References

The symptoms, and the research behind them

Every symptom listed below appears in the published medical literature. Each disease section links to peer-reviewed articles on PubMed, the US National Library of Medicine's research database, so you can read the source yourself or share it with your doctor.

Lyme disease (Lyme borreliosis)

Borrelia burgdorferi and related species

Lyme can affect the skin, joints, nerves, brain and heart. The papers below describe the recognised clinical picture, the limits of testing, and persisting symptoms after treatment.

Reported symptoms

  • Expanding rash (erythema migrans) — absent in a large share of cases
  • Flu-like illness, fever, headache, neck stiffness
  • Migrating joint pain and swelling (Lyme arthritis)
  • Facial palsy, nerve root pain, tingling or burning in hands and feet
  • Memory and concentration problems, brain fog
  • Palpitations, chest pain, fainting (Lyme carditis)
  • Profound fatigue and pain continuing after antibiotics (PTLDS)

Published articles (14)

  1. Lyme borreliosisNat Rev Dis Primers · 2026 · PMID 41888159
  2. Lyme borreliosisLancet · 2012 · PMID 21903253
  3. Lyme borreliosis: diagnosis and managementBMJ · 2020 · PMID 32457042
  4. Guidelines for Lyme borreliosis: clinical manifestationsInfect Dis Now · 2025 · PMID 41319868
  5. Lyme Disease in HumansCurr Issues Mol Biol · 2021 · PMID 33303701
  6. Recent Progress in Lyme Disease and Remaining ChallengesFront Med · 2021 · PMID 34485323
  7. Clinical Practice Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease (IDSA/AAN/ACR)Clin Infect Dis · 2021 · PMID 33483734
  8. Erythema migransInfect Dis Clin North Am · 2015 · PMID 25999220
  9. Erythema migransInfect Dis Clin North Am · 2008 · PMID 18452799
  10. Lyme ArthritisInfect Dis Clin North Am · 2022 · PMID 36116835
  11. Lyme arthritis: linking infection, inflammation and autoimmunityNat Rev Rheumatol · 2021 · PMID 34226730
  12. Lyme Carditis: From Pathophysiology to Clinical ManagementPathogens · 2022 · PMID 35631104
  13. Lyme carditisInfect Dis Clin North Am · 2008 · PMID 18452801
  14. Lyme carditis in EuropeFront Microbiol · 2026 · PMID 42597415

Neurological Lyme (neuroborreliosis)

Borrelia in the nervous system

When Borrelia reaches the nervous system the symptoms can look neurological or psychiatric rather than infectious.

Reported symptoms

  • Facial (Bell's) palsy, double vision, other cranial nerve signs
  • Severe radiating nerve pain, often worse at night
  • Numbness, tingling and burning in the limbs
  • Headache with neck stiffness
  • Cognitive slowing, word-finding difficulty, poor memory
  • Dizziness, unsteadiness, tremor

Published articles (5)

  1. Clinical and epidemiological features of Lyme neuroborreliosis in adultsSci Rep · 2023 · PMID 37964035
  2. Lyme Neuroborreliosis in ChildrenBrain Sci · 2021 · PMID 34200467
  3. Neuroborreliosis: unusual clinical presentation and imaging featuresJ Neurosci Rural Pract · 2023 · PMID 36891091
  4. Tick-induced neurological disordersJ Neurol · 2025 · PMID 40879811
  5. Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease — neurological aspectsNeurology · 2021 · PMID 33257476

Lingering symptoms after treatment (PTLDS)

Post-treatment Lyme disease syndrome

A significant group of people remain unwell after standard antibiotics. These papers describe that pattern and the research into why it happens.

Reported symptoms

  • Disabling fatigue not relieved by rest
  • Widespread musculoskeletal pain
  • Measurable decline in memory and processing speed
  • Unrefreshing sleep
  • Symptoms that flare and remit in cycles

Published articles (5)

  1. Guidelines for Lyme borreliosis: post-treatment Lyme disease syndrome (PTLDS)Infect Dis Now · 2025 · PMID 41314472
  2. A Review of Post-treatment Lyme Disease Syndrome and Chronic Lyme DiseaseClin Rev Allergy Immunol · 2022 · PMID 34687445
  3. What Makes It Tick: Exploring the Mechanisms of Post-treatment Lyme Disease SyndromeCureus · 2024 · PMID 39161484
  4. Cognitive Decline in Post-treatment Lyme Disease SyndromeArch Clin Neuropsychol · 2019 · PMID 29945190
  5. Reassessing Chronic Lyme Disease and PTLDS as Focal InfectionsCureus · 2025 · PMID 41024925

Why Lyme testing can miss the infection

Laboratory diagnosis

Standard antibody testing is indirect and its accuracy varies with the stage of illness and the test used — one reason a negative result does not settle the question.

