Signs and Symptoms of Untreated Lyme Disease

Key points

  • Untreated Lyme disease can produce a wide range of symptoms, depending on the stage of infection. These include fever, rash, facial paralysis, an irregular heartbeat, and arthritis.
  • Seek medical attention if you observe any of these symptoms and have recently had a tick bite, live in an area known for Lyme disease, or have recently traveled to an area where Lyme disease occurs.
Circular red rash with central clearing that slowly expands

Signs and symptoms

Early signs and symptoms (3 to 30 days after tick bite)

  • Fever, chills, headache, fatigue, muscle and joint aches, and swollen lymph nodes may occur in the absence of rash
  • Erythema migrans (EM) rash (see photos):
    • Occurs in approximately 70 to 80 percent of infected people
    • Begins at the site of a tick bite after a delay of 3 to 30 days (average is about 7 days)
    • Expands gradually over several days reaching up to 12 inches (30 cm) or more across
    • May feel warm to the touch but is rarely itchy or painful
    • Sometimes clears as it enlarges, resulting in a target or "bull's-eye" appearance
    • May appear on any area of the body
    • Does not always appear as a "classic bull's-eye" rash
Erythema migrans rashes on two different skin tones to show the wide variety of appearances.
The appearance of the erythema migrans rash can vary widely.

Later signs and symptoms (days to months after tick bite)

  • Severe headaches and neck stiffness
  • Additional EM rashes on other areas of the body
  • Facial palsy (loss of muscle tone or droop on one or both sides of the face)
  • Arthritis with severe joint pain and swelling, particularly the knees and other large joints.
  • Intermittent pain in tendons, muscles, joints, and bones
  • Heart palpitations or an irregular heartbeat (Lyme carditis)
  • Episodes of dizziness or shortness of breath
  • Inflammation of the brain and spinal cord
  • Nerve pain
  • Shooting pains, numbness, or tingling in the hands or feet
Later signs and symptoms of Lyme disease include swollen knees, irregular heartbeat, and facial palsy.
Later signs and symptoms of Lyme disease include swollen knees, irregular heartbeat, and facial palsy.

Reminder‎

Seek medical attention if you observe any of these symptoms and have had a recent tick bite, live in an area known for Lyme disease, or have recently traveled to an area where Lyme disease occurs.

More about rashes

  • A small bump or redness at the site of a tick bite that occurs immediately and resembles a mosquito bite, is common. This irritation generally goes away in 1-2 days and is not a sign of Lyme disease.
  • A rash with a very similar appearance to EM occurs with Southern Tick-associated Rash Illness (STARI) but is not Lyme disease.
  • Ticks can spread other organisms that may cause a different type of rash.
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Content Source:
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)