Lyme disease classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anmol Pitliya, M.B.B.S. M.D.[2]


Lyme disease can be classified into three stages. The first stage is localized Lyme disease, the second is disseminated Lyme disease, and the third is late disseminated Lyme disease. During stage 1, the patient can develop erythema migrans rash. Ten to twenty percent of the patients who have Lyme disease can develop post treatment Lyme disease syndrome. There are various genospecies of Borrelia burgdorferi sensu lato complex that can cause Lyme disease. A novel spirochete, Borrelia mayonii, has been recently discovered to be responsible for Lyme disease.


Classification based on clinical stage

  • Stage 1 is called early localized Lyme disease. The infection is not yet widespread throughout the body.
  • Stage 2 is called early disseminated Lyme disease. The bacteria have begun to spread throughout the body.
  • Stage 3 is called late disseminated Lyme disease. The bacteria have spread throughout the body.

Classification based on causative organism

Borrelia burgdorferi sensu lato (s.l.) complex genospecies
Pathogenic Non-Pathogenic
Commonly infect humans Rare (no human infection) Not isolated from humans yet
  • B. bavariensis
  • B. bissettii
  • B. kurtenbachii
  • B. lusitaniae
  • B. spielmanii
  • B. valaisiana
  • B. americana
  • B. andersonii
  • B. californiensis
  • B. carolinensis
  • B. japonica
  • B. tanukii
  • B. turdi
  • B. sinica
  • B. yangtze
  • However, B. mayonii has recently been discovered to be responsible for development of Lyme disease.[2]
  • The following table demonstrates key clinical and epidemiological features that distinguish B. burgdorferi from B. mayonii:
General information B. burgdorferi B. mayonii

Transmission Tick bite Tick bite
Distribution in the USA Northeast, Mid-Atlantic, and Midwest regions Midwest region
Bacteria Concentration in Blood (Spirochetemia) Lower Higher
Early Symptoms Fever, headache, rash, neck pain Fever, headache, rash, neck pain
Late Symptoms and Complications Joint pain and arthritis Joint pain and arthritis
Nausea / Vomiting? No Yes
Rash Characteristics Bullseye target lesion Diffuse rash
Diagnosis Serology or PCR Serology or PCR
Treatment Doxycycline Doxycycline


  1. Rudenko N, Golovchenko M, Grubhoffer L, Oliver JH (2011). "Updates on Borrelia burgdorferi sensu lato complex with respect to public health". Ticks Tick Borne Dis. 2 (3): 123–8. doi:10.1016/j.ttbdis.2011.04.002. PMC 3167092. PMID 21890064.
  2. Pritt, Bobbi S; Mead, Paul S; Johnson, Diep K Hoang; Neitzel, David F; Respicio-Kingry, Laurel B; Davis, Jeffrey P; Schiffman, Elizabeth; Sloan, Lynne M; Schriefer, Martin E; Replogle, Adam J; Paskewitz, Susan M; Ray, Julie A; Bjork, Jenna; Steward, Christopher R; Deedon, Alecia; Lee, Xia; Kingry, Luke C; Miller, Tracy K; Feist, Michelle A; Theel, Elitza S; Patel, Robin; Irish, Cole L; Petersen, Jeannine M (2016). "Identification of a novel pathogenic Borrelia species causing Lyme borreliosis with unusually high spirochaetaemia: a descriptive study" (PDF). The Lancet Infectious Diseases. 16 (5): 556–564. doi:10.1016/S1473-3099(15)00464-8. ISSN 1473-3099.