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. 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.

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.

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.

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

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)

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.

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.

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.

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

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.

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.

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