Late persistent Lyme disease

Alternative names
Tertiary Lyme disease; Stage 3 Lyme disease; Lyme disease - chronic persistent; Chronic Lyme disease

Chronic persistent Lyme disease is a late stage of an inflammatory disease caused by the bacterium Borrelia burgdorferi, which is transmitted by the bite of a deer tick.

Causes, incidence, and risk factors

Tertiary Lyme disease occurs months to years after the initial infection (see Lyme disease for more information). Symptoms include skin, neurological, and musculoskeletal manifestations.


  • joint inflammation in the knees and other large joints  
  • chronicarthritis  
  • memory loss  
  • mood changes  
  • sleep disorders

Additional symptoms that may be associated with this disease:

  • numbness and tingling  
  • consciousness, decreased  
  • confusion  
  • abnormal sensitivity to light

Signs and tests

  • An ELISA shows antibodies to Borrelia burgdorferi. A Western blot test is done to confirm ELISA results.  
  • A spinal tap will be abnormal if central nervous signs are present.


The objective of treatment is to eliminate the infection by antibiotic therapy. A high dose of penicillin or ceftriaxone is usually required in the late stages of the disease to treat the infection.

Expectations (prognosis)

Symptoms of arthritis may fail to resolve with treatment. Other symptoms should improve with treatment.


  • continued arthritis

Calling your health care provider

Call your health care provider if symptoms develop - particularly if you have had Lyme disease before, or live or travel in high-risk areas.


Early diagnosis and appropriate antibiotic treatment for primary Lyme disease is the most effective way to prevent tertiary Lyme disease.

Johns Hopkins patient information

Last revised: December 5, 2012
by Potos A. Aagen, M.D.

Medical Encyclopedia

  A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z | 0-9

All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.