• “The best private organization-based site that can be recommended to patients for education on Lyme disease is that of the American Lyme Disease Foundation."
    (Clinical Infectious Diseases, 35: 451-464, 2002)

Lyme Disease

What is Lyme Disease?

Lyme disease (LD) is an infection caused by Borrelia burgdorferi, a type of bacterium called a spirochete (pronounced spy-ro-keet) that is carried by deer ticks(Click here for pictures of deer ticks). An infected tick can transmit the spirochete to the humans and animals it bites. Untreated, the bacterium travels through the bloodstream, establishes itself in various body tissues, and can cause a number of symptoms, some of which are severe. Often, an erythema migrans (EM) rash appears within 7-14 days at the site of a tick bite (click to see picture of a typical EM rash).

LD manifests itself as a multisystem inflammatory disease that affects the skin in its early, localized stage, and spreads to the joints, nervous system and, to a lesser extent, other organ systems in its later, disseminated stages. If diagnosed and treated early with antibiotics, LD is almost always readily cured. Generally, LD in its later stages can also be treated effectively, but because the rate of disease progression and individual response to treatment varies from one patient to the next, some patients may have symptoms that linger for months or even years following treatment. In rare instances, LD causes permanent damage.

Although LD is now the most common arthropod-borne illness in the U.S. (more than 150,000 cases have been reported to the Centers for Disease Control and Prevention [CDC] since 1982), its diagnosis and treatment can be challenging for clinicians due to its diverse manifestations and the limitations of currently available serological (blood) tests.

The prevalence of LD in the northeast and upper mid-west is due to the presence of large numbers of the deer tick’s preferred hosts – white-footed mice and deer – and their proximity to humans. White-footed mice serve as the principal “reservoirs of infection” on which many larval and nymphal (juvenile) ticks feed and become infected with the LD spirochete. An infected tick can then transmit infection the next time it feeds on another host (e.g., an unsuspecting human).

Borrelia burgdorferi

The LD spirochete, Borrelia burgdorferi, infects other species of ticks but is known to be transmitted to humans and other animals only by the deer tick (also known as the black-legged tick) and the related Western black-legged tick. Studies have shown that an infected tick normally cannot begin transmitting the spirochete until it has been attached to its host about 36-48 hours; the best line of defense against LD, therefore, is to examine yourself at least once daily and remove any ticks before they become engorged (swollen) with blood.

Generally, if you discover a deer tick attached to your skin that has not yet become engorged, it has not been there long enough to transmit the LD spirochete. Nevertheless, it is advisable to be alert in case any symptoms do appear; a red rash (especially surrounding the tick bite), flu-like symptoms, or joint pains in the first month following any deer tick bite could signal the onset of LD.

Manifestations of what we now call Lyme disease were first reported in medical literature in Europe in 1883. Over the years, various clinical signs of this illness have been noted as separate medical conditions: acrodermatitis, chronica atrophicans (ACA), lymphadenosis benigna cutis (LABC), erythema migrans (EM), and lymphocytic meningradiculitis (Bannwarth’s syndrome). However, these diverse manifestations were not recognized as indicators of a single infectious illness until 1975, when LD was described following an outbreak of apparent juvenile arthritis, preceded by a rash, among residents of Lyme, Connecticut.

Where is Lyme Disease Prevalent?

LD is spreading slowly along and inland from the upper east coast, as well as in the upper midwest. The mode of spread is not entirely clear and is probably due to a number of factors such as bird migration, mobility of deer and other large mammals, and infected ticks dropping off of pets as people travel around the country. It is also prevalent in northern California and Oregon coast, but there is little evidence of spread.

In order to assess LD risk you should know whether infected deer ticks are active in your area or in places you may visit. The population density and percentage of infected ticks that may transmit LD vary markedly from one region of the country to another. There is even great variation from county to county within a state and from area to area within a county. For example, less than 5% of adult ticks south of Maryland are infected with B. burgdorferi, while up to 50% are infected in hyperendemic areas (areas with a high tick infection rate) of the northeast. The tick infection rate in Pacific coastal states is between 2% and 4%.

Recent Tick Surveillance Data

Symptoms of Lyme Disease

The spirochetal agent of Lyme disease, Borrelia burgdoferi, is transmitted to humans through a bite of a nymphal stage deer tick Ixodes scapularis (or Ixodes pacificus on the West Coast). The duration of tick attachment and feeding is a key factor in transmission. Proper identification of tick species and feeding duration aids in determining the probability of infection and the risk of developing Lyme disease.

Spirochete transmission poster: how long has that tick been feeding on you?

