Lyme disease - symptoms, treatment and course

Lyme disease: tick-borne infectious disease

Ticks - although rare - can transmit the bacterial pathogens of Lyme disease to humans. If such an infection occurs, the typical Lyme disease symptoms of the complex clinical picture do not always occur, such as blushing or later muscle and joint complaints as well as neurological disorders. A disease can go unnoticed for a long time or even completely. If the diagnosis is reliable or if there is a reasonable suspicion, antibiotic therapy is absolutely advisable. The best prevention is adequate protection against tick bites.

Brief overview of Lyme disease

  • What is Lyme Disease? Most common tick-borne infectious disease due to bacteria (borrelia).
  • Lyme disease symptoms: First signs of reddening of the skin (flushing) and flu-like symptoms, later muscle and joint complaints and neurological disorders (neuroborreliosis).
  • Course of the disease: Very different incubation times, characteristics and symptom combinations up to asymptomatic courses.
  • Cause of infection: Sting of a tick infected with Borrelia bacteria.
  • diagnosis: Clinical signs, supported by Lyme disease tests, do not always allow a reliable diagnosis.
  • treatment: Antibiotic therapy to combat pathogens required as early as possible; however not prophylactic.
  • Naturopathy and holistic medicine: Supportive procedures, especially for strengthening the body's defenses and healing powers.

Definition: What is Lyme Disease?

Lyme disease is a collective term for bacterial infectious diseases caused by Borrelia (bacteria of the genus Borrelia) are caused. Its name comes from the French bacteriologist Amédée Borrel (1867-1936).

The vast majority of cases of Lyme disease in Europe and Germany are so-called Lyme disease. Therefore, the terms Lyme disease and Lyme disease (Lyme disease) are also used synonymously. The disease is named after the place Lyme (Connecticut, USA), where, for the first time, joint inflammation after tick bites was noticeably observed. Relapse fever (louse relapse fever and tick relapse fever) is one of the rarer borreliosis in humans.

Lyme disease symptoms

Lyme disease is not a typical course of the disease. Rather, a wide variety of diseases can occur in different organs and organ systems. A reliable diagnosis due to the wide range of symptoms is therefore often difficult even with sufficient specialist expertise.

With most infections there are actually no symptoms and there is no manifestation of the disease. However, if there is a disease, it can be divided into three stages. The first two stages belong to the acute phase, while the last stage describes chronic symptoms. However, it is not always the case that all stages are recognizable. The skin and then the nerves, joints and heart are most often affected.

Early stage 1 (localized)

Often - but not always - there is a reddish skin discoloration (erythema migrans) around the injection site three days after the tick bite or even later. The rash then typically spreads out in a ring, while the area immediately around the stitch fades. This so-called wandering blush can also have other appearances (color, shape) and show early as multiple oval redness of different sizes (multiple Erythemata migrantia) on other parts of the body, which indicates a rapid spread of the pathogen. If this is the case, flu-like symptoms can also occur. These include:

  • Fever,
  • Muscle and joint pain,
  • Lymph node swelling,
  • A headache,
  • Conjunctivitis,
  • Exhaustion.

In the transition to the second stage, a so-called borrelia lymphocytoma can also develop, preferably in children. These swellings or nodules (pseudolymphomas) are particularly evident on the earlobes, in the genital area and on the nipples.

Early stage 2 (disseminated)

The second stage begins after weeks or months. While the pathogens and the erythema spread further and several Borrelia lymphocytomas (in children) can occur, the first neurological disorders and other symptoms are also possible.

Most neurological symptoms can be classified as early neuroborreliosis. This is characterized by spinal cord diseases (painful meningoradiculitis of individual spinal nerves). The pain of nerve inflammation also radiates to other, peripheral areas and often occurs with facial paralysis (facial palsy). In children, facial nerve paralysis is usually one-sided and isolated, and it is less common for meningitis to develop.

