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Lyme disease symptoms will differ between people depending on the stage of the infection. In some, symptoms may not be present.

Early Infection

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

Rash

A hallmark symptom of Lyme disease is 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 4 weeks.

Lyme Disease Rash


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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°F or 37.7-39.4°C), 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 or both on both sides of the face—Bell’s palsy
    • 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 symptoms, such as watering, redness, blurred vision, swelling, or light sensitivity (less common)
  • Other nonspecific symptoms, such as skin problems or heart abnormalities (less common)

Note: All symptoms of early manifestation usually occur with the first rash or within about 6 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:
    • Memory problems, including dementia
    • Depression or other emotional problems
    • Sleep disorders
    • Nerve pain or problems
  • Chronic skin problems—can include thinning, thickening, or discoloration of the skin, usually of the hands and feet

References:

A history of Lyme disease, symptoms, diagnosis, treatment, and prevention. National Institute of Allergy and Infectious Diseases website. Available at: http://www.niaid.nih.gov/topics/lymeDisease/Pages/history.aspx. Updated March 29, 2011. Accessed September 26, 2012.

Lyme disease. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114365/Lyme-disease. Updated August 15, 2016. Accessed October 6, 2016.

Lyme disease symptoms. Lyme Disease website. Available at: https://www.lymedisease.org/lyme-basics/lyme-disease/symptoms. Accessed September 26, 2012.

Signs and symptoms of untreated lyme disease. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/lyme/signs_symptoms/index.html. Updated July 26, 2012. Accessed September 26, 2012.



Last reviewed November 2015 by David L. Horn, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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