Reported symptoms

  • Negative antibody test early in infection, before antibodies develop
  • Results that differ depending on which first-tier test the lab uses
  • False positive IgM results causing confusion
  • Differences between Borrelia species affecting test performance

Published articles (5)

  1. Laboratory Diagnosis of Lyme BorreliosisClin Microbiol Rev · 2021 · PMID 33504503
  2. Guidelines for Lyme borreliosis: diagnostic strategiesInfect Dis Now · 2025 · PMID 41314468
  3. Two-Tier Lyme Disease Serology Test Results Can Vary According to the Specific First-Tier Test UsedJ Pediatric Infect Dis Soc · 2020 · PMID 30793167
  4. False Positive Lyme Disease IgM Immunoblots in ChildrenJ Pediatr · 2016 · PMID 27157898
  5. Values of diagnostic tests for the various species of spirochetesMed Mal Infect · 2019 · PMID 30765286

Babesiosis

Babesia spp.

A malaria-like parasite of the red blood cells, carried by the same ticks as Borrelia. Co-infection is linked with more severe illness.

Reported symptoms

  • Drenching night sweats and chills
  • Air hunger — needing to sigh or yawn to catch a breath
  • High fever and severe headache
  • Deep fatigue and weakness
  • Anaemia, dark urine, enlarged spleen

Published articles (7)

  1. Human BabesiosisInfect Dis Clin North Am · 2022 · PMID 36116841
  2. Human babesiosisInt J Parasitol · 2019 · PMID 30690090
  3. Human babesiosisEpidemiol Mikrobiol Imunol · 2023 · PMID 37871992
  4. Human babesiosisAnn Trop Med Parasitol · 1998 · PMID 9683900
  5. Babesia microti Subverts Adaptive Immunity and Enhances Lyme Disease SeverityFront Microbiol · 2019 · PMID 31354683
  6. Investigating disease severity in an animal model of concurrent babesiosis and Lyme diseaseInt J Parasitol · 2019 · PMID 30367867
  7. Diagnosis, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis: A ReviewJAMA · 2016 · PMID 27115378

Bartonellosis

Bartonella spp.

Bartonella is well documented as a cause of neurological, eye, skin and psychiatric symptoms — a pattern often mistaken for a mental health diagnosis.

Reported symptoms

  • Stretch-mark-like skin streaks and other rashes
  • Sore soles, especially on first steps in the morning
  • Anxiety, irritability, rage, mood swings
  • Tics, tremors and other neurological signs
  • Blurred or lost vision (neuroretinitis), eye inflammation
  • Swollen lymph nodes and low-grade fever
  • Memory and concentration decline

Published articles (9)

  1. Clinical Manifestations Associated with Bartonella henselae Infection in a Tropical RegionAm J Trop Med Hyg · 2021 · PMID 33021197
  2. The expanded spectrum of bartonellosis in childrenInfect Dis Clin North Am · 2005 · PMID 16102656
  3. Cutaneous manifestations of bartonellosisAn Bras Dermatol · 2019 · PMID 31780437
  4. Peripheral neurological involvement due to Bartonella henselae in an immunocompetent adolescentDiagn Microbiol Infect Dis · 2026 · PMID 42127721
  5. Bartonella spp. infection in people with Mild Cognitive Impairment: a pilot studyPLoS One · 2024 · PMID 39172940
  6. Schizophrenia and Bartonella spp. Infection: A Pilot Case-Control StudyVector Borne Zoonotic Dis · 2021 · PMID 33728987
  7. Ocular BartonellosisMayo Clin Proc · 2017 · PMID 28778273
  8. The clinical spectrum of ocular bartonellosisJ Ophthalmic Inflamm Infect · 2020 · PMID 33191467
  9. Child Neurology: Bartonella henselae Neuroretinitis in 2 PatientsNeurology · 2022 · PMID 35351795

Anaplasmosis & ehrlichiosis

Anaplasma, Ehrlichia

Acute, sometimes dangerous tick-borne bacterial infections that present as a severe flu with abnormal blood counts.