Other organs can also be affected. Among other things, this can lead to Lyme carditis (inflammation of the heart) and, as a result, cardiac arrhythmias. Furthermore, the so-called Lyme arthritis is one of the early symptoms, which can also occur chronically in batches or later (in stage 3). Most often the knee joints (less often other large joints) are affected.

Late stage 3 (chronic)

Half a year to several years after the tick bite, other symptoms may still appear or the symptoms from the first stages may appear different. Acrodermatitis chronica atrophicans is a possible chronic skin disease. The first swellings on the arms and legs are usually followed by a loss of connective and fatty tissue as well as body hair. As the process progresses, nodes can form near joints. In most cases, peripheral neuropathy (polyneuropathy) also occurs in the affected skin areas, which leads to sensations.

Late neuroborreliosis occurs very rarely and even if only very gradually over a long period (chronic neuroborreliosis). Typically, an inflammatory disease of the central nervous system (encephalomyelitis) with paralysis, a spastic gait, disorders of the bladder function and other diverse side effects then appears.

Incubation period

The incubation period is very variable and can only be specified in larger time intervals. The time to first appearance of erythema migrans is three to thirty days. Early neuroborreliosis appears on average slightly later. Late and chronic symptoms can develop months and years later.

Cause of infection

The bacterium responsible for Lyme disease is Borrelia burgdorferi (discoverer: Dr. Willy Burgdorfer) or different types of bacteria in the Borrelia burgdorferi sensu lato complex.

These bacteria are primarily transmitted by a tick bite; infection from person to person is not possible. In contrast to early summer meningoencephalitis (TBE), the second most common tick-borne infectious disease after Lyme disease, there is no way to get a vaccine.

The transmission takes place primarily via the most common tick species, the tick tick (Ixodes ricinus, common wooden trestle). According to the Robert Koch Institute, the occurrence of borrelia in ticks is subject to strong spatial fluctuations and a tick must have sucked for at least several hours so that the bacteria can be transmitted. But not every transmission leads to an illness. Manifest Lyme disease is only expected in less than 1.5 percent of tick-pricked people. Not only humans, but all mammals can contract the pathogen.

The two most common infectious diseases transmitted by a tick bite, Lyme disease and TBE, differ in many ways and it is therefore important to tell them apart:

Lyme diseaseTBE
PathogenBacteria in the intestine of the tickVirus (flavivirus) in the tick's saliva
transmissiononly after a few hours of sucking bloodFast transfer after the puncture
incubation periodFirst signs 3-30 days, later stages even after months or years5-28 days, rarely up to a month
Possible symptomsSkin reddening (flushing), flu-like symptoms, muscle and joint pain, neurological disordersFlu-like symptoms, neurological disorders
treatmentAntibiotic therapy to combat pathogensOnly symptomatic treatment possible
prophylaxisGeneral measures to avoid tick bitesVaccination, general measures to avoid tick bites
courseDifferent acute and chronic phases, illness can also go unnoticedTypically, the first signs are followed by a symptom-free interval (1 week), later nervous system disease
OccurrenceThroughout GermanyEspecially in TBE risk areas
Infection rateapprox. 10-35%approx. 0.1-5%


Primarily, it is a suspected diagnosis of Lyme disease based on existing symptoms. Certain Lyme disease tests can support this suspicion in some cases, but a reliable diagnosis is not always made.

Clinical signs

The blush may be the first sign of Lyme disease, but it is not compelling evidence of the disease. The same applies to other possible symptoms that occur in very different forms and combinations or that can also be absent for a long time. There are also atypical course of the disease, which makes it even more difficult to recognize Lyme disease.

In general, if symptoms occur - especially after a tick bite has been noticed - a medical examination is recommended, which should also rule out other possible causes for existing symptoms. This applies regardless of whether or not a stab has occurred, which is one of the most important questions when making a diagnosis.

