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

Copyright © Nucleus Medical Media, Inc.

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 2018 by David L. Horn, MD  Last Updated: 12/20/2014