The early symptoms of LD can be mild and easily overlooked. People who are aware of the risk of LD in their communities and who do not ignore the sometimes subtle early symptoms are most likely to seek medical attention and treatment early enough to be assured of a full recovery.

The first symptom is usually an expanding rash (called erythema migrans, or EM, in medical terms) which is thought to occur in 80% to 90% of all LD cases. An EM rash generally has the following characteristics:

  • Usually (but not always) radiates from the site of the tickbite
  • Appears either as a solid red expanding rash or blotch, OR a central spot surrounded by clear skin that is in turn ringed by an expanding red rash (looks like a bull’s-eye)
  • Appears an average of 1 to 2 weeks (range = 3 to 30 days) after disease transmission
  • Has an average diameter of 5 to 6 inches
    (range = 2 inches to 2 feet)
  • Persists for about 3 to 5 weeks
  • May or may not be warm to the touch
  • Is usually not painful or itchy

EM rashes appearing on brown-skinned or sun-tanned patients may be more difficult to identify because of decreased contrast between light-skinned tones and the red rash. A dark, bruise-like appearance is more common on dark-skinned patients.

Ticks will attach anywhere on the body, but prefer body creases such as the armpit, groin, back of the knee, and nape of the neck; rashes will therefore often appear in (but are not restricted to) these areas. Please note that multiple rashes may, in some cases, appear elsewhere on the body sometime after the initial rash, or, in a few cases, in the absence of an initial rash.

Around the time the rash appears, other symptoms such as joint pains, chills, fever, and fatigue are common, but they may not seem serious enough to require medical attention. These symptoms may be brief, only to recur as a broader spectrum of symptoms as the disease progresses.

As the LD spirochete continues spreading through the body, a number of other symptoms including severe fatigue, a stiff, aching neck, and peripheral nervous system (PNS) involvement such as tingling or numbness in the extremities or facial palsy (paralysis) can occur.

The more severe, potentially debilitating symptoms of later-stage LD may occur weeks, months, or, in a few cases, years after a tick bite. These can include severe headaches, painful arthritis and swelling of joints, cardiac abnormalities, and central nervous system (CNS) involvement leading to cognitive (mental) disorders.

The following is a checklist of common symptoms seen in various stages of LD:

Localized Early (Acute) Stage:

  • Solid red or bull’s-eye rash, usually at site of bite
  • Swelling of lymph glands near tick bite
  • Generalized achiness
  • Headache

Early Disseminated Stage:

  • Two or more rashes not at site of bite
  • Migrating pains in joints/tendons
  • Headache
  • Stiff, aching neck
  • Facial palsy (facial paralysis similar to Bell’s palsy)
  • Tingling or numbness in extremities
  • Multiple enlarged lymph glands
  • Abnormal pulse
  • Sore throat
  • Changes in vision
  • Fever of 100 to 102 F
  • Severe fatigue

Late Stage:

  • Arthritis (pain/swelling) of one or two large joints
  • Disabling neurological disorders (disorientation; confusion; dizziness; short-term memory loss; inability to concentrate, finish sentences or follow conversations; mental “fog”)
  • Numbness in arms/hands or legs/feet

Diagnosis of Lyme Disease

If you think you have LD symptoms you should see your physician immediately. The EM rash, which may occur in up to 90% of the reported cases, is a specific feature of LD, and treatment should begin immediately.

Even in the absence of an EM rash, diagnosis of early LD should be made on the basis of symptoms and evidence of a tick bite, not blood tests, which can often give false results if performed in the first month after initial infection (later on, the tests are more reliable). If you live in an endemic area, have symptoms consistent with early LD and suspect recent exposure to a tick, present your suspicion to your doctor so that he or she may make a more informed diagnosis.

If early symptoms are undetected or ignored, you may develop more severe symptoms weeks, months or perhaps years after you were infected. In this case, the CDC recommends using the ELISA and Western-blot blood tests to determine whether you are infected. These tests, as noted above, are considered more reliable and accurate when performed at least a month after initial infection, although no test is 100% accurate.

If you have neurological symptoms or swollen joints your doctor may, in addition, recommend a PCR (Polymerase Chain Reaction) test via a spinal tap or withdrawal of synovial fluid from an affected joint. This test amplifies the DNA of the spirochete and will usually indicate its presence.

