Symptoms of Lyme Disease

by Amy Scholten, MPH

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

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

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