Abstract
Lyme borreliosis is the most common tick-borne disease in the northern hemisphere. It is a zoonosis caused by several species of Borrelia burgdorferi sensu lato and transmitted by the bite of infected ticks of the Ixodes ricinus complex. Lyme borreliosis in North America and Europe differs in certain respects, likely reflecting the different Borrelia species that cause human disease in these locations. The earliest manifestation of Lyme borreliosis is the skin lesion erythema migrans, which develops at the tick bite site, typically 7–14 days after the bite. Some untreated patients will then (within the first few weeks or months after onset of the infection) develop additional erythema migrans skin lesions or other clinical manifestations such as borrelial lymphocytoma, nervous system involvement or carditis. Several months or even years after infection onset, Lyme arthritis or acrodermatitis chronica atrophicans may develop. The diagnosis of typical erythema migrans is clinical, whereas for all other manifestations the diagnosis is supported via serological testing. Treatment with an appropriate antibiotic will result in resolution of clinical symptoms in most patients; however, some patients experience prolonged subjective symptoms, which usually improve over time. Repeated courses of antimicrobials are not beneficial except in rare cases when there is objective evidence of treatment failure.
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Change history
29 April 2026
A Correction to this paper has been published: https://doi.org/10.1038/s41572-026-00704-y
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Acknowledgements
This work was supported by the Slovenian Research and Innovation Agency (grant no. P3-0296). The funder had no role in the design of the article, in the collection, analyses, or interpretation of data, in the writing of the manuscript, or in the decision to publish the results. This research was also supported in part by the Intramural Research Program of the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC). The contributions of the NIH and CDC authors were made as part of their official duties as federal employees, are in compliance with agency policy requirements, and are considered Works of the United States Government. The findings and conclusions presented in this paper are those of the authors and do not necessarily reflect the views of the NIH, CDC or the US Department of Health and Human Services.
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Introduction (F.S. and G.P.W.); Epidemiology (P.S.M. and J.I.T.); Mechanisms/pathophysiology (K.S. and J.E.L.); Diagnosis, screening and prevention (A.M. and A.J.H.); Management (F.S. and G.P.W.); Quality of life (R.E.); Outlook (F.S., K.S., A.M. and G.P.W.); overview of the Primer (F.S., K.S., A.M., A.J.H., R.E., J.E.L., J.I.T., P.S.M. and G.P.W.).
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F.S. served on the scientific advisory board for Roche on Lyme disease serological diagnostics and on the scientific advisory board for Pfizer on Lyme disease vaccines and served as a research investigator for Pfizer and Roche; he is an unpaid member of the steering committee of the European Society of Clinical Microbiology and Infectious Disease Study Group on Lyme Borreliosis and other tick-borne diseases. K.S. served as a consultant for Roche, bioMérieux and New York State Biodefense Fund for the development of diagnostic assays in Lyme borreliosis; he is a member of the European Society of Clinical Microbiology and Infectious Disease Study Group on Lyme Borreliosis and other tick-borne diseases. A.M. has a patent (USA 8,926,989) issued and is an unpaid scientific adviser to the Global Lyme Alliance and to the American Lyme Disease Foundation. A.J.H. has a research collaboration agreement with Pfizer for seroprevalence studies of Lyme borreliosis in Sweden but does not receive any personal honoraria; she is an unpaid member of the executive committee of the European Society of Clinical Microbiology and Infectious Diseases Study Group on Lyme Borreliosis and other tick-borne diseases. R.E. has received travel reimbursement and has received money for lectures for Pfizer. She is a member of the scientific committee of the European Society of Clinical Microbiology and Infectious Disease Study Group on Lyme Borreliosis and other tick-borne diseases, and co-chair of the managing group of infectious diseases in the European Academy of Neurology. J.I.T. is an unpaid board member of the nonprofit American Lyme Disease Foundation. She is a member of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices Lyme disease vaccines working group. G.P.W. reports receiving a research grant from Biopeptides, Corp. He has been an expert witness in malpractice cases involving Lyme disease and babesiosis and is an unpaid board member of the nonprofit American Lyme Disease Foundation. J.E.L. and P.S.M. declare no competing interests.
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Strle, F., Strle, K., Marques, A. et al. Lyme borreliosis. Nat Rev Dis Primers 12, 15 (2026). https://doi.org/10.1038/s41572-026-00691-0
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DOI: https://doi.org/10.1038/s41572-026-00691-0
