Which debilitating disease robbed Shania Twain of her voice?

15 years ago, singer Shania Twain was everywhere.

You could barely turn on MTV or pick up an entertainment magazine without seeing her dynamic smile, sexy outfits and gorgeous hair. Then suddenly she was gone. What happened?

According to Twain, plenty happened, including a 2010 divorce from her producer-husband and a debilitating battle with Lyme disease that she caught in 2003. Twain’s struggle with Lyme disease is in the news now because the 52-year-old performer just released a new album.

In interviews, Twain has been candid about the pain and fear she experienced with Lyme disease. “It can kill you,” Twain told the Associated Press. “And if it doesn’t kill you, it can give you a seriously degenerated quality of life.”

One of the most horrifying characteristics of Lyme disease is that it’s often difficult to diagnose because symptoms mimic those of other illnesses. The bacterial infection comes from the bite of an infected blacklegged tick. Often, people don’t even know they were bitten.

Twain thinks her offending bug caught up with her in Norfolk, Va., when she was on tour in 2003-04 for what would be the last album she would put out for 15 years. She remembers that afterward, she began having dizzy spells, nearly falling off stage at times, and her voice grew weaker and weaker — not good for the top-selling female country singer of all time.

Dr. Deborah Schiappa, an infectious disease physician at Advocate Good Shepherd Hospital in Barrington, Ill., says symptoms early in the disease may include a bull’s eye rash, joint pain and nonspecific symptoms that mimic a viral syndrome. Later symptoms may include heart block, meningitis, Bell’s palsy, numbness or tingling in a limb, swelling and pain in the knee or other joints or chronic skin changes.

“Diagnosis usually requires a history of exposure to ticks with typical clinical symptoms and confirmation with blood testing,” Dr. Schiappa says, adding that treatment depends on the stage of the disease.

For Twain, the diagnosis didn’t come immediately, and when it did, the treatment didn’t erase all of her symptoms. Among other things, she still couldn’t sing. It was a neurologist who figured out that her lost singing voice (dysphonia) had succumbed to Lyme disease.

Symptoms such as headache, fatigue and joint pain can persist for months after treatment.

“There is no clear evidence that these persistent complaints represent ongoing active infection or that repeated or prolonged courses of antibiotics beyond what is recommended by the Infectious Diseases Society of America guidelines provide any benefit,” Dr. Schiappa says.

People living in or visiting the upper Midwest, New England and mid-Atlantic states are at greatest risk for Lyme disease, according to the Centers for Disease Control and Prevention, which estimates 300,000 infections annually. The ticks that cause Lyme disease live in moist and humid environments, particularly in and near wooded or grassy areas.