Issues and Insights Related to the Diagnosis of Lyme Disease:

Misdiagnosis of Lyme disease: when not to order serologic tests

Executive Summary: 2nd Banbury Conference on the Laboratory Diagnosis of Lyme Disease

Straight Talk About the Diagnosis of Lyme Disease

Natural Killer Cell Counts are not Different Between Patients with Post-Lyme Disease Syndrome and Controls

Comprehensive Seroprofiling of sixteen B. burgdoreferi OspC: Implications for Lyme Disease Diagnostics design

The Laboratory Diagnosis of Lyme Borreliosis: Guidelines from the Canadian Public Health Laboratory Network

2-tired Antibody Testing for Early and Late Lyme Disease Using Only and Immunoglobulin G Blot with the Addition of a VlsE Band and the Second-tier Test Rapid, Simple, Quantitative , and Highly Sensitive Antibody Detection for Lyme Disease

CDC Issues Cautions Regarding Testing for Lyme Disease —

BBK07 Immunodominant Peptides as Serodiagnostic Markers of Lyme Disease

Misdiagnosis of Late Lyme Arthritis by Inappropriate Use of Synovial Fluid Borrelia burgdorferi Immunoblot Testing

Single-tier Testing with the C6 Peptide ELISA kit Compared with Two-tier Testing for Lyme Disease

High Frequency of False Positive IgM Immunoblasts for Borrelia burgdoreferi in Clinical

CXCL13 May Improve Diagnosis of Early Neuroborreliosis with Atypical Laboratory Findings: a Case Report

The Nervous System as Ectopic Germinal Center: CXCL13 and IgG in Lyme Neuroborreliosis

An Outer Surface Protein C (OspC) Peptide Derived from Borrelia burgdorferi sensu stricto as a Target for the serodiagnosis of early Lyme disease

Laboratory Diagnostic Testing for Borrelia burgdorferi Infection

Performance of United States Serologic Assays in the Diagnosis of Lyme Borreliosis Acquired from Europe

Identification of OppA2 linear Epitopes as Serodiagnostic Markers for Lyme Disease

U.S. Healthcare Providers’ Experience with Lyme Disease and Other Tick-borne Diseases

A Concise Critical Analysis of Serologic Testing for the Diagnosis of Lyme

Development of a Metabolic Biosignature for the Detection of Early Lyme Disease

Lyme disease diagnosed by alternative methods: a common phenotype with chronic fatigue syndrome

Understanding Antibody-based Diagnostic Tests for Lyme Disease

Testing Patients with Nonspecific Symptoms for Antibodies against Borelia burgdorferi sensu lato does not Provide Useful Clinical Information About Their Etiology

Poor positive predictive value of Lyme disease serologic testing in an area of low disease incidence.

The positive predictive value of Lyme ELISA for the diagnosis of Lyme disease in children

Lyme disease diagnosed by alternative methods: a phenotype similar to that of chronic fatigue syndrome

Development of a multi-antigen panel for improved detection of Borrelia burgdorferi infection in early Lyme disease

Testing practices and volume of non-Lyme tickborne diseases in the United States

Lyme Disease Diagnosis and Serology

New serological test proposed for the diagnosis of infection caused by Borrelia myomotoi

False positive Lyme disease IgM immunoblots in children

Current Guidelines, Common Clinical Pitfalls, and Future Directions for the Laboratory Diagnosis of Lyme Disease, United States.

Comparison of males versus females with culture-confirmed early Lyme disease at presentation and at 11-20 years after diagnosis

Detection of Borrelia burgdorferi nucleic acids after antibiotic therapy does not confirm viability

Evaluation of Modified 2-tiered Serodiagnostic Testing Algorithms for Early Lyme Disease

Metabolic differentiation of early Lyme disease from southern tick associated rash illness (STARI)

High volume of Lyme disease laboratory reporting in a low-incidence State- Arkansas, 2015-2016

Seroreactivity to the C6 peptide in Borrelia miyamotoi infections occurring in the Northeastern United States

Diagnosis of Lyme Disease

Evaluation of Modified Two-Tiered Algorithms for Lyme Disease Laboratory Diagnosis Using Well-Characterized Serum Samples

Limitation and Confusing Aspects of Diagnostic Testing for Neurologic Lyme Disease in the United States.

Is it Possible to Make a Correct Diagnosis of Lyme Disease on Symptoms Alone? Review of Key Issues and Public Health Implications

FDA clears new indications for existing Lyme disease tests that may help streamline diagnosis

Misdiagnosis of Lyme Disease with Unnecessary Antimicrobial Treatment Characterizes Patients Referred to an Academic Infectious Diseases Clinic

Evaluation of the modified two-tiered testing (MTTT) method in children

The Lyme Disease Polymerase Chain Reaction Test Has Low Sensitivity


Updates and Recent Reports

Concerns Regarding a New Culture Method for Borrelia burgdorferi not Approved for the Diagnosis of Lyme Disease

A Critical Assessment of the New Culture Test for the Diagnosis of Lyme Disease

Several U.S. Senators Request Expedited Release of Draft Guidelines by the FDA on Regulation of Laboratory Developed Tests (LDTs)

Announcements from the FDA and CDC on the Diagnosis of Lyme Disease

FDA-approved Diagnostic Tests

Updated CDC Recommendation for the Serologic Diagnosis of Lyme Disease

Treatment Guidelines

Recommended courses and duration of treatment for both early and late Lyme symptoms are shown in our Table of Recommended Antibiotics and Dosages (see also table footnotes).

