Topic Overview

The first symptom of Lyme disease in most people is an
expanding red skin rash (called erythema migrans or an EM rash). In about a
third of people, the rash looks like a bull’s-eye, with a pale center area
surrounded by a bright red rim. The rash is often accompanied by flu-like
symptoms, including:

  • Fatigue (the most common
  • Headache and stiff neck.
  • Fever (which may be
    high in children, but this is rare).
  • Muscle and joint pain.

About 20% of people have viruslike symptoms only (no rash) or
have no symptoms at all.

If Lyme disease is not detected and
treated while early symptoms are present, or if a person never has early
symptoms that trigger the need for treatment, the infection may spread to the
heart, the joints, the brain and spinal cord (nervous system), or sites on the

Heart and nervous system problems may develop weeks to
months after the initial infection, including:

  • Pain, weakness, or numbness in the arms or
  • A gradual inability to control the muscles of one side of the
    face (paralysis of the facial nerves).
  • Irregular heartbeat and
    shortness of breath.
  • Severe headache and stiffness in the

Damage to the joints, nerves, and brain may develop months to
years after a person becomes infected, causing:

  • Swelling, pain, or redness in the
  • Poor memory and reduced ability to
  • Numbness and tingling in the hands, feet, or
  • Severe fatigue.

Related Information


ByHealthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD – Internal Medicine
Specialist Medical Reviewer Christine Hahn, MD – Epidemiology
W. David Colby IV, MSc, MD, FRCPC – Infectious Disease

Current as ofMarch 3, 2017