electrocardiogram (ECG).

Diagnosis

Diagnosis is based on clinical symptoms together with epidemiological information, such as a history of tick exposure or spending time in wooded or grassy areas.

Laboratory tests include detection of Borrelia-specific antibodies (particularly IgM) in the blood. In patients with suspected neuroborreliosis, cerebrospinal fluid analysis is performed to identify signs of inflammation and intrathecal antibody production.

Treatment

Lyme disease may occasionally resolve spontaneously, but antibiotic treatment is recommended to reduce symptoms and prevent complications. Commonly prescribed antibiotics include doxycycline, penicillin G, and third-generation cephalosporins such as ceftriaxone.

Source | Author Doctor Nikas Samuolis, reviewed by Prof. Virginijus Šapoka | Vilnius University | Faculty of Medicine | Head of the Department of Internal Medicine, Family Medicine, and Oncology