COVID and Lyme Disease: Can COVID Make Lyme Worse?
COVID and Lyme disease symptoms may overlap
Some patients report worsening symptoms after infection
Long COVID risk may complicate recovery
COVID and Lyme disease remain important concerns for patients who already have persistent symptoms, fatigue, cognitive difficulties, or autonomic dysfunction. These case reports describe two individuals with a history of Lyme disease who later developed COVID-19 and experienced significant symptom burdens afterward.
Patients frequently ask whether COVID can worsen Lyme disease symptoms. These cases cannot prove causation, but they highlight how viral illness, inflammation, autonomic dysfunction, and post-infectious syndromes may overlap in complex ways.
Cases of Lyme disease with COVID-19
A 16-year-old girl had a history of tick bite exposure, erythema migrans rash, Bell’s palsy, and knee swelling. Her Lyme testing was positive with 5 of 10 IgG Western blot bands. She had been ill for five years and carried diagnoses including chronic fatigue and post-treatment Lyme disease syndrome (PTLDS). She had previously been treated with oral and IV antibiotics and supplements.
Her COVID-19 infection was confirmed by nasal swab. She was not hospitalized but experienced fever, fatigue, headaches, and limitations in daily activities for more than one month.
She felt her history of tick-borne illness made her acute COVID-19 illness worse and later developed long COVID symptoms.
Her GSQ-30 score was 68 out of 120, indicating high symptom burden.
Her most significant symptoms included fatigue, post-exertional worsening, needing more sleep, waking unrefreshed, sensory sensitivity, visual difficulties, temperature dysregulation, tachycardia, irritability, anxiety, memory problems, and slowed thinking.
A 28-year-old woman reported prior knee swelling but no recalled tick bite or rash. She described substantial tick exposure through animals, outdoor activities, and hiking. Her Lyme testing revealed positive IgG Western blot findings but did not meet CDC surveillance criteria. She had been ill for 12 years.
She described a 14-day acute COVID illness with major limitations on daily function.
“I was very weak; I had a hard time doing daily tasks.”
Her symptoms included GI problems, lethargy, headaches, shortness of breath, inability to exercise, and chest tightness.
She later described long COVID symptoms including POTS, tachycardia, vision changes, cognitive impairment, memory issues, anxiety, and seizure-like episodes.
Her GSQ-30 score reached 95 out of 120.
Her worst symptoms included fatigue, exercise intolerance, balance problems, lightheadedness, rapid heartbeats, memory difficulties, and slower processing speed.
Can COVID make Lyme disease worse?
Patients often search whether coronavirus with Lyme disease creates worse outcomes. These cases suggest that some individuals with a history of Lyme disease may experience substantial symptom burdens following COVID infection.
Persistent fatigue, post-exertional symptoms, cognitive dysfunction, autonomic problems, and prolonged recovery may contribute to functional decline after infection.
Why COVID and Lyme disease symptoms may overlap
These cases illustrate why post-treatment Lyme disease syndrome, POTS and autonomic dysfunction, and long COVID may share overlapping symptoms including fatigue, cognitive dysfunction, exercise intolerance, dizziness, tachycardia, and sensory sensitivity.
Overlap does not necessarily imply identical mechanisms, but it may complicate diagnosis, treatment, and recovery.
Patients experiencing persistent symptoms may also describe problems similar to brain fog, autonomic dysfunction, or exercise intolerance.
COVID-19 and Lyme disease patients
What did this Lyme disease and COVID survey find?
This cross-sectional survey revealed a high symptom burden among individuals with Lyme disease who later contracted COVID-19.
Symptom burden appeared greatest in individuals reporting both Lyme disease and COVID histories, with many describing prolonged recovery and long COVID symptoms.
Nearly one in five individuals with both Lyme disease and COVID reportedly developed long COVID, and 20 participants required hospitalization.
Frequently Asked Questions
Can COVID make Lyme disease worse?
Some patients report worsening symptoms after COVID infection, though causality remains uncertain and likely varies among individuals.
Can Lyme disease increase long COVID risk?
These cases suggest some patients with prior Lyme disease may experience substantial symptom burdens following COVID infection.
What symptoms overlap between Lyme disease and COVID?
Fatigue, cognitive dysfunction, tachycardia, exercise intolerance, dizziness, headaches, sensory sensitivity, and autonomic symptoms may overlap.
Can COVID trigger POTS symptoms in Lyme patients?
Some individuals report tachycardia, dizziness, exercise intolerance, and POTS-like symptoms following infection.
Clinical Takeaway
Patients with Lyme disease who later contract COVID-19 may experience overlapping symptoms that complicate diagnosis and recovery.
Fatigue, autonomic dysfunction, cognitive symptoms, and exercise intolerance may persist beyond acute infection and deserve careful evaluation.
Related Articles
POTS and Lyme disease
Post-treatment Lyme disease syndrome
Brain fog in Lyme disease
Autonomic dysfunction and Lyme disease
Reference
Cameron, D. J., & McWhinney, S. R. (2023). Consequences of contracting COVID-19 or taking the COVID-19 vaccine for individuals with a history of Lyme disease. Antibiotics, 12(3), 493.
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).