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Table 1 Clinical case definitions for Lyme borreliosis, mainly* adapted from Stanek et al . [ 1 ]

From: Physician reported incidence of early and late Lyme borreliosis

Erythema migrans Expanding red or bluish-red patch (= > 5 cm in diameter), with or without central clearing. Advancing edge typically distinct, often intensely coloured, not markedly elevated. If <5 cm in diameter a history of tick-bite, a delay in appearance (after the tick bite) of at least 2 days and an expanding rash at the site of the tick-bite is required.
Disseminated lyme borreliosis
Borrelial lymphocytoma Painless bluish-red nodule or plaque, usually on ear lobe, ear helix, nipple or scrotum. More frequent in children (especially on ear) than in adults.
Acrodermatitis chronica atrophicans Long-standing red or bluish-red lesions, usually on the extensor surfaces of extremities. Initial doughy swelling. Lesions eventually become atrophic. Possible skin induration and fibroid nodules over bony prominences.
Lyme neuroborreliosis In adults, mainly meningo-radiculitis, meningitis. Rarely encephalitis, myelitis, neuritis, cerebral vasculitis, Bannwarth’s syndrome: painful radiculitis, lymphocytic meningitis with facial nerve palsies. In children, mainly meningitis and facial palsy.
Lyme arthritis Recurrent attacks or persisting objective joint swelling in one or a few large joints. Alternative explanations must be excluded.
Lyme carditis Acute onset of atrio-ventricular (I–III) conduction disturbances, rhythm disturbances, sometimes myocarditis or pancarditis. Alternative explanations must be excluded.
Ocular manifestations Conjunctivitis, uveitis, papillitis, episcleritis, keratitis.
Persisting symptoms attributed to lyme borreliosis
Lyme encephalopathy Chronic brain syndrome attributed to Lyme borreliosis: impaired memory, concentration, word finding, and sleep; increased fatigue, sensory irritability, emotional lability, headache and depression.
Persisting symptoms Persisting symptoms attributed to Lyme borreliosis after treatment, with or without active Borrelia infection.
  1. *Additional case definitions for ‘persisting symptoms attributed to Lyme borreliosis’, which were not proposed by Stanek et al. [1], are indicated with Italic printing in this table, as well as modifications in the case definition for ‘Lyme neuroborreliosis’.