Relevance. Despite the good prognosis in patients with erythema migrans (EM), chronic, torpid forms of Lyme disease develop in some patients, including the cases after the course of causal antibiotic therapy. Clinical outcome of EM can be affected by a number of factors, including interaction between Borrelia burgdorferi and the host immune system, genotype of B. burgdorferi, and antibiotic resistance. In this study, we investigated the characteristic features of clinical course, innate and adaptive immune response in EM patients to determine the prognosis and choose the direction of pathogenetic therapy. Objective. The objective of the investigation is to study the features of innate and adaptive immunity in patients with erythema migrans and determine their diagnostic significance. Material and methods. Examination of 37 adult EM patients included the study of phagocytic activity of blood neutrophils; expression of TLRs in the peripheral blood mononuclear leukocytes (PBML) and skin cells in the foci of erythema migrans by flow cytometry using mAb to TLR2, TLR3, TLR4, TLR5, TLR6, TLR7, TLR8, TLR9 («Catalog Laboratories», USA) using FC-500 flow cytometer («Beckman Coulter», USA); subpopulation composition of peripheral blood lymphocytes; the levels of proinflammatory, anti-inflammatory, and regulatory cytokines in the serum by ELISA using Biosource test systems (Austria); major immunoglobulin classes (IgG, IgM, IgA) in the blood serum. Results. The patients with erythema migrans demonstrated high levels of TLR2, TLR4, TLR7, and TLR8 expression on the skin cells in the foci, TLR2,4 expression on blood cells; low levels of CD95 + and CD25+, high serum levels of IL-1b, IL-2, and IL-4, and high total IgE. Conclusion. These data indicate that the overexpression of TLR2 and TLR4 in PBML and skin cells in EM foci is a marker of active infection process caused by Borrelia burgdorferi in EM patients. In EM patients, IL-4 and IL-5 levels correlate with the severity of the early stage of Lyme disease.