Early treatment of LD (within the first few weeks after initial infection) is straightforward and almost always results in a full cure. Treatment begun after the first three weeks will also likely provide a cure, but the cure rate decreases the longer treatment is delayed.

Doxycycline, amoxicillin and ceftin are the three oral antibiotics most highly recommended for treatment of all but a few symptoms of LD. A recent study of Lyme arthritis in the New England Journal of Medicine indicates that a four-week course of oral doxycycline is just as effective in treating late LD, and much less expensive, than a similar course of intravenous Ceftriaxone (Rocephin) unless neurological or severe cardiac abnormalities are present. If these symptoms are present, the study recommends immediate intravenous (IV) treatment.

Treatment of late-Lyme patients can be more complicated. Usually LD in its later stages can be treated effectively, but individual variation in the rate of disease progression and response to treatment may, in some cases, render standard antibiotic treatment regimens ineffective. In a small percentage of late-Lyme patients, the disease may persist for many months or even years. These patients will experience slow improvement and resolution of their persisting symptoms following oral or IV treatment that eliminated the infection.

Although treatment approaches for patients with late-stage LD have become a matter of considerable debate, many physicians and the Infectious Disease Society of America recognize that, in some cases, several courses of either oral or IV (depending on the symptoms presented) antibiotic treatment may be indicated. However, long-term IV treatment courses (longer than the recommended 4-6 weeks) are not usually advised due to adverse side effects. While there is some speculation that long-term courses may be more effective than the recommended 4-6 weeks, there is currently no scientific evidence to support this assertion. Click here for an article from the New England Journal of Medicine which presents clinical recommendations in the treatment and prevention of early Lyme disease.

More Information on Treatment Guidelines

The Clinical Assessment, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis: Clinical Practice Guidelines

Practice Parameter: Treatment of Nervous System Lyme Disease (an Evidence-based review) : Report of the Quality Standards Subcommittee of the American Academy of Neurology

The Laboratory Diagnosis of Lyme Borreliosis: Guidelines from the Canadian Public Health Laboratory Network

Recommendations for Diagnosis and Treatment of Lyme Borreliosis: Guidelines and Consensus from Specialist Societies and Expert Groups in Europe and North America

EFNS Guidelines on the Diagnosis and Management of European Lyme Neuroborreliosis

Infectious Diseases Society of America’s Recommendations on the Treatment of Lyme Disease Unanimously Approved by an Independent Review Panel

Endorsement of IDSA Guidelines on Lyme Disease by the Association of Medical Microbiology and Infectious Disease (AMMI), Canada –Link it to this page and have it open in another window

Diagnosis, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis: a Review (2016)

Update of the Swiss guidelines on post-treatment Lyme disease syndrome

Why does the CDC only link to one set of treatment guidelines?

Cutaneous Lyme Borreliosis: Guideline for the German Dermatological Society

Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis, and Treatment of Lyme Disease

Dangers of Long-Term Antibiotic Treatment for Lyme Disease.

Death From Inappropriate Therapy for Lyme Disease

Death Due to Community-associated Clostridium difficile in a Woman Receiving Prolonged Antibiotic Therapy for Lyme Disease

A case of Mycobacterium goodie infection related to an indwelling catheter placed for the treatment of chronic symptoms attributed to Lyme disease

Serious Bacterial Infections Acquired During Treatment of Patients Given a Diagnosis of Lyme Disease – United States.

Adverse Events Associated with Antibiotics and Intravenous Therapies for Post-Lyme Disease Syndrome in a Commercially Insured Sample

Neoplasms Misdiagnosed as “Chronic Lyme Disease”

Ceftriaxone-Induced Immune Hemolytic Anemia as a Life-Threatening Complication of Antibiotic Treatment of “Chronic Lyme Disease”.

Biliary Complications in the Treatment of Unsubstantiated Lyme Disease

Ceftriaxone-Associated Biliary Complications of Treatment of Suspected Disseminated Lyme Disease- New Jersey, 1990-1992

Adverse Events Associated with Antibiotics and Intravenous Therapies for Post-Lyme Disease Syndrome in a Commercially Insured Sample

Life Threatening Complications of Empiric Ceftriaxone Therapy for “Sero-Negative Lyme Disease”

Current Clinical Studies

Current Clinical Studies on Lyme Disease Sponsored by the National Institutes of Health

Neurological Complications of Lyme Disease

Chronic Pain

Cognitive impairments in patients with persistent symptoms attributed to Lyme disease.

