Topic Overview

Lyme disease can go through several stages. It may cause different symptoms, depending on how long you have been infected and where in your body the infection has spread.

Stage 1: Early localized Lyme disease (1 to 4 weeks)

Early localized Lyme disease develops days to weeks after you become infected. You may have:

• An expanding, circular red rash (erythema migrans).
• Flu-like symptoms, with or without the rash. The symptoms include:
  • Lack of energy.
  • Headache and stiff neck.
  • Fever and chills.
  • Muscle and joint pain.
  • Swollen lymph nodes.

In some cases of Lyme disease, the person doesn't notice any symptoms during this stage.

Stage 2: Early disseminated infection (1 to 4 months)

If Lyme disease isn't found and treated while early symptoms are present, or if you don't have early symptoms that trigger the need for treatment, the infection may affect the skin, joints, nervous system, and heart within weeks to months after the initial infection.

Symptoms may include:

• An expanding, circular rash at the site of the bite. More rashes may appear on other parts of your body as the infection spreads.
• Pain, weakness, or numbness in the arms or legs.
• Not being able to use the muscles of the face.
• Headaches or fainting that continues to happen.
• Poor memory and reduced ability to concentrate.
• Conjunctivitis (pinkeye) or sometimes damage to deep tissue in the eyes.
• Brief episodes of pain, redness, and swelling in one or more large joints—most often the knee. Joint problems are common.
• Occasional rapid heartbeats (palpitations) or, in rare cases, serious heart problems.

Late persistent Lyme disease

If Lyme disease isn't promptly or effectively treated, damage to the joints, nerves, and brain may develop months or years after you become infected. It is the last and often the most serious stage of the disease.

Symptoms at this stage may include:

• Arthritis that most often affects the knee. A small number of people eventually get chronic Lyme arthritis, which causes recurring episodes of swelling, redness, and fluid buildup in one or more joints that last up to 6 months at a time.
• Numbness and tingling in the hands, feet, or back.
• Feeling very tired.
• Not being able to control the muscles of the face.
• Problems with memory, mood, or sleep, and sometimes problems speaking.
• Heart problems, which are rare but can occur months to even years after you are bitten by an infected tick. The most serious heart problems—such as inflammation of the structures surrounding the heart (pericarditis)—usually resolve without any lifelong damage. Unfortunately, heart problems can be the first sign of Lyme disease in a small number of people who didn't have early symptoms.

Stage 2 and stage 3 symptoms may be the first signs of Lyme disease in people who didn't have a rash or other symptoms of early infection.