Infectious Diseases Lyme Disease Lyme Disease Guide Lyme Disease Guide Symptoms Causes Diagnosis Treatment Prevention Symptoms of Lyme Disease By Vincent Iannelli, MD facebook 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. Learn about our editorial process Vincent Iannelli, MD Medically reviewed by Medically reviewed by Andy Miller, MD on September 10, 2019 Andy Miller, MD, is board-certified in internal medicine and infectious disease. He is an associate professor at Weill Cornell Medicine in New York City. Learn about our Medical Review Board Andy Miller, MD on September 10, 2019 Print Table of Contents View All Table of Contents Frequent Symptoms Rare Symptoms Complications When to See a Doctor Next in Lyme Disease Guide Lyme Disease: Causes and Risk Factors 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 try to prevent the disease in the first place, and 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. 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 about 90 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. Lyme Disease Doctor Discussion Guide Get our printable guide for your next doctor's appointment to help you ask the right questions. Download PDF Email the Guide Send to yourself or a loved one. Sign Up This Doctor Discussion Guide has been sent to {{form.email}}. There was an error. Please try again. 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. Lyme Disease: Causes and Risk Factors Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources 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. Shapiro ED. Borrelia burgdorferi (Lyme disease). Pediatr Rev. 2014;35(12):500-9. doi:10.1542/pir.35-12-500 Aucott JN, Crowder LA, Yedlin V, Kortte KB. Bull's-Eye and Nontarget Skin Lesions of Lyme Disease: An Internet Survey of Identification of Erythema Migrans. Dermatol Res Pract. 2012;2012:451727. doi:10.1155/2012/451727 Lyme Disease | Tick-borne Diseases | Ticks | CDC. Centers for Disease Control and Prevention. Sept 3, 2019. Arvikar SL, Steere AC. Diagnosis and treatment of Lyme arthritis. Infect Dis Clin North Am. 2015;29(2):269-80. doi:10.1016/j.idc.2015.02.004 Scheffold N, Herkommer B, Kandolf R, May AE. Lyme carditis--diagnosis, treatment and prognosis. Dtsch Arztebl Int. 2015;112(12):202-8. doi:10.3238/arztebl.2015.0202 Krause PJ, Bockenstedt LK. Cardiology patient pages. Lyme disease and the heart. Circulation. 2013;127(7):e451-4. doi:10.1161/CIRCULATIONAHA.112.101485 Additional Reading Bramwell KK, Teuscher C, Weis JJ. Forward Genetic Approaches for Elucidation of Novel Regulators of Lyme Arthritis Severity. Frontiers in Cellular and Infection Microbiology. 2014;4:76. doi:10.3389/fcimb.2014.00076. Centers for Disease Control and Prevention (CDC). Signs and Symptoms of Untreated Lyme Disease. Updated October 26, 2016. Long SS, Prober CG, Fischer M. Principles and Practice of Pediatric Infectious Diseases. 5th ed. Philadelphia, PA: Elsevier; 2017. Sanford C. Lyme Disease. In: Jong EC, Stevens DL, eds. Netter's Infectious Diseases. Philadelphia, PA; Elsevier; 2012. doi:10.1016/B978-1-4377-0126-5.00071-9.