Prospective Evaluation of the Frequency and Severity of Symptoms in Lyme Disease Patients with Erythema Migrans Compared with Matched Controls at Baseline, 6 Months and 12 Months

Pediatric Lyme Disease Biobank, United States, 2015-2020

NIAID Clinical Trials

Two Controlled Trials of Antibiotic Treatment in Patients with Persistent Symptoms and a History of Lyme Disease ( The above clinical trials were conducted under the following protocols that were approved by the NIAID Clinical Studies Group, the Institutional Review Board, the NIAID Biostatistics Group, and the Food and Drug Administration (FDA) before the trails were conducted. To ensure complete compliance with the protocols, all procedures associated with the trials were carefully monitored by an independent Data Safety and Monitoring Board (DSMB) that included several distinguished biostatisticians. Note that the protocols stipulated that an interim statistical analysis be performed when 100 subjects have been enrolled.)

Clinical Protocol for the Seropositive Arm of the Trial

Clinical Protocol for the Seronegative Arm of the Trail

Research and Clinical Studies

Lyme neuroborreliosis in Children: a Prospective Study of Clinical Features, Prognosis , and Outcome

Lyme borreliosis: a European Perspective on Diagnosis and Clinical Management

Antibiotic Treatment of Animals Infected with Borrelia burgdorferi

Lyme Disease: Current State of Knowledge

Lyme Disease in Pregnancy: Case Report and Review of the Literature

Lyme Disease Serology in Amylotrophic lateral sclerosis (ALS

Editor’s Note: Since ceftriaxone has been reported to have profound neuroprotective effects (Nature 433: 73-77, 2005) and is often used to treat Lyme disease with neurological complications, clinical studies are now in progress to assess its efficacy in the treatment of ALS.

Antibiotic Treatment Duration and Long-term Outcomes of Patients with Early Lyme Disease from a Lyme Disease –Hyperendemic Area

Efficacy of Antibiotic Prophylaxis for the Prevention of Lyme Disease: an Updated systemic Review and Meta-Analysis

Neurological Manifestations of Lyme Disease

A Case Revealing the Natural History of Untreated Lyme Disease ( Although the data are not shown in the publication, the author confirms that the IgG Western blot was positive by the CDC criteria and showed the presence of 21,28,30,39,41,45,58,66, and 93 kDa bands. )

Long-term Lyme Disease Antibiotic Therapy Beliefs Among New England Residents

On-going and Completed NIH-supported Clinical Trials on Lyme Disease

Musculoskeletal Features of Lyme Disease: Understanding the Pathogenesis of Clinical Findings Helps Make Appropriate Therapeutic Choices

Biodiversity of Borrelia burgdorferi Strains in Tissues of Lyme Disease Patients

Lyme Borreliosis

The Amber Theory of Lyme Arthritis: Initial Description and Clinical

The Nervous System as Ectopic Germinal Center: CXCL13 and IgG in Lyme Neuroborreliosis

A Critical Analysis of Treatment Trials of Rhesus macaques Infected with Borrelia burgdorferi Reveals Important Flaws in Experimental Design

Spirochete Antigens Persist Near Cartilage after Murine Borreliosis

A Novel Human Autoantigen, Endothelial Growth Factor, is a Target of T and B Cell Responses in Patients with Lyme Disease

Lyme Disease-Human Granulocytic Anaplasmosis Co-Infection-Impact of Case Definition on Co-Infected Rates and Illness

Differentiation of Reinfection from Relapse in Recurrent Lyme Disease

Detection of Borrelia burgdorferi Nucleic Acids after Antibiotic Treatment does not Confirm Viability

Reductions in Human Lyme Disease Risk Due to the Effects of Oral Vaccination on Tick-to-Mouse and Mouse-to-Tick Transmission

Common Misconceptions about Lyme Disease

Nervous System Lyme Disease: Diagnosis and Treatment

Borrelia burgdorferi BbHtrA Degrades Host ECM Proteins and Stimulates Release of Inflammatory Cytokines in Vitro

Non-viable Borrelia burgdorferi Induce Inflammatory Mediators and Apoptosis in Human Oligodendrocytes

A Systematic Review of Borrelia burgdorferi Morphologic Variants does not Support a Role in Chronic Lyme Disease

