Patients often ask me: How do you know if you have Lyme disease? Although there is no single sign or test that can provide a definitive diagnosis, there are several signs and symptoms that can raise suspicion. Keeping alert for the possibility that you may have Lyme disease is important since early recognition is critical.

The sooner it is identified, the easier it is to treat effectively.

What Is Lyme Disease?

Lyme disease is a bacterial infection caused by Borrelia burgdorferi, transmitted through blacklegged ticks (deer ticks). It is the most common vector-borne illness in the U.S., with hundreds of thousands of cases reported each year.

✅ Early treatment works best — antibiotics can be highly effective in the first weeks of infection.
❌ Delayed or missed diagnosis allows the bacteria to spread to joints, the nervous system, and the heart, leading to far more serious complications.

Early Signs and Symptoms of Lyme Disease

Early Localized Lyme Disease (3–30 Days After a Tick Bite)

The Bull’s-eye Rash (Erythema Migrans)

1. Appears 3 – 30 days after a tick bite

2. Only about 1 in 4 rashes show the classic bull’s-eye pattern

3. More than half are flat, solid red patches rather than rings

4. Some rashes do not expand much, while others steadily enlarge

5. Usually painless, but can sometimes be itchy or scaly

6. Typically over 2 inches in diameter

7. Can occur anywhere on the body, not just at the bite site

Flu-Like Symptoms
Along with or instead of a rash, you may experience:

1. Fever and chills

2. Severe headaches

3. Profound fatigue

4. Muscle and joint aches

5. Swollen lymph nodes

These symptoms are often mistaken for viral illness, which is one reason Lyme disease is missed in its earliest stage.

Early Disseminated Lyme Disease (Days to Weeks After Infection)

If Lyme is not diagnosed and treated quickly, it can spread through the bloodstream. Patients may develop:

1. Multiple secondary rashes in different locations

2. Migrating joint or muscle pain

3. Neurological problems such as Bell’s palsy, meningitis-like headaches, or shooting nerve pain

4. Heart involvement (Lyme carditis), leading to palpitations, chest pain, dizziness, or shortness of breath

This stage often develops within weeks and is frequently misattributed to autoimmune disease, stress, or viral infection.

Late Disseminated Lyme Disease (Months After Infection)

Without treatment, Lyme disease can progress further, producing:

1. Arthritis with painful, swollen joints (often knees)

2. Cognitive issues such as memory loss, brain fog, and difficulty concentrating

3. Nerve damage causing numbness or tingling in extremities

4. Cardiac complications such as heart block, irregular rhythms, or fainting

Advanced Clinical Presentations of Lyme Disease

Even after the initial stages, Lyme may cause persistent or complex symptoms that overlap with other conditions:

Neuropsychiatric & Neurological

1. Mood swings, depression, anxiety

2. Sleep disturbances and insomnia

3. Cognitive issues: brain fog, memory loss, difficulty concentrating

4. Tremors, muscle twitches, and coordination problems

5. Autonomic dysfunction (blood pressure changes, temperature regulation)

6. Cranial nerve involvement (vision, hearing, swallowing)

Systemic & Fatigue-Related

1. Severe, chronic fatigue out of proportion to activity

2. Post-exertional malaise (worsening after physical or mental effort)

3. Temperature dysregulation (feeling unusually hot or cold)

4. Hypersensitivity to light, sound, touch, or chemical odors

5. Gastrointestinal problems: nausea, abdominal pain, bowel changes

Pediatric Presentations

1. Sudden behavioral changes or rage episodes

2. School performance decline (concentration and memory issues)

3. Sleep disturbances (night terrors, difficulty falling asleep)

4. Possible overlap with PANS/PANDAS: OCD-like symptoms, tics, food restriction

Ocular Manifestations

1. Conjunctivitis (red, irritated eyes)

2. Uveitis (inflammation inside the eye)

3. Optic neuritis (optic nerve inflammation)

4. Double vision or light sensitivity

Clues to Co-Infections

Ticks can carry multiple pathogens. And a single tick bite can transmit more than just Lyme disease. Babesia, for example, is a common co-infection that may cause:

1. Night sweats

2. Shortness of breath or “air hunger”

3. Fatigue that feels worse than expected with Lyme alone

Identifying co-infections, such as Babesia, is critical since treatment may differ.

The Challenge of Diagnosis

1. Blood tests often miss early Lyme disease — antibodies may not appear for weeks, leading to false negatives.

2. Even later, tests can miss 20 – 50% of cases.

3. Lyme disease is called “The Great Imitator” because it can resemble the flu, autoimmune diseases, MS, or even psychiatric conditions.

4. A clinical diagnosis — based on symptoms, exposure, and risk factors—remains essential.

The Bottom Line

So, how do you know if you have Lyme disease?

1. Look for early warning signs like a rash or flu-like illness (But remember, the rash isn’t always present. You don’t need to a bull’s-eye rash to have Lyme disease)
2. Consider whether you have symptoms affecting multiple bodily systems
3. Don’t dismiss neurological or joint symptoms weeks later
4. Trust your instincts and seek care early

👉 Have you experienced possible Lyme disease symptoms? Share your story below — I read every one!

Resources

1. 1. CDC Lyme Disease Overview
   2. Dr. Cameron’s blog – Is It Lyme Disease? Unexpected Symptoms of Lyme disease
   3. Video – Signs and symptoms of Lyme disease