Lyme disease, the most common vector-borne disease in the United States, can cause various non-specific symptoms. This can make Lyme complicated and difficult to diagnose – especially as the infection progresses. In the following article, learn the most and least common Lyme disease symptoms, how the disease can change over time, and more.
Contracting Lyme disease
Lyme disease, also known as Lyme borreliosis, is caused by the spiral-shaped Borrelia burgdorferi bacteria. Eight of the 20 accepted genospecies of B. burgdorferi are known to cause Lyme disease. The bacteria is spread via a bite from an infected tick of the genus Ixodes.
Ticks carrying the Lyme bacteria live throughout most of the US, and they’re also common in Europe, China, and Canada. Due to their minute size, tick bites usually do not hurt. Throughout the tick’s life cycle, the nymphal stage is usually where Lyme disease is transmitted because they are so small that they may feed for long periods without detection. Not all ticks carry Lyme disease.
Typical Lyme disease symptoms
Lyme disease symptoms typically develop in stages, starting from shortly after a bite from an infected tick.
Stage 1 Lyme disease symptoms:
- Erythema migrans (a ‘bulls-eye’ rash)
- Fever
- Fatigue
- Chills
- Headache
- Body aches and joint pain
Stage 2 Lyme disease symptoms
- Severe headaches
- Neck stiffness
- New erythema migrans rashes on different parts of the body
- Bell’s palsy, a.k.a. facial palsy (loss of muscle tone or droop on one or both sides of the face)
- Neurological side-effects
- Inability to flex the neck
- Photosensitivity
- Lyme carditis
Stage 3 Lyme disease symptoms
- Lyme arthritis
- Lyme encephalopathy
- Mental health disturbances
Early, localized symptoms of Lyme disease (Stage 1)
According to the Centers for Disease Control and Prevention (CDC), Lyme disease symptoms typically occur 3 to 30 days after a bite from an infected tick.
Erythema migrans
The first signs of Lyme disease will appear as a localized infection in the area of the bite. Most notably, a rash known as erythema migrans will develop at the site. Erythema migrans are usually rounded, red or occasionally bluish, and gradually fade toward the edges, forming the typical ‘bulls-eye’ pattern that most recognize in association with Lyme disease. Typically, the rash will expand 2-3 centimeters per day, reaching a diameter of anywhere from 5-70 cm, with 16 cm representing the median.
In some cases, the center is elevated slightly. It may feel warm to the touch, but erythema migrans is not itchy and is only rarely painful.
A bull’s eye rash is only detectable in 25-50% of patients. When it does show up, it may not have the “classic” bull’s eye shape or appear on a part of the body that is not easily seen. Unfortunately, some doctors dismiss a patient’s concerns about Lyme disease unless a bull’s eye rash is identified.
In 10-20% of untreated cases, erythema migrans will develop in spots on the body unrelated to where the initial tick bite occurred. This is usually seen within stage 2.
Flu-like symptoms
Often, but not always, symptoms associated with viral infections will accompany an erythema migrans rash, such as fatigue, headache, body aches, and fever with associated chills and headaches. Nausea and upper respiratory symptoms are less common. These symptoms may be present without a rash or linger even after an erythema migrans rash has faded.
Individuals who have been bitten by a tick may also not show these symptoms, even if they have contracted Lyme disease. Lyme can also progress without a rash or symptoms.
Patients and physicians should be aware that the absence of any of the above symptoms does not rule out a Lyme infection or other tick-borne disease. If a patient is aware that they’ve been bitten by a tick but does not have symptoms yet, an IGeneX T-cell test should still be administered to detect disease within the first month of infection.
Early disseminated Lyme disease symptoms (Stage 2)
After the onset of a local infection, Borrelia may travel to the bloodstream, or into the body’s lymphatic system when left untreated with antibiotics. This usually occurs anywhere from a few days to a few weeks after the earliest Lyme disease symptoms begin to show.
Neuroborreliosis
Another condition associated with Lyme disease, neurologic Lyme or Lyme neuroborreliosis, can develop and lead to neurological symptoms such as progressive dementia, strokes, seizures, and more. An estimated 15-40% of patients with Lyme disease at this stage develop such symptoms. Neurological Lyme appears within 4-6 weeks after a tick bite when Lyme disease affects the central nervous system (i.e., brain and spinal cord).
Head, ears, nose, neck, and throat symptoms
If left untreated, neurological Lyme can develop into symptoms associated with the head, neck, ears, nose, and throat, also known as otolaryngological symptoms.
Cranial neuritis, or inflammation of the cranial nerves, may be caused by various factors. When it is present as a symptom of Lyme disease, it tends to lead to facial palsy. Facial palsy impairs movement on one or both sides of the face, impacting chewing, blinking, speaking, and smiling.