Evidence for Strain-specific Immunity in Patients Treated for Early Lyme Disease

Functional Outcomes in Patients with Borrelia burgdorferi Reinfection

Xenodiagnsosis to Detect Borrelia burgdorferi Infection: a First-in-human Study —

The Role of Eocosanoids in Experimental Lyme Arthritis

Oral Doxycycline for Lyme Neuroborreliosis with Symptoms of Encephalitis,, myelitis, Vasculitis, or Intracranial Hypertension

Natural Killer Cell Counts are not Different Between Patients with Post-Lyme Disease Syndrome and Controls

Implications of Gender in Chronic Lyme Disease

Ceftriaxone-induced Hemolysis in a Child with Lyme Arthritis: a case for Antimicrobial Stewardship

Sympathetic Neural Hyperalgesia Edema Syndrome, a Frequent Cause of Pelvic Pain in Women, Mistaken for Lyme Disease with Chronic Fatigue

A Systematic Review of Borrelia burgdorferi Morphologic Variants does not Support a Role in Chronic Lyme Disease

Views and Facts About Chronic Lyme Disease from the National Institute of Allergy and Infectious Diseases (NIAID)

Immune hemolytic anemia as a life-threatening complication of extended antibiotic therapy for “chronic Lyme disease’

Insights into Borrelia miyamotoi infection

Fatigue in patients with erythema migrans


Clinical Relevance of Borrelia burgdorferi persisters

Clinical Association: Lyme Disease and Guillian-Barre Syndrome

Borrelia Infection and Risk of Celiac Disease

Oral management for pediatric Lyme meningitis

Borrelia miyamotoi : an emerging tick-borne pathogen

Internet-based self-diagnosis of Lyme disease caused death of a young woman with systemic lupus erythematosus

Depressive Symptoms in Patients Referred to a Tertiary Lyme Center: High Prevalence in those Without Evidence of Lyme Disease

Lyme Borreliosis and Depressive Symptoms in Patients Aged 65 Years and Older Referred to a Tertiary Lyme Center

Effect of prolonged antibiotic treatment on cognition in patients with Lyme borreliosis.

Evaluation of the clinical relevance of vancomycin for the treatment of Lyme disease.

Global Transcriptome Analysis Identifies a Diagnostic Signature for Early Disseminated Lyme Disease and its Resolution

How to Evaluate the Claims About Cures and Treatments for Long-term, Chronic Conditions

“I Don’t Know What to Believe…”

Studies on Chronic Lyme Disease Syndromes

Post-Treatment Lyme Disease Syndrome

Chronic Lyme Disease: in Defense of the Scientific Enterprise

Chronic Lyme Disease: a Dubious Diagnosis

Chronic Lyme disease: misconceptions and challenges for patient management

Chronic Lyme Disease and other Medically Unexplained Syndromes

A Critical Appraisal of Chronic Lyme Disease

Dispelling the Chronic Lyme Disease Myth

Perspectives on Chronic Lyme Disease

Psychiatric Co-morbidity and Other Psychological Factors in Patients with “Chronic Lyme Disease”

Subjective Symptoms after Treatment of Early Lyme Disease

Anti-neural Antibody Reactivity in Patients with a History of Lyme Borreliosis

Chronic Lyme Disease: the Controversies and the Science

The Pain of Chronic Lyme Disease: Moving the Discourse in a different Direction

Chronic Lyme Disease

Chronic Lyme: Diagnostic and Therapeutic Challenges

Neoplasms Misdiagnosed a “chronic Lyme Disease”

Long-term Assessment of Fibromyalgia in Patients with Culture-confirmed Lyme Disease

Long-term Assessment of Fatigue in Patients with Culture-confirmed Lyme Disease

Long-term Assessment of Post-Treatment Symptoms in Patients with Culture-Confirmed Early Lyme Disease.

Quality of life, fatigue, depression, and cognitive impairment in Lyme neuroborreliosis

Long-term assessment of health-related quality of life in patients with culture-confirmed early Lyme disease.

Nervous system Lyme disease, chronic Lyme disease, and none of the above

NIH takes action to bolster research on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Causes of neuropathy in patients referred a “idiopathic neuropathy”.

No geographic correlation between Lyme disease and death due to 4 neurodegenerative disorders, United States, 2001-2010

Association of immune response to endothelial cell growth factor with early disseminated and late manifestations of Lyme disease, but not post-treatment Lyme disease syndrome

Can human B cell responses to Borrelia burgdorferi VlsE protein be used as a biological marker for distinguishing early to late stages of Lyme disease?

Longitudinal transcriptome analysis reveals a sustained differential gene expression signature in patients treated for acute Lyme disease

Comorbid conditions can influence the overall quality of life of patients with post-treatment Lyme disease symptoms.

