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3 Challenges That Make Lyme Disease So Hard To Diagnose

For people who live in parts of the world where Lyme disease is prevalent, it’s becoming more and more common to meet someone who has been diagnosed with this disease. As cases of this complex condition grow in number, so do the number of lives who are touched by it.

Reported cases of Lyme disease have been increasing steadily over the last two decades, meaning that even if you don’t live in a place where Lyme infection is typically transmitted, chances are you’ve at least heard of the disease. Once something of a ‘fringe’ illness, Lyme disease has become a public health concern, and more people are talking about it.

But just because awareness of Lyme disease has increased doesn’t mean that there aren’t still gaps in information. Many healthcare professionals simply don’t have Lyme disease on their radar, and those who do know about it can’t always spot the symptoms.

This lack of education around Lyme disease is one of the reasons this condition is often misdiagnosed. Let’s take a closer look at Lyme disease transmission and symptoms, as well as three challenges that make Lyme disease so hard to diagnose.


What is Lyme disease?

Lyme disease is a bacterial infection caused by Borrelia burgdorferi, a type of bacterium known as a spirochete because its shape resembles that of a corkscrew. Lyme disease is an inflammatory condition that impacts many systems of the body. Early on in its localised stage, Lyme disease starts by affecting the skin. Later, if left untreated, Lyme infection spreads to the joints, nervous system and potentially even some organs.


How is Lyme disease contracted?

Lyme disease is almost always transmitted through a tick bite. Deer ticks, also known as Ixodes or black-legged ticks, are vectors (carriers) of Borrelia burgdorferi. These ticks become infected with Borrelia burgdorferi when they feed off other carriers like deer and the white-footed mice. When an infected ticks bites a human, it transmits Borrelia burgdorferi through the bite, and the person who has been bitten contracts Lyme disease.


Deer are carriers of Borrelia burgdorferi.


What are the stages of Lyme disease?

Lyme disease can be divided into two phases: acute and chronic. The acute stage of Lyme disease occurs right after infection. The most common symptom of acute Lyme infection is an expanding rash known as erythema migrans (EM) that is believed to occur in between 80–90% of Lyme cases. Typically, an EM rash:

  • Radiates from the site of the tick bite
  • Appears as either a solid red blotch or a bullseye
  • Averages a diameter of five to six inches
  • Lasts for approximately three to five weeks

Other symptoms of acute Lyme disease may include:

  • Headaches and neck stiffness
  • Fever
  • Fatigue
  • Joint pain and swelling
  • Weakness or paralysis of facial muscles
  • Lightheadedness or fainting
  • Heart palpitations or chest pain

If Lyme infection isn’t diagnosed and treated in the acute phase, it can become chronic. Some of the symptoms of chronic Lyme disease are:

  • Fatigue
  • Muscle aches
  • Joint pain
  • Headaches
  • Impaired cognition (including memory loss, trouble concentrating or ‘brain fog’)
  • Neuropathy (including nerve pain, numbness, or tingling)
  • Sleep problems
  • Changes in mood
  • Digestive issues


Why is Lyme disease so difficult to diagnose?

What makes diagnosing Lyme disease so difficult, particularly after it into the chronic phase? Here are three challenges that make Lyme disease hard to diagnose.


  1. Medical illiteracy

Many in the medical community aren’t yet adept at spotting the symptoms of Lyme disease. Even those who practise in areas where Lyme disease is prevalent aren’t always well educated about the disease, especially the chronic phase. In fact, some practitioners don’t believe in the existence of chronic Lyme disease at all.


  1. Subtlety of symptoms

Patients infected with Lyme may not realise they’ve been bitten by a tick, so any symptoms they experience may present to them as the flu or another common illness. It’s especially challenging for patients and practitioners alike to recognise symptoms of chronic Lyme, which can mimic those of so many other health conditions.


  1. Testing inaccuracy

Blood tests can be useful for diagnosing Lyme disease, but only under certain conditions. If a person is tested in the first couple weeks after exposure to Lyme disease, antibodies may not have had enough time to develop, meaning the person might test negative for Lyme even though they’ve been infected with the disease. False negatives can occur for other reasons, too, making blood tests for Lyme somewhat unreliable. For this reason, the BCA-clinic focuses on the following diagnostic methods:

  • ELISpot, which has been a reliable test on a cellular level for the determination of an infection with Borrelia or with other different co-pathogens
  • LymeSpot, the new ELISpot test, provides even more detailed information on the activity of the infection and possible inflammation. In addition, the new test can differentiate whether an active or latent infection is present. This makes it possible for the first time to evaluate infection, inflammation and autoimmune processes simultaneously.


Blood tests can be useful for treating Lyme disease, but are sometimes unreliable.


Lyme disease can be difficult to diagnose and treat, but arming ourselves with knowledge about the disease helps us meet these challenges head-on.