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.

Typical Course

• Stage 1. In the majority of cases, the first sign of early Lyme disease is the appearance of a bull's-eye skin rash. It usually develops about 1 - 2 weeks after the bite, although it may appear as soon as 3 days, 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 bloodstream 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, a persistent infection can occur after a few weeks or months, leading to prolonged bouts of arthritis and neurologic problems, such as concentration problems or personality changes. Fatigue is a prominent feature of both early and late stages.

Skin Rash

The bull's-eye skin rash, known as erythema chronicum migrans (ECM), 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, may take 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 6 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.

Up to 20% of people infected with Lyme disease do not exhibit the rash. In most patients, any rash fades completely after 3 - 4 weeks, although secondary rashes may appear during the later stages of disease.

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 - 21 days and may include:

• Fatigue
• Chills and fever (100 - 103 °F)
• 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

Joint Pain

Joint pain can arise at the same time as the skin rash. In early stages of Lyme disease, patients may experience migratory pain in joints, muscles, and tendons. In the later stages of the disease, arthritis may develop in one or two large joints such as the knee, elbow, or shoulder. (Knees are usually affected most.) About 10% of patients with untreated Lyme disease develop chronic arthritis that can erode bone and cartilage.

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.

Bell's Palsy. In 5 - 10% of untreated Lyme patients, the facial nerve is affected, which results in Bell's palsy. This is a sudden weakness and drooping of the facial muscles and eyelid on one side of the face. Nerves around the facial area may also cause numbness, dizziness, double vision, and hearing changes. Another common neurologic problem is pain in the lower spine. It resembles low back pain from arthritis (although in the case of Lyme disease the skin near the spine may have abnormal sensations). Of note, Lyme disease has been observed in more than half the children who develop Bell's palsy.

Symptoms of Meningitis. In about 10 - 15% of patients, the infection takes place in the membranes that surround the brain and spinal cord (called meningitis). This can cause:

• Episodes of headache not relieved by over-the-counter medication
• Mild stiff neck
• Sensitivity to light

Symptoms of Lyme Encephalopathy. In some cases of untreated disease, the infection causes a condition called Lyme encephalopathy or neuroborreliosis. This causes the following symptoms:

• Unexplained mood changes
• Depression
• Trouble concentration and remembering
• Irritability
• Feelings of "pins and needles" or numbness in the arms or legs

Other Neurologic Symptoms.

• If the infection affects the white brain matter, symptoms resemble multiple sclerosis.
• If the infection occurs in the nerves affecting the skin, some patients experience pricking, tingling, or creeping feelings.
• Children have a higher risk than adults for neurologic effects on the eye. (This is still rare, however.)

Other Symptoms

Heart symptoms, such as an irregular heartbeat, may develop several weeks after infection, but this is not very common. In rare cases, Lyme disease may cause eye inflammation (conjunctivitis).