Claims-based diagnostic patterns of patients evaluated for Lyme disease and given extended antibiotic therapy

Adverse events associated with antibiotics and intravenous therapies for post-Lyme disease syndrome in a commercially insured sample

Borrelia burgdorferi peptidoglycan is a persistent antigen in patients with Lyme arthritis

Posttreatment Lyme disease syndromes: distinct pathogenesis caused by maladaptive host response

A Distinctive Microbiome Signature in Post-treatment Lyme Disease Syndromes

A Distinct Microbiome Signature in Posttreatment Lyme Disease Patients

News Articles and Commentaries

Doctors and Others Indicted in Lyme Disease Case Ticks Aren’t the Only Parasites Living Off Patients in Borreliosis-prone Areas

Lyme Disease in pregnancy: case report and review of the literature

Four Patients Falsely Diagnosed with Lyme Disease win Verdicts Totaling $30 Million

Unorthodox Alternative Therapies Marketed to Treat Lyme Disease

New Insights into the Tyrolean Iceman’s Origin and Phenotype as Inferred by Whole-Genome Sequencing

Confronting the Misnomer of Chronic Lyme Disease.

Serious Bacterial Infections Acquired During Treatment of Patients Given a Diagnosis of Chronic Lyme Disease – United States.

More Political Science: Proposed laws protect “Lyme literate” doctors from discipline

Peer-Reviewed Scientific Publications

Misconceptions About Lyme Disease: Confusion Hiding Behind Ill-chosen Terminology

Practice Parameter: Treatment of Nervous System Lyme Disease (an Evidence-Based Review

Bullying Borrelia: When the Culture of Science is Under Attack

Clinical Trials on the Efficacy of Extended Antibiotic Therapy

Two Controlled Trials of Antibiotic Treatment in Patients with Persistent Symptoms
and a History of Lyme Disease
( The above clinical trials were conducted under the following protocols that were approved by the NIAID Clinical Studies Group, the Institutional Review Board, the NIAID Biostatistics Group, and the Food and Drug Administration (FDA) before the trails were conducted. To ensure complete compliance with the protocols, all procedures associated with the trials were carefully monitored by an independent Data Safety and Monitoring Board (DSMB) that included several distinguished biostatisticians. Note that the protocols stipulated that an interim statistical analysis be performed when 100 subjects have been enrolled.)

Clinical Protocol for the Seropositive Arm of the Trial

Clinical Protocol for the Seronegative Arm of the Trail

Study and Treatment of Post Lyme Disease (STOP-LD) : a Randomized Double Masked Clinical

Cognitive Function in Post-treatment Lyme Disease: Do Additional Antibiotics Help?

NA Randomized, Placebo-controlled Trial of repeated IV Antibiotic Therapy for Lyme Encephalopathy

Treatment Trials for Post-Lyme Disease Symptoms Revisited

Randomized trial of longer-term therapy for symptoms attributed to Lyme disease

Time for a different approach to Lyme disease and long-term symptoms
(For additional perspective on this important issue, see “The Pain of Chronic Lyme Disease: Moving the Discourse in a Different Direction“)

Lyme Disease and Co-Infections

Chronic Co-infections in Patients with Chronic Lyme Disease: A Systematic Review

There is no Published Evidence Supporting the Diagnosis of Chronic Lyme Disease, Atypical Tick-borne Co-infections in Patients Diagnosed with Chronic Lyme Disease

The Results of European Studies Show That Patients with Early Lyme Disease are Rarely Co-infected with Other Tick-transmitted Agents

Co-infections in Persons with Early Lyme Disease, New York, USA

Microbiome analysis of Ixodes scapularis ticks from New York and Connecticut


CDC Webinar on Vaccines for Lyme Disease, 2015

Vaccines against Lyme disease: what happened and what lessons can we learn?

Live-vaccinia virus encapsulation in pH-sensitive polymer increases safety of a reservoir-targeted Lyme disease vaccine by targeting gastrointestinal release

Pre-exposure prophylaxis with OspA-specific human monoclonal antibodies protects mice against tick transmission of Lyme disease spirochetes

It’s past time for a Lyme disease vaccine

Can a New Lyme Disease Vaccine Overcome a History of Distrust and Failure?

