Does Lyme Disease Make You Immunocompromised?
DOES IT INCREASE THE RISK
OF LYME DISEASE SPREAD?
Lyme disease does not typically make a person immunocompromised, but individuals with weakened immune systems may experience a different pattern of infection.
This distinction is important because many patients ask whether Lyme disease weakens the immune system or whether immune suppression affects disease severity and spread.
A study by Maraspin and colleagues examined whether patients receiving immunosuppressive therapy were more likely to develop disseminated Lyme disease.
Researchers identified 7 patients with erythema migrans (EM) who were being treated with Rituximab for underlying conditions. Four of the seven were also taking additional immunosuppressive medications, including corticosteroids, methotrexate, and bortezomib.
Higher Risk of Disseminated Lyme Disease
In these patients, signs of disseminated Lyme disease were more common (43%) compared with immunocompetent individuals (approximately 8%). The isolation of Borrelia from blood before antibiotic treatment was also higher (40% vs <2%).
This higher rate of bloodstream infection suggests that impaired immunity may allow the infection to spread more readily in the early stages of Lyme disease.
Rituximab is an anti-CD20 monoclonal antibody that affects B cells and impairs antibody production, antigen presentation, and cytokine signaling. It is commonly used for conditions such as non-Hodgkin lymphoma, rheumatoid arthritis, chronic lymphocytic leukemia, and granulomatosis with polyangiitis.
Interestingly, patients receiving Rituximab were less likely to develop detectable antibodies to Borrelia, which may affect standard diagnostic testing.
This may also make diagnosis more difficult in patients receiving immunosuppressive therapy.
Signs of disseminated Lyme disease
These findings reinforce the higher rate of dissemination in immunocompromised patients.
“Impaired immunity may explain the more complicated course of Lyme disease in these patients,” the authors wrote.
However, in this study a “complicated course” included both dissemination and treatment response. Only one patient met criteria for treatment failure.
Three patients with multiple EM rashes were treated with intravenous antibiotics, while the remaining individuals received oral antibiotics.
One patient, a 65-year-old woman, had persistence of her skin lesion for more than 2 months after doxycycline treatment but improved after retreatment with amoxicillin.
Despite the higher rate of early dissemination, outcomes were favorable. At 1-year follow-up, none of the patients had objective signs of Lyme disease.
The authors did not report on persistent symptoms such as fatigue, pain, or cognitive difficulties.
Editor’s note:
Immunosuppression may change how Lyme disease presents—particularly increasing dissemination and reducing antibody responses—without necessarily worsening long-term outcomes when treated.
The impact of impaired immunity on persistent symptoms, including fatigue, pain, and cognitive dysfunction, remains unclear and warrants further study.
Related Articles:
People re-infected with Lyme disease may develop strain-specific immunity
References:
- Maraspin V, et al. Erythema Migrans: Course and Outcome in Patients Treated With Rituximab.
Open Forum Infect Dis. 2019;6(7):ofz292.
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 had undiagnosed Lyme in mid 80′ -`1994 ,5,96
never positive so not treated for years. Dr.s in England wrote all the info, which i followed , first a positive IGG and IGM ( was told by Yale ” what do they know in England, you have fibromyalgia ,” eventually a very positive spinal tap before the first spinal surgery in 1994.
Obviously much more occurred and was observed which I will skip.
other than severe rheumatoid arthritis and erosive and sjogrens syndrome etc
i felt the lyme was more or less gone and the autoimmune situation was actually probably helping with that. Recently i was put on sulfasalazine first and then cimzia
right away after first injection i knew somethng was not right, by the second the arthritis exploded in the only 2 uninvolved joints left , my hips, both knees, Left already replaced, became white hot, swollen etc , left ring finger went ballistic and throbbed unlike other long ago attacks on my hands that had already crippled and deformed them etc. ETC.
I had a new arthritis dr, whom i had never seen, no tests were ever done , and when i finally 5 months later saw the new dr and told her what was happening and what i thought had happened she had me tested and said i was fine. i said exactly what this article says and she was rather unpleasant! After reading this article thank you!
I will never take another drug for this and hope my immune system will kick in and help . I now live in Florida ( having moved from Westport CT) I am writing a synopsis of my experience through all these years for John Hopkins which I hope will help others, including 1 heart attack and 3 TIAs that occurred while it was active.
I am an 80 year old female. Rower , athlete , now having incredible difficulty walking, and unable to row for the last 1 1/2 yr after c2- t2 cervical surgery which caused more problems along with this new explosion. thank you it felt great to read this article and to vent that i was right1
marisol laux
You are not alone