Symptoms of Lyme Disease

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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. 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 do daily tick checks if you've been in an area where you might be bitten by a tick, such as a campsite, no matter who you are.

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

Frequent Symptoms

The first symptom of 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 70 percent to 80 percent 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 is untreated, you may develop other symptoms weeks, months, or even years after infection, including:

  • Multiple erythema migrans rashes
  • Eye inflammation
  • Hepatitis (liver disease)
  • Severe fatigue

None of these problems is likely to appear without other Lyme disease symptoms being present.

Complications

Serious symptoms and 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 percent to 60 percent of people not treated with antibiotics develop recurrent attacks of painful and swollen joints that last a few days to a few months. The arthritis can shift from one joint to another, and the knee is most commonly affected.

Neurological Issues

Lyme disease also can affect your nervous system, causing symptoms such as:

  • Stiff neck and severe headache (meningitis)
  • Temporary paralysis of facial muscles in which one side of the face droops (Bell’s palsy)
  • Numbness, pain, or weakness in the limbs
  • Poor muscle movement

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

  • Memory loss
  • Difficulty concentrating
  • Change in mood or sleep habits

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

Heart Problems

Around 1 percent of people with Lyme disease develop heart problems such as irregular heartbeat, which can start with dizziness or shortness of breath and may indicate Lyme carditis—a cause of heart block. With treatment, these symptoms rarely last more than a few days or weeks.

When to See a Doctor

Keep in mind that not all people have all of the classic Lyme disease symptoms, which makes it important to see your doctor 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.

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 percent at the most. It's so low because even though up to 50 percent 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.

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

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