Lyme Disease

Key takeaways

• Erythema migrans is an expanding rash that may not form a classic bull’s-eye and can be diagnosed without waiting for antibodies.
• Early antibody tests can be negative, while positive tests without compatible exposure and symptoms may not indicate active disease.
• Antibiotic choice and route depend on manifestation, age, pregnancy and neurological or cardiac involvement.

The listings below do not confirm Lyme disease; tick geography, clinical pattern and appropriate testing should guide treatment.

Diagnosis by stage

Early local disease may cause rash, fever and aches. Facial palsy, meningitis symptoms, conduction abnormalities or intermittent large-joint swelling can occur later. Two-tier antibody testing supports disseminated disease but should not be used as a general screen for non-specific fatigue.

Treatment and persistent symptoms

Doxycycline, amoxicillin, cefuroxime or intravenous ceftriaxone have manifestation-specific roles. Recommended courses are intended to cure active infection; prolonged repeated antibiotics have not shown benefit for non-specific persistent symptoms and can cause serious harm. Alternative diagnoses and recovery support deserve review.

When to seek urgent care

Seek urgent care for fainting, chest pain or marked palpitations, severe headache with neck stiffness, new weakness, breathing difficulty or a rapidly swollen painful joint with fever.