Lyme meningitis is a rare but potentially serious form of meningitis. It can develop following Lyme disease, which is a bacterial infection that spreads through the bites of ticks.

Most people who get Lyme disease will not develop meningitis. However, if the bacteria that cause Lyme disease affect the brain or spinal cord, the condition can be life threatening.

People who develop Lyme meningitis may have various symptoms, including headaches, a stiff neck, fever, and nerve pain. If a person seeks early treatment, they are likely to make a full recovery.

This article looks at Lyme meningitis in more detail, including its symptoms and the treatment options.

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Lyme meningitis is a rare complication of Lyme disease, which is a bacterial illness that occurs when the bacterium Borrelia burgdorferi transfers from a tick to a human. Ticks are tiny insects that feed on blood, and when they bite a human, organisms inside their body can enter the bloodstream.

Lyme meningitis occurs when B. burgdorferi bacteria invade the central nervous system, which comprises the brain and spinal cord. The result is inflammation of the meninges, which are the membranes surrounding the brain and spinal cord.

This complication is a form of Lyme neuroborreliosis, or neurological Lyme disease. The three other inflammatory conditions that fall into this category are:

  • cranial neuritis, or inflammation of the cranial nerves
  • radiculopathy, which is inflammation of the spinal root nerves
  • peripheral neuropathy, which is inflammation of the peripheral nerves in the hands and feet

Some early symptoms that indicate that Lyme disease might be affecting the nervous system include:

  • numbness
  • pain
  • weakness
  • facial palsy, which causes part of the face to droop
  • visual disturbances and meningitis symptoms

In adults, the most common symptoms are nerve pain and paresis, or weakening of the muscles. In children, facial nerve palsy and subacute meningitis are more common. Children may also experience a loss of appetite, fatigue, or mood changes.

The neurological symptoms of Lyme disease typically appear in the early disseminated phase, which is when the bacteria from the tick have spread throughout the body. This can occur days or months after the initial tick bite.

However, neurological symptoms do not always indicate meningitis. Other possible symptoms of Lyme meningitis include:

If a person thinks that they or someone else might have Lyme meningitis, they should dial 911 immediately. They should tell the operator about any recent tick bites, even if they occurred several weeks ago.

Early treatment is essential for preventing serious complications, so if the symptoms of Lyme meningitis develop, it is vital not to delay seeking medical care.

Doctors estimate that about 15% of individuals with Lyme disease have nervous system involvement. However, only 6% of cases turn into meningitis.

According to the Centers for Disease Control and Prevention (CDC), there are approximately 30,000 cases of Lyme disease annually in the United States. However, some experts believe that the true incidence is much higher. Recent estimates suggest that close to 476,000 people get Lyme disease each year in the U.S.

Doctors may use various approaches to diagnosing Lyme meningitis, including:

  • taking a medical history
  • performing a physical exam to look for tick bites or a bull’s-eye rash
  • testing the blood for signs of Lyme disease
  • performing a lumbar puncture, also known as a spinal tap

However, diagnosing Lyme disease or Lyme meningitis poses certain challenges. Blood testing for neurologic Lyme disease is only 70–90% sensitive, meaning that some people with this condition do not test positive.

The same problem occurs with lumbar punctures. This procedure allows doctors to take a sample of cerebrospinal fluid, which may show signs of infection if a person has meningitis. However, not everyone with the condition tests positive.

Other tests that doctors can use may show:

  • an elevated erythrocyte sedimentation rate, which indicates inflammation
  • leukopenia, which refers to a low white blood cell count
  • thrombocytopenia, which refers to low platelet levels
  • brain changes, which a doctor can measure via medical imaging

A doctor may also take risk factors for Lyme disease into account when making a diagnosis. For example, they may ask the person whether they have recently been hiking in a high risk area.

Doctors are unlikely to diagnose Lyme meningitis in children if:

  • the headache has lasted less than 7 days
  • the cerebrospinal fluid has less than 70% mononuclear cells
  • there is an absence of Bell’s palsy or another cranial nerve palsy

The treatment for Lyme meningitis in adults and children consists of oral or IV antibiotics. According to the CDC, doctors typically use doxycycline or ceftriaxone, and the course lasts 14–21 days.

It is essential to finish the course of antibiotics that a doctor has prescribed, unless they say otherwise. Most people with Lyme disease respond well to antibiotics and make a full recovery.

However, people who do not receive treatment in the early stages may have long lasting effects.

When doctors treat Lyme disease meningitis early, there are not usually long-term effects. However, certain factors can prevent a person from getting treatment until a later stage. Examples include:

  • being unaware of a tick bite
  • late symptom onset
  • getting an incorrect diagnosis
  • antibiotic failure
  • immune system suppression
  • having other tick-borne diseases, such as ehrlichiosis or babesiosis

A person who undergoes treatment at a later stage of the disease may have permanent nervous system damage.

Another potential long-term effect is post-treatment Lyme disease syndrome. This is when a person has lingering symptoms long after the initial Lyme disease infection. These symptoms may include:

  • fatigue
  • pain
  • joint and muscle aches
  • cognitive difficulties, which people may refer to as “brain fog

Approximately 5% of people who get Lyme disease experience symptoms for 6 months or more following treatment. However, most people eventually recover without any long-term complications. Clinical outcomes are generally better in children than in adults.

Below, we answer some commonly asked questions about Lyme meningitis.

How long does Lyme meningitis last?

People usually recover from Lyme neuroborreliosis relatively quickly following effective treatment. Research suggests that about 63% of children recover within 4–6 weeks, and more than 97% recover within 12 weeks.

Is Lyme meningitis contagious?

No, there is no evidence that Lyme disease or Lyme meningitis can transmit between humans. However, in rare cases, it can pass from a person to a fetus during pregnancy.

Can you have Lyme meningitis without knowing?

If a person does not know that they received a tick bite and does not develop symptoms at an early stage, they may not realize that they have Lyme meningitis. It is also possible that a person may not test positive for the condition despite having it. However, in time, symptoms are likely to develop. As soon as a person notices symptoms, they should speak with a doctor.

Lyme meningitis is a rare form of meningitis that can develop if the bacteria that cause Lyme disease affect a person’s brain or spinal cord.

People who receive early treatment with antibiotics generally have a good outlook. However, without treatment, the condition can lead to permanent nerve damage and other severe complications.

Anyone who suspects that they have Lyme meningitis should consult a doctor as soon as possible for a diagnosis and treatment.