The symptoms of Lyme borreliosis and Bartonella infections can be extremely varied: neurological symptoms, migratory joint and muscle pain, neuropathy, skin manifestations, and ophthalmic or cardiac symptoms may all occur. For this reason, differential diagnosis – that is, ruling out other possible diseases – is crucial. Conversely, in cases of diseases of unknown origin presenting with symptoms similar to those of borreliosis or bartonellosis, we should consider these infections!
It is important to note that some of the symptom complexes, syndromes and diseases described below are currently considered to be of unknown origin and may even be directly linked to Borrelia or Bartonella infection.
- Autoimmune diseases
-Multiple sclerosis (MS): numbness, visual disturbances, fatigue, dizziness, coordination problems
-SLE (systemic lupus erythematosus): joint pain, exhaustion, neurological symptoms
-Rheumatoid arthritis: joint pain, stiffness, inflammation
-Sjögren’s syndrome: dry eyes and mouth, neuropathy, fatigue
- Neurological disorders
-Peripheral neuropathies (e.g. due to diabetes, B12 deficiency)
-Migraine variants (dizziness, visual disturbances, headache, cognitive complaints)
-Early forms of Parkinson’s disease
-Small fibre neuropathy
- Infectious diseases
-Epstein–Barr virus (EBV) / mononucleosis
-Cytomegalovirus (CMV)
-Long COVID / post-COVID syndrome
-Babesia infection (night sweats, shortness of breath, fatigue)
-Anaplasma / Ehrlichia infections
-Mycoplasma or Chlamydia pneumoniae infection
-Syphilis, less commonly HIV or other chronic infections
- Endocrine and metabolic disorders
-Hypothyroidism / Hashimoto’s thyroiditis
-Adrenal gland disorders
-Iron deficiency, ferritin deficiency
-Vitamin B12, folic acid or vitamin D deficiency
-Diabetes mellitus and insulin resistance
- Rheumatological and pain syndromes
-Fibromyalgia
-Chronic fatigue syndrome (ME/CFS)
-Myofascial pain syndrome
- Psychiatric or neuropsychiatric conditions
-Generalised anxiety
-Panic disorder
-Depression
-Sleep disorders, sleep apnoea
- Cardiological abnormalities
-POTS (postural orthostatic tachycardia syndrome)
-Arrhythmias
-Autonomic nervous system dysfunctions
When should further investigation for Lyme/Bartonella be considered?
Suspicion of Lyme disease or co-infection arises particularly if:
-there has been a known or suspected tick bite,
-recurring or migrating symptoms are present,
-multiple organ systems are affected simultaneously (neurological + joint + cardiac + skin complaints),
-routine investigations do not provide a clear explanation.
Diagnosing Lyme disease can be complex, as conventional serological tests do not always provide early or clear results; therefore, it is important to use direct diagnostic methods and to consult a doctor with expertise in Lyme disease.
(C) Lyme Borreliosis Foundation
