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Diagnosing Lyme Disease Symptoms Can Be Difficult

Lyme Disease symptoms are many and diverse, which makes it notoriously difficult to diagnose the disease… and that’s not the worst of it. Most LD symptoms mimic the symptoms of other, more common ailments, from arthritis to the flu to (of all things) ringworm.

As if that weren’t bad enough, the diagnostic tests used to verify the disease are notoriously unreliable, so that some people without LD end up treated for the disease, while many who actually are ill suffer for years without treatment.

In this article, we’ll take a closer look at a just a few of the reasons that LD is so hard to diagnose.

Rashes and Skin Irritations

You’d think that erythema migrans (EM), the bull’s-eye rash that’s probably the most famous LD symptom, would be a slam-dunk as a diagnostic indicator — but sadly, that’s not the case. EM doesn’t appear in as many as 40-50% of LD patients, and even when it does, it can be mistaken for something else.

For example, EM may look like a bruise on dark-skinned people, which may explain why doctors have disproportionately diagnosed LD in Caucasians.  Otherwise, it can be misidentified as a number of other skin ailments, from a spider or insect bite to fungal infections like ringworm.

Joint Pain, Muscle Aches, Headache and Fever

These symptoms are common to LD, but they’re also standard issue for viral illnesses like influenza, the flu, and pneumonia. Coupled with fatigue (another common LD symptom), they can suggest a more long-term infection, such as viral meningitis or mononucleosis.

Other, less common illnesses, such as Jamaican dengue (break-bone) fever, may also echo many or all of these symptoms.


Medical personnel often misdiagnose Lyme-related joint pain, stiffness, and swelling as simple arthritis, especially in older individuals. Sometimes they misidentify it as scleroderma, a progressive condition that presents very similar symptoms.

Multiple Symptoms

Several illnesses produce a range of symptoms very similar to LD’s.

For example: rheumatic fever, an inflammation of the heart, joints, skin, or nervous system, can cause most of the symptoms discussed previously, as well as a host of others. A common LD co-infector, Rocky Mountain spotted fever, also has similar symptoms.

Issues with Diagnostic Tests

The organism that causes LD, the spirochete Borrelia, is extremely difficult to isolate within blood and other body fluids and tissues. Therefore, most diagnostic tests for LD look for the presence of antibodies produced by the immune system to fight the disease.

However, there are many problems with these tests; so in most cases, a single test cannot rule LD either in or out. Among other things, false positives can occur when the test picks up antibodies for other spirochete infections, including those that cause dental infections and syphilis.

False negatives can occur for many reasons: for example, steroids can mask the antibodies; the antibodies may be attacking the Borrelia spirochetes, so that very few are detectible in the bloodstream; or the infection may be so recent that the antibody load in the bloodstream is too low to detect.

It’s also possible that the Borrelia have already gone to ground in some part of the body, such as the brain or spinal fluid, so that the body doesn’t produce the antibodies.

Proper diagnosis of Lyme Disease typically requires multiple tests of different types, often carried out across a time-scale of weeks or months. For this reason, doctors and (especially) managed care organizations are often unwilling to put in the required effort to definitively identify Lyme Disease symptoms.

For many individuals with Lyme Disease, the journey to diagnosis is a long, difficult odyssey filled with false starts and inappropriate treatment. It can take years just to force a proper diagnosis. Knowing the most common Lyme Disease symptoms, you can be your own patient advocate and encourage your medical provider to perform the correct battery of tests to receive the proper diagnosis.