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 bulls-eye skin rash. It usually develops about 1 to 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 blood stream 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, then within a few weeks or months a late or persistent infection can occur, which leads 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.

Some people may develop a chronic set of symptoms called post-Lyme disease syndrome, although the definition and actual prevalence of this condition is unclear.

Skin Rash

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Evidence suggests that up to 90% of patients with Lyme disease exhibit a rash a few days to a month after a tick bite. (Some experts argue that the rate of Lyme disease occurring without a rash is much higher, but more studies are needed to determine this.) The rash, known as erythema migrans, usually first appears on the thigh, buttock, or trunk in older children and adults, and on the head or neck in young children.