Lyme Disease and Related Tick-Borne Infections - Symptoms

It is important to note that in a 2002 study, only 9% of patients diagnosed with Lyme disease exhibited this classic pattern. Nearly 60% had a rash that was more general in appearance and 32% had a circular dense red rash.

In most patients, any rash fades completely after 3 or 4 weeks, although secondary rashes may appear during the later stages of disease.

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Flu-like Symptoms

A flu-like condition is the most common sign of Lyme infection and it can occur with or without a rash. Symptoms can last from 5 to 21 days and may include the following:

Fatigue
Chills and fever (100 to 103 degrees)
Headache (usually most prominent at the back of the head)
Joint aches (usually in the large joints)
Stiff neck
Backache
Swollen glands (in the area around the tick bite or elsewhere)
Less often, nausea, vomiting, and sore throat occur

Some experts recommend that children in high-risk areas be tested for Lyme in the summer months if they have the most common Lyme symptoms (fever, headache, joint aches)--even if they have no tell-tale rash. Severe and sustained flu symptoms without the rash in such patients may indicate the presence of human granulocytic ehrlichiosis (HGE) or babesiosis--the other infections carried by the Ixodes tick.

Conjunctivitis

The infection may appear in the eye in some people, causing inflammation and redness (conjunctivitis).

Arthritis

Joint pain can arise at any time after the appearance of a skin rash. In the absence of a rash, arthritic symptoms may be the first indication of Lyme disease. Or, as suggested by some studies, it can develop months after the disease has been diagnosed. Arthritic symptoms may occur as follows:

Aches, stiffness, and swelling, sometimes massive, of large joints, such as the knee, elbow, or shoulder. One or both knees are affected most often. The ankle, wrist, jaw, and finger joints are involved less often.
Typically, no more than three joints are affected during the course of the disease. If several joints are involved, they tend to be asymmetrically distributed.
Joint pain flare-ups are often accompanied by muscle pain.
Arthritis symptoms usually last for a few days or weeks and are interspersed with longer periods during which the joints feel fine.
The severity and frequency of attacks peak within a year or two then decrease and usually resolve, even without treatment.

Neurologic Symptoms

About 15% of untreated patients develop neurologic symptoms. They can occur in all stages of the disease and can affect any part of the nervous system.

Common Early Neurologic Symptoms. Most often, neurologic symptoms first appear while the initial skin rash is still present or within 6 weeks after its disappearance. Sometimes they are the first symptoms that the patient experiences. The most common neurologic symptoms may be headaches, sleep problems, and mood disturbance. Memory problems can also occur. Neurologic symptoms typically improve or resolve within a few weeks or months, even in untreated patients.