Lyme disease symptoms vary from person to person. It depends on the stage of the infection. Some people may not have symptoms.

Early Infection

These symptoms often develop 3 to 30 days after a tick bite:

Rash

A red rash known as erythema migrans (EM) may develop. It starts as a small red spot at the site of the tick bite. The rash expands over a period of days or weeks. It becomes oval-shaped. The rash often looks like 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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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.

Flu-like Symptoms

Flu-like symptoms may develop. They may occur with or without the rash. They may include muscle and joint aches, headache, fever (a temperature of 100 to103°F or 37.7-39.4°C), stiff neck, swollen glands, and tiredness. These symptoms usually last about 5 to 21 days.

Early Widespread Infection

  • The rash may appear in several places on the body.
  • Arthritis—Joint pain may be the first symptom noticed. Stiffness and swelling may affect 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:
    • Bell’s palsy—Weakness and drooping of the face and eyelid on one side or both on both sides of the face
    • Low back pain
    • Wide-spread numbness, tingling, and burning
    • Problems with coordination, focusing, or sleeping
    • Lasting headache
    • Stiff neck
    • Mood changes
    • General weakness
  • Eye symptoms, such as watering, redness, blurred vision, swelling, or light sensitivity (less common)
  • Other symptoms, such as skin problems or heart abnormalities (less common)

Note: Early symptoms usually happen 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
  • Long term nervous system problems:
    • Memory problems, including dementia
    • Depression or other emotional problems
    • Sleep disorders
    • Nerve pain or problems
  • Long term skin problems—such as thinning, thickening, or color changes to the skin, usually of the hands and feet
REFERENCES:

Lyme disease. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/lyme-disease. Accessed November 11, 2021.

Lyme disease symptoms. Lyme Disease.org website. Available at: https://www.lymedisease.org/lyme-basics/lyme-disease/symptoms. Accessed November 11, 2021.

Ross Russell AL, Dryden MS, et.al. Lyme disease: diagnosis and management. Pract Neurol. 2018;18(6):455-464.

Signs and symptoms of untreated lyme disease. Centers for Disease Control and Prevention website. Available at: https://www.cdc.gov/lyme/signs_symptoms/index.html. Accessed November 11, 2021.

Last reviewed November 2021 by EBSCO Medical Review Board David L. Horn, MD  Last Updated: 11/11/2021