Common and Unusual Symptoms of Lyme Disease

You can get Lyme disease after you are bitten by a tick, usually a deer tick, that is infected with the Borrelia burgdorferi bacteria if the tick isn't removed before 48 to 72 hours. Symptoms of infection can vary and depend on the disease stage.

Early common symptoms include:

  • A rash called erythema migrans
  • Fever
  • Headache
  • Chills
  • Fatigue
  • Joint pain

If left untreated, some people may present with unusual symptoms of Lyme disease, such as heart inflammation, irregular heartbeat, weakness, pain, sensory symptoms, and problems with memory or concentration. This article discusses the signs and symptoms of Lyme disease, as well as possible complications of infection.

lyme disease symptoms
Illustration by Joshua Seong. © Verywell, 2018. 

Common Symptoms

The first symptom of early Lyme disease is often the classic rash that most people are familiar with called erythema migrans. However, it's important to be aware of all the symptoms of Lyme disease since they can be different for each individual.

Erythema Migrans

This circular rash occurs at the site of the tick bite, about seven to 14 days after you've been bitten, although it may begin as early as three days or as late as 30 days after the tick bite. Erythema migrans occurs in about 90% of people infected with Lyme disease.

Because the rash looks different depending on the person and the stage of the disease, it's a good idea to have your primary care provider look at any suspicious rash. If you live in an area where ticks abound and/or Lyme disease is common, it's even more important to be aware of any unusual rashes.

This erythema migrans rash may be described as:

  • Having the typical red outside ring with a dark purple clearing between the area
  • Having a red outside ring, a red center, and a purplish-tinted clearing between the area
  • Having a red outside ring, the red "bullseye" in the center, and a clear area between the two (This is an advanced rash and most likely started out much smaller and looking less like a bullseye.)
  • Being itchy, warm, and sometimes painful
  • Gradually expanding to a size of 7 to 14 inches
  • Lingering for about two weeks

Flu-Like Symptoms

Other Lyme disease symptoms may resemble the flu and can include:

  • Fever
  • Myalgia (muscle aches)
  • Chills
  • Headaches
  • Fatigue
  • Joint pain (arthralgia)
  • Swollen lymph nodes (lymphadenopathy)

Although these symptoms may resemble those of common viral infections, Lyme disease symptoms can persist or may come and go.

Rare Symptoms

Less commonly, if Lyme disease goes untreated, the infection may spread from the bite location to other parts of the body—such as the nervous system or heart. When this happens, you may develop other symptoms and complications weeks, months, or even years after infection.

Neurological Issues

Lyme disease can affect your nervous system, causing a variety of symptoms such as:

  • Temporary paralysis of facial muscles in which one side of the face droops (Bell’s palsy)
  • Nerve pain
  • Numbness, shooting pains, or tingling in the hands or feet
  • Poor muscle movement or weakness
  • Hearing loss

More subtle changes have also been associated with untreated Lyme disease such as:

  • Memory loss
  • Difficulty concentrating
  • Mental fogginess
  • Change in mood or sleep habits
  • Severe fatigue

Nervous system problems can develop weeks, months, or even years following an untreated infection. These symptoms occur in approximately 10% to 12% of people and often last for weeks or months.

Ocular Symptoms

Lyme disease can also cause eye inflammation and visual disturbances such as:

  • Sensitivity to light
  • Color vision loss
  • Blurred vision
  • Double vision

Heart Problems

Around 1% of people with Lyme disease develop heart problems, which may indicate Lyme carditis—a cause of heart block. With treatment, this condition rarely lasts more than a few days or weeks. Symptoms of Lyme carditis include:

Skin Symptoms

If left untreated, the infection can spread from the bite location to other areas of the skin. When this happens, you may develop:

  • Multiple erythema migrans rashes (distant from the tick bite site)
  • Small oval rashes that don't change in size (often on the face and limbs)
  • A bluish-red lump (known as borrelial lymphocytoma)

Complications

Rare but serious complications can occur if your Lyme disease isn't treated. These can develop days to months after you've been bitten by a tick.

Arthritis

After several months of B. burgdorferi infection, 30% to 60% of people not treated with antibiotics develop recurrent attacks of painful and swollen joints that last a few days to a few months—a condition known as Lyme arthritis. The arthritis can shift from one joint to another. The knee is commonly affected, but other large joints such as the shoulder, elbow, jaw, wrist, hip and ankle may also be affected.

Meningitis

When Borrelia bacterium spreads through the lymphatic system to the brain and spinal cord, it can lead to meningitis. Lyme meningitis can cause fever, headache, stiff neck, and extreme sensitivity to light.

Hepatitis

Some people with Lyme disease have liver function abnormalities. Although not common, chronic infection can also lead to hepatitis (inflammation of the liver).

Skin Changes

If you were bit by a tick in Europe, untreated Lyme disease can lead to permanent skin changes, particularly on the hands and feet. The skin can start to harden and shrink, forming deep lines. In very rare cases, chronic infection can lead to the growth of skin tumors—an uncommon type of skin cancer known as cutaneous B-cell lymphoma.

