COVID-19 and Lyme disease symptoms overlap

COVID-19 and Lyme disease symptoms overlap in important ways, particularly when neurological or psychiatric complications develop. Both infections can affect the brain and nervous system, leading to symptoms such as confusion, cognitive changes, mood disturbances, and altered mental states.

These similarities have become more apparent as researchers study neurological complications of COVID-19. Many of the symptoms now widely reported in COVID-19 patients have long been recognized in individuals with neurologic Lyme disease.

Neurological complications reported in COVID-19 patients

Investigators described neurological and psychiatric complications in 153 COVID-19 patients in the United Kingdom who were hospitalized during the early phase of the pandemic. Treating clinicians included specialists in neurology, stroke medicine, psychiatry, and intensive care.

More than 9 out of 10 patients had laboratory-confirmed COVID-19 infection.

The most common presenting complication was a cerebrovascular event.

Two-thirds of patients experienced an ischemic stroke.
One-third developed an intracerebral hemorrhage.
One patient developed central nervous system vasculitis.

Patients older than 60 years of age were more likely to present with cerebrovascular complications.

However, neurological symptoms were not limited to older individuals. Nearly one-third of patients presented with an altered mental state, and about half of those individuals were younger than 60 years old.

[bctt tweet=”Neurological and psychiatric symptoms are common in both COVID-19 and Lyme disease patients.” username=”DrDanielCameron”]

Patients with altered mental status presented with a range of neurological and psychiatric conditions including:

Unspecified encephalopathy
Encephalitis
New-onset psychosis
Dementia-like neurocognitive syndrome
Affective disorders

Seven patients (30%) also developed additional psychiatric disorders, including cases of catatonia and mania.

Author’s note: The study has several limitations. Because the patients were hospitalized, the neurological and psychiatric complications cannot be generalized to individuals with mild COVID-19 infection. The study also did not determine whether patients had neurological or psychiatric symptoms prior to infection or how long these complications persisted.

Neuropsychiatric symptoms of Lyme disease

Lyme disease patients can experience many of the same neurological symptoms seen in COVID-19. Individuals with chronic neurologic Lyme disease may develop cognitive impairment, mood changes, and mild encephalopathy.

In one study, 24 of 27 patients with chronic neurologic Lyme disease presented with mild encephalopathy.

Psychiatrist Dr. Robert Bransfield from the Department of Psychiatry at Rutgers–Robert Wood Johnson Medical School has described a broad spectrum of neuropsychiatric symptoms associated with Lyme disease.

According to Bransfield, Lyme disease may produce immune and metabolic effects that lead to a gradually developing range of neuropsychiatric complications. These symptoms may include:

Cognitive impairment
Depression and anxiety disorders
Panic disorder and post-traumatic stress symptoms
Sleep disturbances
Seizure disorders
Dementia-like cognitive decline
Behavioral and emotional changes

Dr. Brian Fallon from the Department of Psychiatry at Columbia University has also described a wide range of psychiatric manifestations of Lyme disease. These may include paranoia, bipolar disorder, panic attacks, major depression, obsessive-compulsive symptoms, and dementia-like cognitive changes.

Author’s note: Neither Bransfield nor Fallon designed their studies to determine whether psychiatric symptoms were present before Lyme disease infection.

Why COVID-19 and Lyme disease symptoms overlap

The similarities between COVID-19 and Lyme disease symptoms likely reflect shared effects on the nervous system. Both infections can trigger immune activation, inflammation, and changes in brain function.

These processes may lead to:

Neuroinflammation
Altered brain metabolism
Cognitive dysfunction
Psychiatric symptoms
Autonomic nervous system disruption

Recognizing that COVID-19 and Lyme disease symptoms overlap may help clinicians better understand post-infectious neurological syndromes and improve care for patients experiencing persistent symptoms.

For a comprehensive overview of the Long COVID and Lyme disease connection—including my peer-reviewed research on 889 patients—see Long COVID and Lyme Disease: What Patients Need to Know.

Long COVID and Lyme Disease: What Patients Need to Know

9 ways COVID-19 and Lyme disease can look alike

Opinion: Neurologic problems in Lyme disease also seen in COVID-19

Six cases of neurological Lyme disease

Can Lyme disease cause dementia?

References:

Varatharaj A et al. Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study. Lancet Psychiatry. 2020;7(10):875-882.
Logigian EL, Kaplan RF, Steere AC. Chronic neurologic manifestations of Lyme disease. N Engl J Med. 1990;323(21):1438-1444.
Bransfield RC. Neuropsychiatric Lyme Borreliosis: An Overview. Healthcare (Basel). 2018;6(3).
Fallon BA, Nields JA. Lyme disease: a neuropsychiatric illness. Am J Psychiatry. 1994;151(11):1571-1583.

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