Laboratory diagnostics: Lyme disease test

If there is a suspicion of Lyme disease, various laboratory analyzes can be consulted to further support the diagnosis in connection with the individual symptoms. But here, too, the results are not always clear.

Blood or nerve water samples (for neuroborreliosis) are usually tested for Borrelia antibodies. However, these tests are often difficult to interpret because, for example, the corresponding antibodies may still be missing in the early phase or may not even be formed by those affected. In these cases, “false” negative results can occur.

But a positive test result does not always mean that there is also Lyme disease at the time of the analysis. An infection can also be years ago and already healed or it can be fought so well by the body's own defenses that there is no manifestation of the disease at all.

Furthermore, there are also other special test procedures that are not part of the standard procedure due to certain disadvantages or lack of validation and do not always lead to a more reliable result. This also includes the dark field diagnostics often used in naturopathy and complementary medicine, in which an optical microscope is used to examine whether Borrelia can be detected directly in samples taken (e.g. blood).


In the early stage of Lyme disease, the disease can be treated well with antibiotic therapy and completely cured. Doxycycline, amoxicillin or other antibiotics are usually administered orally. It is taken over a period of ten days to one month. Therapy that is only started at later stages or with late manifestations is generally less successful and more permanent symptoms can occur.

Prophylactic antibiotics after a tick bite are generally discouraged.

Naturopathy and holistic medicine for Lyme disease

In contrast to the infectious disease TBE, Lyme disease is not fundamentally prohibited from treatment for alternative practitioners. According to the Infection Protection Act (IfsG), Lyme disease is not subject to a nationwide reporting obligation, but the Robert Koch Institute points out additional state reporting requirements in some federal states.

If you take a holistic view of those affected, in addition to conventional antibiotic therapy against the pathogens, additional support for natural body defense functions can help with healing. Complementary treatment methods used in Lyme disease are primarily immunostimulating micronutrient therapies, classic homeopathy or nosode therapy.

In addition, herbal medicine (phytotherapy) - a classic method from naturopathy - offers opportunities to strengthen the sick and to promote the healing process.

After expert advice and diagnosis, all of these measures can help those affected in addition to antibiotic therapy, but do not guarantee an effective effect and cannot replace the antibiotics required in an emergency. (ay, cs)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dr. rer. nat. Corinna Schultheis


  • Robert Koch Institute (ed.): RKI advisor Lyme disease, status: April 2019, access: 03.09.2019, rki.de
  • Federal Center for Health Education (publisher): Pathogen profiles - Lyme disease, access: 03.09.2019, infektionsschutz.de
  • Professional Association of Pediatricians (ed.): Pediatricians online - Lyme disease (Lyme disease), access: 03.09.2019, kinderaerzte-im-netz.de
  • Siegmund-Schultze, Nicola: Infection after tick bite: Doubtful Lyme disease tests, in: Deutsches Ärzteblatt, Issue 104 (26) / 2007, aerzteblatt.de
  • Fingerle, Volker, Sing, Andreas and Hofmann, Heidelore: Lyme disease: pitfalls in diagnosis and therapy, in: Deutsches Ärzteblatt, Issue 112 (23) / 2015, aerzteblatt.de
  • German Society of Neurology (DGN): S3 guideline: Neuroborreliosis - guidelines for diagnostics and therapy in neurology. As of March 2018. AWMF register number: 030/071, awmf.org
  • German Dermatological Society (DDG): S2k guideline: Cutaneous Lyme disease. As of March 2016. AWMF register number: 013/044, awmf.org
  • Fust, Elfie: tick bites. Disease patterns and treatment options. Fundamentals and practice, 2nd edition, 2009
  • Bierbach, Elvira (ed.): Naturopathic practice today. Textbook and Atlas, 4th edition, Elsevier, 2009

ICD codes for this disease: A69.2ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.

Video: Ticks and Lyme Disease: What You Need to Know (January 2022).