LYME borreliosis guidelines map the full spectrum of clinical manifestations from erythema migrans to neuroborreliosis. Developed using European data, the recommendations describe how this tick-borne zoonosis evolves over time and across organ systems, highlighting features that should prompt early recognition and appropriate antibiotic treatment. The guideline authors summarize localized, early disseminated and late disseminated disease, focusing on skin, joint, neurologic, cardiac and ophthalmologic involvement.
Clinical Spectrum Of Lyme Borreliosis
Lyme borreliosis is caused by Borrelia burgdorferi sensu lato species and presents with diverse but stage related manifestations. Erythema migrans is the most frequent presentation and accounts for most cases in European cohorts. It typically appears three to thirty days after a tick bite as a painless, centrifugally expanding erythematous lesion centered on the bite site and resolves within around fifteen days under adequate antibiotic therapy. The guidelines reaffirm that clinical criteria alone are sufficient to diagnose erythema migrans, without waiting for serology, and position this early localized form as a key entry point for timely treatment that may prevent progression to disseminated disease.
Neurological And Articular Presentations
The guidelines describe neuroborreliosis as a disseminated form that occurs in a minority of Lyme borreliosis cases but carries significant morbidity if unrecognized. In this cohort, neurological involvement most often reflects meningoradiculitis or peripheral facial palsy, usually with favorable outcomes after antibiotic therapy, although some patients experience persistent post infectious symptoms. The authors emphasize that any new neurological manifestations appearing within one year of an untreated erythema migrans episode or a clearly documented tick bite should prompt consideration of Lyme neuroborreliosis. Painful radicular syndromes that disrupt sleep and remain resistant to usual analgesics are highlighted as a key red flag. For non febrile subacute arthritis of a large joint, in the absence of a convincing alternative diagnosis, clinicians are advised to consider Lyme borreliosis.
Implications For Diagnosis And Practice
Beyond common skin, neurologic and articular disease, the guidelines outline rarer cardiac and ophthalmologic complications, as well as atypical presentations that are not specifically linked to Lyme borreliosis yet may still coexist. Special populations such as pregnant and immunocompromised patients receive specific attention given their distinct risk profiles and management considerations. Overall, the section on clinical manifestations is designed to support rational diagnostic pathways and treatment choices by clearly aligning symptom patterns with disease stage and organ involvement. For U.S. based clinicians managing patients with relevant exposure histories, these clinically oriented signals can help refine pre test probability assessments, reduce diagnostic delay and guide timely initiation of appropriate antibiotic regimens.
Reference: Baux E et al. Guidelines for Lyme borreliosis: clinical manifestations. Infectious Diseases Now. 2025;55(8 Suppl):105202.
