Lyme disease symptoms will differ between people depending on the stage of the infection. In some, symptoms may not be present.

Early Infection

These symptoms typically occur within 3-32 days of a tick bite.

Rash

A hallmark symptom of Lyme disease is a red rash, known as erythema migrans (EM). The rash starts as a small red spot at the site of the tick bite and expands over a period of days or weeks, forming a circular- or oval-shaped rash. The rash often resembles a bull’s eye: a red ring surrounding a clear or bluish area with a red center. The size of the rash can range from dime-sized to the entire width of a person’s back. More than one ring may develop. Typically, the rash goes away within 4 weeks.

Lyme Disease Rash
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Although Lyme disease is often associated with this rash, many people do not have the rash right away or at all. Or they may have a red rash, without the bull's eye pattern. If you have other symptoms that you think might be due to Lyme disease, see your doctor; do not wait for a rash to appear.

Flu-like Symptoms

Muscle and joint aches, headache, fever (a temperature of 100-103°F or 37.7-39.4°C), stiff neck, swollen glands, and fatigue may occur with or without the rash. These symptoms usually last about 5-21 days.

Early Widespread Infection

  • Multiple EM lesions—The rash may appear in several places on the body.
  • Arthritis—Sometimes joint pain is the first symptom that is noticed. Other joint problems include stiffness and swelling, particularly in the large joints, such as the knee, elbow, and shoulder.
  • Nervous system problems—The bacteria can affect the brain, spinal cord, and other nerves of the body. Symptoms of this include:
    • Weakness and drooping of the face and eyelid on one side or both on both sides of the face—Bell’s palsy
    • Low back pain
    • Wide-spread numbness, tingling, and burning
    • Impaired motor coordination
    • Persistent headache
    • Stiff neck
    • Mood changes
    • Difficulty concentrating or sleeping
    • Generalized weakness
  • Eye symptoms, such as watering, redness, blurred vision, swelling, or light sensitivity (less common)
  • Other nonspecific symptoms, such as skin problems or heart abnormalities (less common)

Note: All symptoms of early manifestation usually occur with the first rash or within about 6 weeks of it. They may go away on their own within a few weeks or months.

Late Infection

  • Joint pain—painful inflammation of the joints, as well as intermittent or chronic arthritis
  • Chronic nervous system problems:
    • Memory problems, including dementia
    • Depression or other emotional problems
    • Sleep disorders
    • Nerve pain or problems
  • Chronic skin problems—can include thinning, thickening, or discoloration of the skin, usually of the hands and feet

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