#4-23E. Unraveling Lyme Borreliosis: Pathogenesis, Diagnosis, and Management (NatRevDisPrimers, 2026)

When evaluating a patient with a recent tick bite or unexplained systemic symptoms, how confidently can you navigate the diverse clinical spectrum of Lyme disease? This comprehensive review on Lyme borreliosis, the most prevalent tick-borne zoonosis in the northern hemisphere, explores its multifaceted clinical manifestations ranging from classic erythema migrans to severe neurological, cardiac, and late-stage articular complications. A critical clinical takeaway is that the disease's heterogeneity is heavily driven by the genetic diversity of the specific infecting Borrelia species and the host's subsequent immune response, which together dictate tissue tropism and symptomatology. However, clinicians must carefully consider that persistent post-treatment symptoms are overwhelmingly linked to sustained immune dysregulation rather than ongoing active infection; thus, empirical prolonged antibiotic retreatment lacks evidence and poses significant risks. For the practicing physician, mastering the distinction between active spirochetal infection and post-infectious inflammatory syndromes is paramount. This insight directly enhances daily practice by promoting timely, targeted antibiotic regimens for early disease while avoiding the pitfalls of unnecessary long-term therapies for post-treatment sequelae.

Citation: Strle, F., et al. Lyme borreliosis. Nature Reviews Disease Primers. 2026. DOI: 10.1038/s41572-026-00691-0

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