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:
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 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.
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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
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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%5Fsymptoms/index.html. Accessed November 11, 2021.
Revision Information
- Reviewer: EBSCO Medical Review Board David L. Horn, MD
- Review Date: 11/2021
- Update Date: 11/11/2021