Can Lyme Disease Be Diagnosed While Traveling Abroad?
Lyme disease may be diagnosed far from where it was acquired
Travel history can reveal an earlier exposure
Rash recognition may lead to timely treatment
Doctors in Bogotá, Colombia, described the case of a 24-year-old American woman who was diagnosed with Lyme disease shortly after arriving from Virginia, USA. In their report, Mantilla-Flórez and colleagues outlined how travel history and recognition of a classic erythema migrans rash led to a timely diagnosis and treatment.1
American Traveler Develops Lyme Disease Symptoms in Colombia
The woman sought care in a Bogotá emergency department after developing a pruritic rash on her right flank. She reported walking through wooded areas with her dog approximately one week earlier and recalled noticing a dark spot at the center of the rash.
Initially, the lesion was diagnosed as cellulitis, and she was prescribed oral cephalexin.1
The following day, infectious disease specialists re-evaluated her condition. Based on her travel history, exposure risk, symptoms, and the appearance of a 27-centimeter target-like rash, clinicians diagnosed Lyme disease.
In addition to the rash, she reported:
- Malaise
- Headache
- Arthralgia
- Abdominal pain
She was treated with doxycycline 100 mg every 12 hours for 10 days. Her symptoms resolved, and the rash disappeared by the seventh day of treatment.1
Why Travel History Matters in Lyme Disease Diagnosis
Patients may develop Lyme disease symptoms after leaving the region where the tick bite occurred. As a result, clinicians evaluating travelers may not immediately consider Lyme disease if they practice in areas where the disease is uncommon.
This case highlights the importance of reviewing recent travel, outdoor activities, tick exposure, and rash history when evaluating unexplained symptoms in travelers.
Travel history can be especially valuable when laboratory testing is negative or symptoms are still evolving. Learn more about the challenges of Lyme disease testing.
Erythema Migrans Remains an Important Diagnostic Clue
The patient’s 27-centimeter target-like rash was consistent with erythema migrans, the most recognized sign of early Lyme disease.
Although not every patient develops a classic bull’s-eye appearance, recognizing erythema migrans can allow treatment before laboratory testing becomes positive.
Learn more about erythema migrans rashes and how they may appear.
Lyme Disease Is Often Missed Outside Endemic Regions
Patients traveling internationally may encounter physicians who see Lyme disease less frequently than clinicians practicing in endemic regions. Without a recognized rash or known tick bite, diagnosis can be delayed.
This challenge becomes even greater for patients with atypical symptoms, negative early testing, or later manifestations of Lyme disease.
Other travelers have presented with neurologic symptoms or atypical skin lesions that were initially attributed to more familiar local conditions. These cases are discussed in Lyme Disease in Travelers: A Missed Diagnosis Abroad.
Many patients with Lyme disease do not recall a tick bite. Others never develop a classic erythema migrans rash. These factors contribute to the broader problem of missed Lyme disease diagnoses.
Can Lyme Disease Be Diagnosed Abroad?
Yes. Lyme disease can be diagnosed anywhere if clinicians recognize the symptoms, exposure history, and characteristic findings such as erythema migrans.
In this case, the patient likely acquired Lyme disease in Virginia before traveling to Colombia, where doctors correctly identified the illness and initiated treatment.
This illustrates how Lyme disease can cross geographic boundaries, creating diagnostic challenges when symptoms begin during travel or after arrival in another country.
Frequently Asked Questions
Can Lyme disease be diagnosed while traveling abroad?
Yes. Lyme disease can be diagnosed anywhere if clinicians recognize the symptoms, exposure history, and characteristic findings such as erythema migrans.
Can Lyme disease symptoms appear after international travel?
Yes. Symptoms may begin days or weeks after a tick bite, meaning patients can become ill while traveling or after arriving in another country.
Is Lyme disease common in Colombia?
This case involved an American traveler who likely acquired Lyme disease in Virginia before traveling to Colombia. The report does not establish that the infection was acquired in Colombia.
Can Lyme disease be mistaken for cellulitis?
Yes. Early Lyme disease rashes are sometimes mistaken for cellulitis, insect bites, allergic reactions, or other skin conditions.
Clinical Takeaway
Lyme disease may be diagnosed far from where the infection was acquired. For travelers presenting with rash, fatigue, headache, or joint pain, exposure history and recognition of erythema migrans remain critical.
Clinicians should consider where a patient recently traveled and where the possible tick exposure occurred, rather than relying only on the location where symptoms appeared.
Related Articles
Can You Travel With Lyme Disease?
Is It Too Late to Treat a Tick Bite?
Lyme Disease Symptoms Guide
References
- Mantilla-Flórez, Y. F., Faccini-Martínez, Á. A., & Pérez-Díaz, C. E. American woman with early Lyme borreliosis diagnosed in a Colombian hospital. Travel Medicine and Infectious Disease. 2017;16:72–73.
This article is for informational purposes only and is not intended to provide medical advice, diagnosis, or treatment.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
I am looking for a research company that deals with Lyme disease. I have a niece that has had it for probably eight or nine years. She rarely gets out of bed. She found a doctor in Arizona that wanted $75,000 up front. Was told insurance does not cover it. If you know of any clinic or if anyone reads this that knows of a research station that would use her to find out more about the disease please contact me