Lyme disease: signs, symptoms, and complications


You can get Lyme disease after being bitten by a tick, usually a deer , infected with Borrelia burgdorferi bacteria, if the tick is not removed within 48 to 72 hours. Some people think that if you get Lyme disease, you cannot get it again, which is not true. That's why it's important to try to prevent disease in the first place and do daily tick checks if you've been in an area where ticks can bite you, like camping, no matter who you are.

Illustration by Joshua Song. © Get Drug Information, 2018.

Frequent symptoms

The first symptom of Lyme disease is usually the classic rash known to most people called erythema migrans . However, it is important to know all the symptoms of Lyme disease, as they can be different for each person.

Migraine erythema

This circular rash occurs at the site of the tick bite around 7-14 days after the tick bite, although it can start as early as three days or 30 days after the tick bite. Erythema migrans occurs in about 90 percent of people with Lyme disease .

Because a rash looks different depending on the person and the stage of the disease, it is a good idea to ask your healthcare professional to check for any suspicious rashes. If you live in an area where ticks are high and / or Lyme disease is common, it is even more important to be aware of any unusual rashes.

This rash of erythema migrans can be described as:

  • Have a typical red outer ring with a dark purple space between the areas
  • Have a red outer ring, a red center, and a magenta stripe between the area
  • With a red outer ring, a red target in the center, and a clear area in the middle (this is a developed rash that probably started much smaller and less on the target ) .
  • Itching, warmth, and sometimes pain
  • It gradually expands from 7 to 14 inches.
  • It lasts about two weeks.

Flu-like symptoms

Other symptoms of Lyme disease can resemble the flu and include:

  • Hot
  • Myalgia (muscle pain)
  • Shaking chills
  • Headache
  • Fatigue
  • Joint pain (arthralgia)
  • Swollen lymph nodes (lymphadenopathy )

Although these symptoms can mimic those of common viral infections, Lyme disease symptoms can persist or come and go.

Rare symptoms

Less commonly, if Lyme disease is not treated, you can develop other symptoms weeks, months, or even years after infection, including:

  • Multiple erythema migrans, rash
  • Inflammation of the eyes
  • Hepatitis (liver disease)
  • Severe fatigue

None of these problems are likely to appear without other symptoms of Lyme disease.


If Lyme disease is not treated, serious symptoms and complications can occur. They can develop several days or months after the tick bite.


After several months of infection with B. burgdorferi , 30 to 60 percent of people who have not received antibiotics develop recurrent attacks of painful and swollen joints that last from several days to several months . Arthritis can pass from one joint to another. and the knee is the most commonly affected.

Neurological problems

Lyme disease can also affect your nervous system and cause symptoms such as:

  • Stiff neck and severe headache (meningitis)
  • Temporary paralysis of the facial muscles, in which one side of the face sags (Bell's palsy)
  • Numbness, pain, or weakness in the extremities
  • Poor muscle movement

More subtle changes have also been associated with untreated Lyme disease, such as:

  • Memory loss
  • Difficult to focus
  • Changes in mood or sleeping habits.

Nervous system problems can develop weeks, months, or even years after an untreated infection. These symptoms occur in about 10 to 12 percent of people and often last for weeks or months.

Heart problems

About 1 percent of people with Lyme disease have heart problems, such as an irregular heartbeat that can start with dizziness or shortness of breath and can indicate Lyme carditis , the cause of heart block. With treatment, these symptoms rarely last more than a few seconds. days or weeks.

When to contact a healthcare provider

Note that not everyone has all the classic symptoms of Lyme disease, so it is important to see your doctor if you develop a rash or fever after a tick bite, especially if you live or visit a place where there are many. cases of Lyme disease. In the United States, this includes the Northeast, Mid-Atlantic, or North Central states.

Guide to Talking to Your Lyme Disease Doctor

Get our printable guide to your next doctor's appointment to help you ask the right questions.

Even in hyperendemic areas (places where there are many cases of Lyme disease), the risk of developing Lyme disease is generally estimated to be no more than 3.5 percent. This is so small because while up to 50 percent of ticks in endemic areas are infected with the bacteria that cause Lyme disease, most people kill the ticks before the bacteria can infect them.

Lyme disease is generally easily treated with conventional antibiotics. The earlier you start treating Lyme disease the better, but even in the later stages, medications usually work well.

Simple blood tests , which sometimes must be repeated to rule out infection, can reassure you and your family.

Frequently asked questions

  • About 80% of infections start with a rash that widens at the site of a tick bite, which can often look like a bull's eye. The rash may be warm but not itchy, and is often accompanied by flu-like symptoms (fever, malaise, muscle aches).

  • In some cases, yes. But people who do not receive treatment or receive insufficient treatment are more likely to experience a disease progression called early disseminated infection. This is when the virus spreads to the brain and other organ systems over days or weeks, often causing a secondary rash and / or a cascade of neurological symptoms called Lyme neuroborreliosis .

  • About 10% to 15% of untreated or untreated people will develop neuroborreliosis, a neurological manifestation of Lyme disease. Symptoms vary from person to person.

    and can include:

    • Meningitis (usually mild with headache, neck stiffness, and photosensitivity)
    • Facial paralysis (muscle damage on one side of the face)
    • Radiculopathy (causing nerve pain with weakness and abnormal sensations)
    • Encephalitis (causing disturbances in movement, speech, or tremors)

  • In about 10% of untreated cases, Lyme disease can cause a complication called Lyme carditis, which can cause palpitations , dizziness, shortness of breath, and fainting. In some people, this can lead to cardiomegaly (an enlarged heart), heart valve dysfunction, and congestive heart failure.

  • Left untreated or under-treated, people can develop further disease progression several months after the initial infection. This stage of the disease, called late-spreading infection, can cause:

  • The incubation period for Lyme disease is usually one to two weeks, but can sometimes be shorter (a few days) or longer (several months). This depends a lot on the type of Borrelia bacteria and the genus of the mites.

  • Yes, but it is rare. Research shows that only about 7% of infected people get rid of their symptoms completely. Even if symptoms develop, not all people with Lyme disease will have severe illness or progression to a later stage of infection. Early diagnosis and treatment are essential to prevent disease progression and complications.

  • Yes, with proper treatment (usually 10-21 days of oral antibiotics ), most cases resolve without complications. Lyme disease is not fatal, and symptoms rarely reappear in people being treated. Still, some people may take longer to recover than others and will need additional treatment if the infection spreads.

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