Comparison of Lyme Disease in the United States and Europe

Adriana R. Marques; Franc Strle; Gary P. Wormser


Emerging Infectious Diseases. 2021;27(8):2017-2024. 

In This Article


Lyme disease is common in many areas of the United States and Europe and may have a variety of clinical manifestations. The duration of infection and the species of Lyme borrelia causing the infection can affect the clinical features of Lyme disease. In the United States, patients with erythema migrans more often have concomitant systemic symptoms than do patients in Europe. In Europe, Lyme arthritis is associated with B. burgdorferi s.s. and Lyme neuroborreliosis with B. garinii. Certain cutaneous manifestations of Lyme disease in Europe do not occur at all in the United States. It will be valuable to delineate the specific virulence factors of the different species of Lyme borrelia that contribute to these clinical differences.