Lyme Disease and COVID-19: Case Reports
Patients with a history of Lyme disease have reported a wide range of symptoms after contracting COVID-19. The following case reports describe individuals with prior Lyme disease who later developed COVID-19 and experienced significant symptom burden.
Cases of Lyme Disease with COVID-19
A 16-year-old girl had a history of a tick bite, erythema migrans rash, Bell’s palsy, and a swollen knee. Her Lyme disease test was positive with 5 of 10 IgG Western blot bands.
She had been ill for five years and had also been diagnosed with chronic fatigue and post-treatment Lyme disease syndrome (PTLDS). She was treated for three years with oral and intravenous antibiotics as well as nutritional supplements. At the time of the survey, she remained chronically ill but was no longer receiving antibiotic treatment.
Her COVID-19 infection was confirmed by nasal swab testing. She was not hospitalized but reported fever, fatigue, and headaches, along with significant limitations in daily activities. Her illness lasted for more than one month.
She believed that her history of tick-borne illness made her acute COVID-19 illness more severe. She subsequently developed long COVID.
Her GSQ-30 score was 68 out of 120, indicating a high symptom burden.
Her most severe symptoms included:
- Severe fatigue and low energy
- Worsening symptoms after physical activity
- Needing more sleep than usual
- Unrefreshing sleep
- Sensitivity to light and sound
- Visual disturbances and difficulty focusing
- Hot or cold sensations in the extremities
- Irregular or rapid heartbeats
- Anxiety and mood changes
- Word-finding difficulty and memory problems
- Slowed thinking
A 28-year-old woman reported a history of Lyme disease with a swollen knee but no recalled tick bite or rash. She had frequent tick exposure through outdoor activities, dogs and cats, horses, and hiking.
Her Lyme disease testing revealed positive IgG Western blot bands but did not meet CDC diagnostic criteria. She had been ill for 12 years, beginning at age 16, and had also been diagnosed with chronic fatigue syndrome.
She received eight months of oral antibiotic therapy and magnesium supplementation. At the time of the survey she remained chronically ill and was not receiving antibiotic treatment.
She described her acute COVID-19 illness:
“I was diagnosed October of 2020 with COVID-19. I was very weak and had difficulty performing daily tasks. I had gastrointestinal problems, headaches, shortness of breath, inability to exercise, and chest tightness.”
She visited the emergency room where imaging studies were performed and low oxygen saturation was noted. She was treated with an inhaler and discharged home. Her acute illness lasted 14 days followed by 7 days of quarantine.
She later described persistent symptoms consistent with long COVID:
“POTS, random tachycardia, vision changes similar to traumatic brain injury, memory problems, and seizure-like episodes that make me unable to speak.”
During these episodes she experienced:
- Racing heart rate
- Severe cognitive impairment
- Loss of time awareness
- Difficulty speaking
- Anxiety and panic symptoms
These episodes occurred one to two times per week and lasted 10–20 minutes. She reported impaired cognition for 24–48 hours afterward and was unable to drive or perform complex tasks during recovery.
Her GSQ-30 score was 95 out of 120, indicating a very high symptom burden.
COVID-19 and Lyme Disease Patients
Study Highlights
Question: What symptoms occur when individuals with a history of Lyme disease develop COVID-19?
Findings: In a survey of 1,168 individuals with Lyme disease, the highest symptom burden occurred among the 288 participants who also developed COVID-19. Nearly one in five developed long COVID, and 20 required hospitalization.
Meaning: Lyme disease patients who contract COVID-19 may experience a high symptom burden and an increased risk of long COVID.
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
This is an exceptionally important survey and article. Besides pointing toward the susceptibility that Lyme patients have toward long haul Covid ( twice the risk pointed toward here), there are implications of serious viral impacts on long haul ( chronic) Lyme that further validates patients claims that two weeks of doxycycline is not an adequate protocol for those with tick borne illness. Imagine that someone with a broken leg has their ankle set and the cast taken off about three days later, and if they complain of pain afterwards they are sent to a psychiatrist? That is what chronic Lyme patients feel when their complaints are dismissed. Altered immune systems ( many describe chronic Lyme as a B cell type of HIV), and co infections, especially bartonella which becomes an opportunistic infections once the immune system is crippled, and is easily caught from domestic animals etc., are being ignored. Indeed we need accurate Lyme tests ( such as a cross sectional survey of the general population using accurate testing ) to know the true prevalence. Since Borrelia B has been repeatedly proven to be an STD, our community should demand a similar budget as HIV. This ignoring of what might be a driving factor in bankruptcy of our National and perhaps global health care budget needs to stop.
I have been particularly concerned that someone with Lyme disease or related tick borne infection might be dismissed as long covid.
At least, maybe then we’ll get some help!
What do you suggest for treatment of chronic Lyme with symptoms? Can we ameliorate some of the burden?
I often identify treatment options that are overlooked during my patient evaluations. I always advise working with a doctor with experience treating Lyme disease in addition to other doctors if they remain ill.
I think it would be VERY interesting for a study to evaluate if long Covid patients test positive for Lyme Disease with a blood culture (not the useless CDC Western blot that results in 71% false negatives at best, BALF 2020).