Lyme borreliosis (disseminated and late infection)

Last Updated: 2023-07-07

Author(s): Anzengruber F., Navarini A.

ICD11: 1C1G.1Z

Disseminated and late infection of Lyme disease.

  • Mostly found in Europe and America.
  • Up to 30-40% of all ticks are infected with Borrelia. 
  • In Switzerland, approx. 10000 people contract Lyme disease per year.
  • In Germany, an incidence of 100-150 infections/100000/year is assumed.
  • Seasonally, infections occur from May-July.

  • Pathogen
    • Borrelia burgdorferi sensu lato (Europe).
    • Borrelia burgdorferi sensu stricto (North America).

3 stages

  • Stage I (localised early infection of the skin).
  • Stage II (disseminated early infection).
  • Stage III (late infection with organ manifestation).
  • Stage I:
    • Erythema chronicum migrans.
    • Ggl. pruritus.
    • Borrelia lymphocytoma.
    • Stage II:
      • Partially asymptomatic.
      • In some cases, flu-like symptoms begin only a few days after the onset of erythema chronicum migrans.
      • Locoregional lymph node adenopathy.
      • If applicable, reduced general condition, febrile temperatures, cephalgias.
      • Multiple erythema migrantia.
      • Unspecific exanthema.
      • Borrelia lymphocytoma.
      • Meningopolyneuritis Garin-Bujadoux-Bannwarth: cephalgias, possibly meningitis or encephalitis, unilateral radiculitis (painful paralyses) and cranial nerve palsies.
      • Arthralgias, myalgias, myo-/pericarditis.
      • Iritis, chrioretinitis.
      • Carditis.
    • Stage III
      • Acrodermatitis chronica atrophicans.
      • Acrodermatitis acuta.
      • Malignant B-cell lymphoma.
      • Peripheral neuropathy.
      • Subacute encephalopathy.
      • Chronic encephalomyelitis.
      • Recurrent chronic arthritis (arthritides are typical in patients from the USA).
      • Fibromyalgias.
      • Chronic pain syndrome.
      • Neurological symptoms are observed mainly in Europe.
      • Acrodermatitis chronica atrophicans (leading symptom). 
      • Nodular Panniculitis (rare).
      • Early summer meningoencephalitis in the context of a double infection (very rare).
      • Progressive encephalomyelitis.
      • CAVE: Stages can be skipped.
      • Post-infectious Lyme disease syndrome (post Lyme disease):
      • Persistent feeling of illness with myalgias and arthralgias after symptoms have subsided and adequate antibiotic therapy.


  • Anamnesis: Tick bite remembered? Erythema migrans remembered?
  • In about 60% of patients, circulating immune complexes can also be detected.
  • Borrelia serology (antibodies are not detectable from the beginning).
  • IgM: Detectable after 2 weeks in 50% of patients, after >4 weeks in 80%.
  • IgG: Detectable after 2-3 months.
  • Clinical>pathogen detection (serum, CSF, synovial fluid, tissue)
  • Blood culture.
  • If necessary, CSF puncture (CSF serum index).
  • If necessary. Detection of Borrelia in joint fluid.
  • If necessary, biopsy with pathogen detection.
  • Stage II: long-term ECG, neurological presentation.

Plasma cell-rich, perivascular infiltrates are typical.

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