A patient may also exhibit:
- An inability to move or flex the neck fully
- Tinnitus
- Photosensitivity
- Lyme radiculopathy, also called a ‘pinched nerve’ in the neck, though it can occur in other areas of the body
Lyme carditis
Lyme carditis is a heart complication associated with untreated Lyme disease. Symptoms of Lyme carditis include dizziness, fainting, heart palpitations, chest pain, and shortness of breath. In some cases, this may be a patient’s first indication of Lyme disease if they have not been tested or previously diagnosed.
Late-stage Lyme disease symptoms
As Lyme disease progresses, symptoms can worsen, change, and spread to different systems of the body. Some of the later signs and symptoms below can develop within days or weeks of a tick bite, while others may take months or years to appear.
As mentioned, the longer Lyme disease goes untreated, the more likely it is for the above symptoms to appear and affect different body systems. In particular, late-stage Lyme is associated with the development of neurological and psychiatric symptoms that have both direct and indirect sources.
Lyme arthritis
In 60% of untreated patients, Lyme arthritis develops about six months after the initial infection. The most common location is usually a knee, hip, or temporomandibular joint (where the jaw connects to the skull.) Lyme arthritis may cause joint effusion and swelling, though pain remains mild to moderate.
Mental health side effects & Lyme encephalopathy
But late-stage or chronic Lyme disease can also affect a patient’s mental health indirectly, contributing to depression, anxiety, pain, cognitive problems, and other neurological and psychiatric symptoms by way of the debilitating nature of its other symptoms as well as the frustrating process of diagnosing and treating late-stage Lyme.
Note: Many of the late-stage Lyme disease symptoms described above have also been seen in the similar but distinct disease Tick-Borne Relapsing Fever. If your Lyme disease test results are negative, but you continue to experience symptoms, you may be infected with TBRF or another tick-borne disease.
Chronic Lyme and PTLDS
Lyme disease symptoms can become chronic if the infection is not caught and treated promptly. Some patients experience symptoms despite receiving antibiotic treatment – the CDC calls these cases Post-Treatment Lyme Disease Syndrome, or PTLDS – while for others, the disease has never been treated, leading to the development of a chronic condition. Either way, chronic symptoms can be severe and debilitating, and are much harder to treat than earlier-stage Lyme.
Chronic Lyme disease symptoms can include:
- Intermittent fevers, chills, and sweats
- Chronic inflammation
- Roving aches and stiffness
- Numbness and tingling in the limbs
- Dizziness and shortness of breath
- Tremors
- Respiratory infections
- Sore throats
- Stomach pains
- Heart palpitations and irregular heartbeat
- Anxiety and paranoia
- Rage
- Hallucinations
- Hearing sensitivity
- Dysphonia (vocal cord damage)
- New food allergies
- Multiple-chemical sensitivities
- Seizures
As with other Lyme disease cases, one patient’s chronic Lyme may look very different from another patient’s case. This makes chronic Lyme tricky to diagnose and treat, adding to the challenge for chronic Lyme patients, who tend to report a poorer quality of life than patients with other chronic illnesses.
Diagnosing your symptoms
The longer Lyme disease goes untreated, the more likely it is to affect multiple body systems and develop into a chronic condition that is much harder to detect and treat. Some symptoms associated with untreated, late-stage Lyme – such as Lyme carditis – can even be fatal. This is why the diagnostic process for Lyme and other tick-borne diseases is so important.
When a patient presents with Lyme-like symptoms, it is recommended that doctors consider their symptoms and exposure history alongside lab test results, typically blood tests. Unfortunately, the testing process for Lyme disease is prone to error and can lead to many mis- or missed diagnoses.
First, testing too early or too late can result in false negatives if the immune system has yet to produce enough antibodies to appear on the test. Second, many guideline-recommended tests, such as the ELISA and Western Blot, are not sensitive or specific enough to detect Lyme at multiple stages or to detect the different species of Borrelia that cause Lyme.
Finally, many patients with Lyme disease also have co-infections, or other tick-borne diseases alongside their Lyme infection. Co-infections will not show up on a Lyme test; they may need to be detected and treated separately for symptoms to resolve fully. What’s more, as with Lyme, many tick-borne diseases have non-specific or uncommon symptoms that patients or physicians may initially miss or dismiss.
This is why it is essential to get tested by a reputable lab using the most accurate testing methods possible. It’s also important to work with a trusted physician familiar with how Lyme manifests at different stages.
Learn about the Lyme and tick-borne disease tests available at IGeneX. If you suspect you may be infected with a tick-borne disease, you can also evaluate your symptoms with the IGeneX Symptom Checker.
