Long COVID and Lyme Disease: Overlapping Symptoms and Diagnostic Challenges
Long COVID and Lyme disease can share similar symptoms
Fatigue, pain, brain fog, and autonomic symptoms may overlap
The timing and pattern of illness can help guide the diagnosis
Long COVID and Lyme disease can produce remarkably similar symptoms. Fatigue, cognitive difficulties, pain, dizziness, sleep disruption, exercise intolerance, and autonomic symptoms may occur with either condition.
This overlap can make diagnosis challenging, particularly when someone has experienced both a tick bite and COVID-19. Symptoms should not automatically be attributed to Long COVID, Lyme disease, or another single diagnosis without a careful clinical evaluation.
Survey of People With Lyme Disease and COVID-19
An earlier exploratory survey recruited individuals with a history of Lyme disease through social media using a snowball sampling strategy. Of the 1,168 people who completed the survey, 288 reported contracting COVID-19.
Nearly one in five respondents with both a history of Lyme disease and COVID-19 reported developing Long COVID.
However, the participants were self-selected, and their diagnoses were based on self-reported information. The results should therefore be viewed as an observation from this particular survey—not as an estimate of the population-wide risk of Long COVID among people with Lyme disease.
How Long COVID and Lyme Disease Symptoms Overlap
Long COVID and Lyme disease may affect multiple body systems. Overlapping symptoms can include:
- Persistent or disabling fatigue
- Brain fog, memory problems, or difficulty concentrating
- Muscle and joint pain
- Headaches
- Dizziness or lightheadedness when standing
- Heart palpitations or a rapid heart rate
- Sleep disturbances
- Numbness, tingling, or burning pain
- Exercise intolerance
- Worsening symptoms following physical or mental exertion
Post-exertional malaise—a delayed worsening of symptoms following physical or mental activity—is frequently reported in Long COVID. Exercise intolerance and post-exertional worsening may also be reported by some patients with persistent symptoms following Lyme disease.
Autonomic dysfunction can be another area of overlap. Patients may experience dizziness when standing, changes in heart rate, palpitations, sweating abnormalities, temperature dysregulation, or gastrointestinal symptoms.
Clues That May Help Distinguish the Conditions
No single symptom reliably distinguishes Long COVID from Lyme disease. Doctors must consider the complete clinical history rather than relying on a symptom checklist alone.
Important considerations include:
- Whether symptoms began before or after COVID-19
- A history of a tick bite or exposure in an endemic area
- The presence of an erythema migrans rash
- Facial nerve palsy, meningitis, carditis, or objective joint swelling
- Changes in smell or taste associated with COVID-19
- Respiratory symptoms following the acute viral illness
- The timing and limitations of laboratory testing
- Possible tick-borne coinfections or unrelated medical conditions
A recalled tick bite or bull’s-eye rash can support a Lyme disease diagnosis, but their absence does not exclude it. Likewise, some individuals who develop Long COVID had only a mild or unrecognized initial COVID-19 illness.
Can Someone Have Both Lyme Disease and Long COVID?
Yes. A patient with previous or persistent Lyme disease symptoms can later contract COVID-19 and develop a new post-infectious illness. The presence of one condition does not exclude the other.
It is also important to consider other explanations for persistent symptoms, including anemia, thyroid disease, sleep disorders, medication effects, autoimmune conditions, cardiac or neurologic disorders, and other tick-borne infections.
Evaluation may include a detailed timeline of symptoms, physical examination, appropriate laboratory testing, and targeted cardiac, neurologic, autonomic, or pulmonary studies when clinically indicated.
Frequently Asked Questions
Can Lyme disease symptoms resemble Long COVID?
Yes. Both conditions may involve fatigue, brain fog, pain, dizziness, sleep disruption, exercise intolerance, and autonomic symptoms.
Can someone have Lyme disease and Long COVID at the same time?
Yes. A person with a history of Lyme disease can later develop COVID-19 followed by persistent symptoms. One diagnosis does not automatically exclude the other.
How do doctors distinguish Lyme disease from Long COVID?
Doctors consider the timing and pattern of symptoms, tick and COVID-19 exposure histories, physical findings, laboratory results, and other possible medical explanations. There is no single test that can resolve every case.
Does a negative Lyme disease test rule out Lyme disease?
Not necessarily. Antibody testing may be negative early in the illness, and test results must be interpreted in the context of symptom duration, exposure history, and clinical findings.
Should persistent symptoms automatically be attributed to Long COVID?
No. Long COVID is an important diagnostic consideration, but clinicians should also evaluate Lyme disease, tick-borne coinfections, and other medical conditions when the history or findings warrant it.
Clinical Takeaway
Long COVID and Lyme disease can cause overlapping fatigue, cognitive difficulties, pain, dizziness, post-exertional worsening, and autonomic symptoms.
The timing of symptom onset, exposure history, physical findings, and appropriate testing can help guide the differential diagnosis. Some patients may have more than one condition, so persistent symptoms should not automatically be attributed to either Long COVID or Lyme disease alone.
More research is needed to understand how different infection-associated chronic conditions overlap and whether a prior illness influences recovery from a later infection.
Related Articles
- Lyme Disease or Long COVID? How to Tell the Difference
- Autonomic Dysfunction and Lyme Disease
- Lyme Disease and POTS
References
Centers for Disease Control and Prevention. Long COVID signs and symptoms.
Adler BL, et al. Dysautonomia following Lyme disease: A key component of post-treatment Lyme disease syndrome? Front Neurol. 2024.
Marques A. Persistent symptoms after treatment for Lyme disease. Infect Dis Clin North Am. 2022.
Peluso MJ, et al. Infection-associated chronic conditions: Why Long COVID is part of a broader medical challenge.
This article is intended for educational purposes and does not provide individual medical advice. Patients should discuss persistent or worsening symptoms with a qualified healthcare professional.
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
