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 symptom).
• 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 skin.

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

• Pain, weakness, or numbness in the arms or legs.
• 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 neck.

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

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