When to See a Healthcare Provider

Keep in mind that not all people have all of the classic Lyme disease symptoms, which makes it important to see your practitioner if you develop a rash or fever following a tick bite, especially if you live in or visited an area where there are a lot of Lyme disease cases. In the United States, this includes the Northeast, Mid-Atlantic, or north-central states.

Lyme Disease Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

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Even in hyperendemic areas (places where there are a lot of Lyme disease cases), the risk of developing Lyme disease is usually estimated to only be 3.5% at the most. It's so low because even though up to 50% of ticks in endemic areas are infected with the bacteria that causes Lyme disease, most people remove ticks before the bacteria has had enough time to infect them.

Simple blood tests, which sometimes must be repeated to rule out infection, can give you and your family peace of mind.

If you do have Lyme disease, infection is normally easily treated with common antibiotics. The earlier you're treated for Lyme disease, the better, but even later stage cases usually respond well to medication.

Some people who receive treatment for Lyme disease continue to have symptoms for more than 6 months after completing their course of antibiotics. This condition is known as post-treatment Lyme disease syndrome (PTLDS). Those with PTLDS may experience fatigue, pain, brain fog, muscle aches, sensory issues, and cardiac effects. It's still unclear why this occurs. However, symptoms usually improve over time.

Summary

Symptoms of Lyme disease can vary widely from person to person. Typical early symptoms of infection include fever, headache, chills, fatigue, and a characteristic rash called erythema migrans. If left untreated, infection can spread to other parts of the body, causing rare symptoms and serious complications. This may include heart inflammation, weakness, arthritis, sensory symptoms, meningitis, and cognitive problems.

If you develop a rash or fever following a tick bite, it's important to see a healthcare provider right away.

A Word From Verywell

Early diagnosis and treatment is vital to prevent Lyme disease from progressing through later stages—which can lead to rare but serious complications. By understanding the various signs and symptoms of Lyme disease, you will be better equipped to identify a possible infection and seek out the appropriate medical care.

Some people think once you've been infected with Lyme disease, you can't be infected again, which is untrue. That is why it's important to try to prevent the disease in the first place and always seek the help of a healthcare professional if you suspect you may have Lyme disease.

Frequently Asked Questions

  • What are the early signs of Lyme disease?

    Roughly 80% of infections will start with an expanding rash at the site of the tick bite that can often look like a bull’s eye. The rash may feel warm but not itchy and is typically accompanied by flu-like symptoms (fever, malaise, muscle aches).

  • Can Lyme disease symptoms end with only a local rash?

    In some cases, yes. But people left untreated or undertreated are more likely to experience a progression of disease, called an early disseminated infection. This is when the virus spreads to the brain and other organ systems over the course of days or weeks, often causing a secondary rash and/or a cascade of neurological symptoms called Lyme neuroborreliosis.

  • What are the neurological symptoms of Lyme disease?

    Around 10% to 15% of untreated or undertreated people will develop neuroborreliosis, a neurological manifestation of Lyme disease. Symptoms vary from person to person and may include:

    • Meningitis (typically mild with headache, stiff neck, and light sensitivity)
    • Facial palsy (impairing muscles on one side of the face)
    • Radiculopathy (causing nerve pain with weakness and abnormal sensations)
    • Encephalitis (causing impaired movement, speech, or tremors)
  • Can Lyme disease cause heart symptoms?

    In up to 10% of untreated cases, Lyme disease can cause a complication called Lyme carditis that can cause heart palpitations, dizziness, shortness of breath, and fainting. In some people, this can lead to cardiomegaly (enlarged heart), heart valve dysfunction, and congestive heart failure.

  • What are possible complications of Lyme disease?

    If left untreated or undertreated, people may experience a further progression of disease several months after the initial infection. This stage of disease, called a late disseminated infection, can cause:

  • How soon after a tick bite do Lyme disease symptoms appear?

    The incubation period for Lyme disease is typically one to two weeks but can sometimes be shorter (several days) or longer (several months). This depends largely on the type of Borrelia bacteria and genus of tick involved.

  • Can Lyme disease be asymptomatic?

    Yes, but it is uncommon. Studies suggest that only around 7% of infected people will be entirely symptom-free. Even if symptoms develop, not everyone with Lyme disease will experience severe illness or progress to the later-stage infection. Early diagnosis and treatment are essential for preventing disease progression and complications.

  • Is Lyme disease curable?

    Yes, With the appropriate treatment (typically 10 to 21 days of oral antibiotics), most cases will resolve without complications. Lyme disease is not fatal, and the recurrence of symptoms is rare in people who are treated. Even so, some people may take longer to recover than others and require additional treatments if the infection disseminates.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Vincent Iannelli, MD
 Vincent Iannelli, MD, is a board-certified pediatrician and fellow of the American Academy of Pediatrics. Dr. Iannelli has cared for children for more than 20 years.