Lyme Disease: Signs, Symptoms, and Complications

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.

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 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 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.

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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 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.

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:
- Lyme arthritis (typically affecting the knee, hip, or other large joints)
- Chronic neuropathy (causing persistent burning, numbness, or tingling sensations)
- Encephalomyelitis (causing symptoms similar to multiple sclerosis)
- Frank psychosis (causing symptoms similar to bipolar disorder or schizophrenia)
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.

Lyme Disease: Causes and Risk Factors