Field evaluation of a novel oral-reservoir-targeted vaccine against Borrelia burgdorferi utilizing an inactivated whole-cell bacterial antigen expression vehicle


Popular Antibiotics May Carry Serious Side Effects

Types of Antibiotics, How They Work, and Their Side Effects

Tetracyclines, including Doxycycline the Drug of Choice in Treating Lyme Disease, are also Pain Relievers and have Anti-Inflammatory Properties

Beta-lactam Antibiotics Offer Neuroprotection by Increasing Glutamate Transporter Expression

Evaluation of the clinical relevance of vancomycin for the treatment of Lyme disease

Commentaries and Reviews on Lyme Disease

Lyme Disease: the Great Controversy

Autism-Lyme Correlation Debunked

Nervous System Lyme Disease: Diagnosis and Treatment.

An Open Letter to the Editors of the Poughkeepsie Journal: In Defense of the Scientific Enterprise

Neoplasms Misdiagnosed as “Chronic Lyme Disease”

Political Science: Chronic Lyme Disease

Chronic Coinfections in Patients with Chronic Lyme Disease: a Systematic Review

Ending the Lyme Disease Wars

Chronic Lyme Disease: In Defense of the Scientific Enterprise

The Pain of Chronic Lyme Disease: Moving the Discourse in a Different Direction

What Do Experts Recommend about the Treatment of Lyme Disease?

Borrelia burgdorferi vs Treponema pallidum- what’s in a name?

Understanding Chronic Pain

False and Misleading Information about Lyme Disease

Lyme Disease (a 2017 review article)

Critical analysis of a doxycycline treatment trial of rhesus macaques infected with Borrelia burgdorferi

Discovery of the Lyme Disease Agent

A neurologist’s view of Lyme disease and other tick-borne infections

Challenges in the Diagnosis and Treatment of Lyme Disease

Borrelia burgdorferi vs Treponema pallidum – what’s in a name?

There is no published evidence supporting the diagnosis of chronic, atypical tick-borne co-infections in patients diagnosed with chronic Lyme disease.

The results of European studies show that patients with early Lyme disease are rarely co-infected with other tick-transmitted agents.

Understanding Chronic Pain

Vaccines against Lyme disease: what happened and what lessons can we learn?

Jarisch-Herxheimer and Lyme Disease

There are 350 unrelated medical conditions with symptoms associated with those of Lyme disease.

Lyme Disease in Humans

Immune Response to Borrelia: Lessons from Lyme Disease Spirochetes

Lyme Disease Pathogenesis

Human and Veterinary Vaccines for Lyme Disease

Immune Response to Borrelia: Lessons from Lyme Disease Spirochetes

Host Transcriptome Response to Borrelia burgdorferi sensu lato


From the Desk of the Executive Director


Misinformation on Lyme Disease


Quiz on Lyme Disease

Test your general knowledge of Lyme disease

Frequently Asked Questions About Lyme Disease


Lyme Disease Stories

Stories from the CDC website

Woman’s Death Connected to Inter-Net Self-Diagnosis of Lyme Disease

The Ultimate Lyme test: Julia’s Story

Are ALL Lyme Disease Fundraisers Scams?

Ginger Savely: Admits Unprofessional Conduct

ILADS Jennifer Armstrong- Admits Professional Misconduct

More Victims of Lyme Quackery- Updated January 25, 2019

Chronic Lyme” VIP, Daniel Cameron, disciplined by New York medical authorities

Legal Actions Brought Against Several Lyme Literate Physicians or LLMDs

Lyme Science: Because Patients Deserve Better

My Son Got Lyme Disease. He’s Totally Fine

Maybe It’s Lyme

The Challenge of Diagnosing Lyme Disease

More victims of Lyme quackery

Dubious Alternative Lyme Treatments are Killing Patients

Serious Bacterial Infections Acquired During Treatment of Patients Given a Diagnosis of Chronic Lyme Disease- United States


Unorthodox Treatments Being Promoted to Treat Lyme Disease

Readers should note that there is no published, peer-reviewed evidence to indicate that any of the treatments presented in this incomplete listing is beneficial for the treatment of Lyme disease and/or “chronic Lyme disease”. In fact, some of them may even be unsafe when used a prescribed. Consequently, the reader is urged to demand to see documented evidence of their benefit before even considering their use. This listing in no way implies endorsement by the American Lyme Disease Foundation.

Ozone Therapy

Ultraviolet Blood Irradiation Therapy

Cold Laser Therapy

Rife Machines

Sauna detox Therapy

Heavy Metal Chelation

Colloidal Silver Therapy

Neurotoxin Elimination

Natural Remedies for the Treatment of Lyme Disease

Coffee Enemas

Informative Videos and Websites About Lyme Disease

How Should Clinician Manage Patients with Chronic Lyme Disease?”

Chronic Lyme Disease Video

Tufts University Lyme Disease Initiative

Centers for Disease Prevention and Control (CDC): Lyme Disease

National Institute of Allergy and Infectious Diseases (NIAID): Lyme Disease