Lyme disease, Epstein-Barr, and long COVID
Tick-borne co-infections, EBV reactivation, post-COVID condition
Chronic conditionThree infections that can leave lasting symptoms. Each is diagnosed in its own way, and the evidence for long-term effects differs for each.
Medical Disclaimer
For education only — this guide can't diagnose you. If these signs sound familiar, talk with a healthcare provider. Book a consult
What happens
Lyme disease spreads through deer tick bites. It often starts with an expanding rash and flu-like illness, and it can later affect the joints, nerves, or heart. The same ticks can carry babesiosis and anaplasmosis. Antibiotics cure most Lyme cases, but some people have fatigue, pain, or brain fog for months, which is recognized as post-treatment Lyme disease syndrome. 'Chronic Lyme' with no evidence of ongoing infection is debated, and long antibiotic courses haven't helped in trials. Epstein-Barr virus (EBV) causes mono and then stays dormant in nearly everyone. Antibody results can stay high for years, so they can't reliably show 'reactivation' as a cause of fatigue. Long COVID is a recognized condition in which symptoms last 3 months or more after COVID-19.
Who gets it
Lyme risk depends on tick exposure in areas such as the Northeast, mid-Atlantic, and upper Midwest. Most adults have had EBV. Long COVID is more common in women, especially in midlife, and vaccination lowers the risk.
Signs worth getting checked
- An expanding red rash, sometimes with a clear center, after a tick bite
- Fever, chills, and aches in the weeks after a tick bite
- Swollen, painful joints, often a knee
- Facial droop, numbness, or heart palpitations
- Fatigue and a crash after effort
- Brain fog and trouble with memory or focus
- Shortness of breath, or a racing heart when standing
- Sore throat and swollen lymph nodes during mono
Labs to ask about
- Two-tier Lyme blood testing, which can be negative in the first few weeks
- A blood smear or PCR for babesiosis and anaplasmosis if you have fever after a tick bite
- EBV antibody panel (VCA IgM and IgG, and EBNA) when the timing of infection matters
- CBC, metabolic panel with liver enzymes, and CRP
- TSH, ferritin, B12, and vitamin D to look for other causes of fatigue
- A 10-minute standing test, ECG, or breathing tests for long COVID symptoms
Treatments your doctor may discuss
- A standard course of antibiotics, often doxycycline, for confirmed Lyme disease
- Specific medicines for babesiosis or anaplasmosis when confirmed
- Rest and fluids for mono. Antivirals haven't been shown to help EBV-related fatigue.
- Pacing and treating symptoms such as POTS, sleep problems, and pain in long COVID
- Care from a long COVID clinic or specialist for complex symptoms
Supportive steps to discuss with your provider
- Prevent tick bites with repellent, long sleeves, and daily tick checks.
- Remove an attached tick with fine tweezers, and note the date.
- Ask what a test can and can't show before paying for specialty Lyme or EBV panels.
- Be cautious about long-term antibiotics without clear evidence of infection. They carry real risks.
- Track activity and symptoms to find your limits, and stay current on COVID-19 vaccines.
See a doctor promptly if you have
- Chest pain, fainting, or severe shortness of breath: call 911
- Fever with a stiff neck, severe headache, or confusion: call 911
- Sharp pain in the upper left abdomen during or after mono: go to the emergency room
- An expanding rash, fever, facial droop, or palpitations after a tick bite: get same-day care
- Symptoms lasting more than 3 months after an infection
Related conditions
Ready to find the root cause?
Dr. Lesher is a Naturopathic Doctor who focuses on autoimmune and chronic conditions in women. Since 2020, she's helped hundreds of patients stop managing symptoms and start healing.