Reported symptoms

  • High fever, chills and sweats
  • Severe headache and muscle pain
  • Nausea, vomiting, loss of appetite
  • Confusion or other neurological symptoms
  • Low white cells and platelets, raised liver enzymes

Published articles (5)

  1. Human granulocytic anaplasmosisInfect Dis Clin North Am · 2008 · PMID 18755383
  2. Epidemiological, clinical, and laboratory characteristics of human granulocytic anaplasmosisJ Clin Microbiol · 2024 · PMID 38329335
  3. Anaplasmosis (StatPearls review)StatPearls · 2023 · PMID 30020713
  4. Neurological manifestations of ehrlichiosis among a cohort of patientsBMC Infect Dis · 2024 · PMID 39020279
  5. Dermatoses from ticksJ Am Acad Dermatol · 2003 · PMID 12963900

Mycoplasma

Mycoplasma spp.

A stealth bacterium without a cell wall, studied both as a respiratory pathogen with wide-ranging effects outside the lungs and in chronic fatigue research.

Reported symptoms

  • Persistent fatigue and post-exertional worsening
  • Joint and muscle pain
  • Chronic cough, sinus and chest symptoms
  • Skin rashes and mucosal involvement
  • Neurological symptoms including headache and encephalitis in some cases

Published articles (6)

  1. Classification of Extrapulmonary Manifestations Due to Mycoplasma pneumoniae InfectionFront Microbiol · 2016 · PMID 26858701
  2. Epidemiology, clinical manifestations, pathogenesis and laboratory detection of Mycoplasma pneumoniae infectionsFEMS Microbiol Rev · 2008 · PMID 18754792
  3. Mycoplasma pneumoniae and its role as a human pathogenClin Microbiol Rev · 2004 · PMID 15489344
  4. Insight into the Pathogenic Mechanism of Mycoplasma pneumoniaeCurr Microbiol · 2022 · PMID 36459213
  5. Detection of Mycoplasma genus and Mycoplasma fermentans by PCR in patients with Chronic Fatigue SyndromeFEMS Immunol Med Microbiol · 1998 · PMID 9879928
  6. Absence of antibody to Mycoplasma fermentans in patients with chronic fatigue syndromeClin Infect Dis · 1993 · PMID 8110942

Heavy metal toxicity

Mercury, lead and other metals

Metal exposure produces neurological and cognitive symptoms that overlap heavily with chronic tick-borne illness, and can keep people unwell when infection alone is treated.

Reported symptoms

  • Brain fog, poor memory and concentration
  • Tremor and unsteady coordination
  • Numbness and tingling in hands and feet
  • Mood change, irritability, anxiety
  • Hearing changes and tinnitus
  • Persistent fatigue and headache

Published articles (4)

  1. The toxicology of mercuryCrit Rev Clin Lab Sci · 1997 · PMID 9288445
  2. Informal gold miners with mercury toxicity: novel asymmetrical neurological presentationsS Afr Med J · 2023 · PMID 38525630
  3. Lead exposure-induced cognitive impairment through RyR-modulating intracellular calcium signallingToxicology · 2019 · PMID 30905827
  4. Ototoxicity of Divalent MetalsNeurotox Res · 2016 · PMID 27142062

Mould & biotoxin illness

Damp indoor environments, mycotoxins

Damp and mould exposure is linked with fatigue, respiratory and inflammatory symptoms, and is one of the most common reasons recovery stalls.

Reported symptoms

  • Fatigue that improves away from the building
  • Blocked nose, sinus problems, cough, wheeze
  • Recurrent respiratory infections
  • Headache and brain fog
  • Itchy eyes and skin, allergy-like reactions

Published articles (5)

  1. Exposure and Health Effects of Fungi on HumansJ Allergy Clin Immunol Pract · 2016 · PMID 26947460
  2. Fatigue and exposure to mold and/or dampness: a systematic reviewEnviron Anal Health Toxicol · 2025 · PMID 41265402
  3. Exposure to residential mold and dampness and associations with respiratory tract infections and symptomsPaediatr Respir Rev · 2023 · PMID 37482434
  4. AWMF mould guideline "Medical clinical diagnostics for indoor mould exposure" — update 2023Allergol Select · 2024 · PMID 38756207
  5. Understanding Mycotoxin-induced Illness: Part 1Altern Ther Health Med · 2022 · PMID 36069791

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These references are provided for information only. They are not a diagnosis and do not replace advice from a qualified clinician.