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Symptoms of Lyme Disease by Editorial Staff And Contributors

The symptoms of Lyme disease can be confusing and differ among infected persons both in their nature and in their severity. Some people may not have any symptoms at all, but Lyme disease may still be diagnosed through a blood test.

Lyme disease progresses through different stages with varying and sometimes overlapping symptoms. Symptoms include the following:

Early Infection

These symptoms typically occur within 3-32 days of a tick bite.

Rash

Many infected people first notice a red rash, known as erythema migrans (EM). The rash starts as a small red spot at the site of the tick bite and expands over a period of days or weeks, forming a circular- or oval-shaped rash. The rash often resembles a bull’s eye: a red ring surrounding a clear or bluish area with a red center. The size of the rash can range from dime-sized to the entire width of a person’s back. More than one ring may develop. Typically, the rash goes away within four weeks.

Lyme Disease Rash

Although Lyme disease is often associated with this rash, many people do not have the rash right away or at all. Or they may have a red rash, without the bull's eye pattern. If you have other symptoms that you think might be due to Lyme disease, see your doctor; do not wait for a rash to appear.

Flu-like Symptoms

Muscle and joint aches, headache, fever (a temperature of 100-103 degrees Farenheit [37.7-39.4 degrees Celsius]), stiff neck, swollen glands, and fatigue may occur with or without the rash. These symptoms usually last about 5-21 days.

Early Widespread Infection

Multiple EM lesions—The rash may appear in several places on the body.
Arthritis—Sometimes joint pain is the first symptom that is noticed. Other joint problems include stiffness and swelling, particularly in the large joints, such as the knee, elbow, and shoulder.
Nervous system problems—The bacteria can affect the brain, spinal cord, and other nerves of the body. Symptoms of this include:
- Weakness and drooping of the face and eyelid on one side (Bell’s palsy)—It may also occur on both sides of the face.
- Low back pain
- Wide-spread numbness, tingling, and burning
- Impaired motor coordination
- Persistent headache
- Stiff neck
- Mood changes
- Difficulty concentrating or sleeping
- Generalized weakness
Eye problems—such as conjunctivitis (redness and inflammation)
Other body systems—Affected areas may include the heart, liver, lymph nodes, testes, and eyes.

Note: All symptoms of early manifestation usually occur with the first rash or within about six weeks of it. They may go away on their own within a few weeks or months.

Late Infection

Joint pain—painful inflammation of the joints, as well as intermittent or chronic arthritis
Chronic nervous system problems—These may include:
- Memory problems, including dementia
- Depression or other emotional problems
- Sleep disorder
- Nerve pain or problems
Chronic skin problems—can include thinning, thickening, or discoloration of the skin, usually of the hands and feet

References:

Signs and symptoms lyme disease. Centers for Disease Control and Prevention (CDC). Available at: http://www.cdc.gov/lyme/signs_symptoms/index.html. Updated July 26, 2012. Accessed September 26, 2012.
Lyme disease. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated June 29, 2012. Accessed September 26, 2012.
Lyme disease. lymedisease.org. Available at: http://www.lymedisease.org/lyme101/lyme_disease/lyme_disease.html. Accessed September 26, 2012.
Lyme disease. National Institute of Allergy and Infectious Diseases website. Available at: http://www.niaid.nih.gov/topics/lymeDisease/understanding/Pages/intro.aspx. Updated March 29, 2011. Accessed September 26, 2012.

Last reviewed October 2012 by Michael Woods, MD

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