Lymes disease can lead to a neurological disorder

Lyme disease: first signs & symptoms

First signs

After successful transmission, the Borrelia first multiply locally in the skin in the area of ​​the tick bite and then spread to the surrounding skin. From there, it can spread through the bloodstream in the body and into various organs. Without therapy, Borrelia can survive for months, sometimes even for years, despite the immune response of the infected (host) and cause diseases at every stage or even die spontaneously. Even borreliosis that has been through and healed spontaneously or after therapy does not leave any lasting immunity.

In Europe, Lyme disease begins with the development of erythema migrans in around 40% of cases (in the USA in around 70-80%). Erythema is a general term that simply describes reddening of the skin. It is caused by the inflammatory reaction of the body with increased blood flow to the skin as a result of the local multiplication of Borrelia. Erythema migrans (Latin: migrare = to wander) is also called "wandering redness". The reddening is initially at the puncture site and manifests itself after 3 to 30 days, but usually not before a week after transmission It usually reaches a diameter of several centimeters and can occasionally be over 20 centimeters in size. Often the reddening fades in the course in the middle and therefore appears ring-shaped. It can also appear in several parts of the body. The erythema migrans is of one distinguish local reddening of the skin as a direct result of the tick bite, which is generally limited to the puncture site, does not extend to several centimeters and does not fade in the center.


The multifaceted Lyme disease can be described as a multi-system disease. Depending on the nature of the first appearance of symptoms, the time from infection to disease (incubation period) varies greatly: days to weeks for the early manifestations, months to years for the late manifestations. The previously common staging (stages I-III) is increasingly perceived as too artificial, since the disease often does not go through the sequence of these stages, but each disease manifestation can occur in isolation, but can also occur in different combinations. Spontaneous healing is also possible in all stages.

Early manifestations

Stage I.

In Europe, more than half of the infections are asymptomatic, i.e. without the occurrence of erythema migrans as a typical early manifestation of stage I (see above). Some of the patients - with or without erythema migrans - experience general symptoms such as fatigue, slight fever, muscle and joint pain, headache, sweating, conjunctivitis, gastrointestinal complaints and swelling of the lymph nodes in the first few weeks after infection. These complaints can be pronounced, but they can also be very weak and are caused by the spread of Borrelia in the body. Occasionally, multiple erythema migrans occur as a result of Borrelia spreading into the skin via the bloodstream.

Stage II

The early organ manifestations can occur a few weeks to months after the infection even without a noticeable tick bite and without previous erythema migrans or acute general symptoms. This stage is characterized by an involvement of the nervous system (early neuroborreliosis). Inflammation of the heart (myocarditis) or muscles (myositis) and inflammation of the optic nerves rarely occur.
In early neuroborreliosis, inflammation typically occurs in the area of ​​the nerve roots of the spinal cord (radiculitis), characterized by excruciating, burning pain, which increases especially at night and which is in some cases locally related to the tick bite or the previous erythema migrans. At the same time, asymmetrical and unsystematically distributed flaccid paralysis are often observed. In addition, there are sensitive failures (sensory disturbances). The neurological deficits often also affect cranial nerves, predominantly as unilateral or bilateral facial paralysis (facial paralysis). Acute meningitis or isolated facial palsy is also often observed in children. Meningitis and meningitis are rather rare in adults in Europe.

Heart muscle inflammation is a relatively rare manifestation in Europe (more common in the USA), which is often associated with cardiac arrhythmias due to disturbances in the conduction of stimuli. In addition to palpitations and palpitations, this can also lead to a slowdown in the heartbeat, which in pronounced cases can make the temporary use of a pacemaker necessary.

Borrelia lymphocytoma is an early skin manifestation which, however, occurs much less often than erythema migrans.These are small blue-red skin nodules that are mainly found in the area of ​​the nipples, in the genital area, on the ear lobes and nostrils and especially in children and adolescents as well as occur in women.

Late stages

The late stages (from stage III) only manifest themselves after months to years and mainly affect the joints. Lyme arthritis is an intermittent or chronic inflammation of one or more joints. The large joints are particularly affected, especially the knee joints and, with decreasing frequency, ankle, elbow, finger, toe and wrist joints as well as temporomandibular joints. The pain and swelling often subside after a few weeks, but can recur and jump from joint to joint. Such complaints are still too rarely recognized as Lyme disease.

A less common manifestation is acrodermatitis, a chronic inflammation of the skin that occurs mainly in older women. The extensor sides of the legs and arms as well as fingers and toes are particularly affected. At first, the skin is red and swollen. If left untreated, skin atrophy (thin as a cigarette paper) develops with a bluish-gray or bluish-purple (livid) discoloration and pronounced vein markings. In the further course, joint involvement and nerve damage can occur.

Another, but very rare, late manifestation is chronic neuroborreliosis with a chronic progressive inflammation of the brain (encephalitis) and the spinal cord (myelitis) (so-called encephalomyelitis), which can cause symptoms similar to multiple sclerosis. Chronic inflammation of the spinal cord (myelopathy) can manifest itself with spastic-atactic gait disorders, bladder paralysis, sensory disorders distributed across the board, as well as central and peripheral paralysis symptoms (paresis), chronic inflammation of the brain (encephalitis) with speech and speech disorders, hearing impairment and coordination disorders. Rare manifestations are epilepsy, organic psychosyndrome (poor concentration, impaired consciousness, hallucinations) and vascular inflammation in the brain (cerebral vasculitis, sometimes with thalamic or brainstem infarction).