Lyme Disease and Related Tick-Borne Infections - Symptoms

Highlights	Diseases with Similar Symptoms	Babesiosis
Introduction	Diagnosis	Resources
Symptoms	Treatment	References
Risk Factors	Prevention
Complications	Ehrlichiosis

Symptoms

Symptoms of Lyme disease are diverse and often occur in early and late phases. They vary widely from person to person. Any one symptom may fail to appear, and symptoms may overlap in various combinations. Death from Lyme disease is very rare and occurs only in a few cases in which the heart is severely affected.

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Typical Course

Stage 1. In the majority of cases, the first sign of early Lyme disease is the appearance of a bulls-eye skin rash. It usually develops about 1 to 2 weeks after the bite, although it may appear as soon as 3days, and as late as 1 month.In some cases, it is never detected. Flu-like symptoms (joint aches, fever, and general fatigue) commonly develop.
Stage 2. Untreated, the infection spreads through the blood stream and lymph nodes within days to weeks, involving the joints, nervous system, and possibly the heart. Multiple rashes may erupt in other places. If the infection affects the nervous system in stage 2, it most often causes weakness or paralysis in the nerves of the face (Bell's palsy) or in nerves of the spine.
Stage 3. If the disease remains untreated, then within a few weeks or months a late or persistent infection can occur, which leads toprolonged bouts of arthritis and neurologic problems, such as concentration problems orpersonality changes. Fatigue is a prominent feature of both early and late stages.

Some people may develop a chronic set of symptoms called post-Lyme disease syndrome, although the definition and actual prevalence of this condition is unclear.

Skin Rash

Evidence suggests that up to 90% of patients with Lyme disease exhibit a rash a few days to a month after a tick bite. (Some experts argue that the rate of Lyme disease occurring without a rash is much higher, but more studies are needed to determine this.) The rash, known as erythema migrans, usually first appears on the thigh, buttock, or trunk in older children and adults, and on the head or neck in young children.

The bull's eye rash, which is commonly believed to be the classic sign of Lyme disease, maytake the following course:

It can first appear as a pimple-like spot, which expands over the next few days into a purplish circle. The circle may reach up to six inches in diameter with a deeper red rim. In some cases the ring is incomplete, forming an arc rather than a full circle.
The center of the rash often clears or may turn bluish. Or secondary concentric rings may develop within the original ring, creating the bull's-eye pattern. Over the next several weeks, the circular rash may grow to as large as 20 inches across.
Patients often describe the sensation of the rash as burning rather than itching.