Signs and Symptoms of Lyme Disease

Lyme disease symptoms can affect many parts of the body. While many people associate Lyme disease with a bull’s-eye rash, Bell’s palsy, or flu-like symptoms, the infection can also cause sensory, cognitive, neurologic, and cardiac complications — even in its earliest stage.

Unfortunately, the signs and symptoms of Lyme disease are often mistaken for other conditions. This can delay diagnosis and treatment.

Objective signs of Lyme disease may include Bell’s palsy, synovitis of the knee, and the classic erythema migrans (bull’s-eye) rash. However, many patients experience a broader set of symptoms that may fluctuate in intensity and appear in different organ systems.

Common Lyme Disease Symptoms

• Bull’s-eye rash (erythema migrans)
• Bell’s palsy (facial nerve paralysis)
• Fatigue
• Joint pain or swelling
• Headaches
• Memory or concentration problems
• Sleep disturbances
• Dizziness or lightheadedness
• Numbness or tingling sensations
• Sensitivity to light, sound, or temperature

Bell’s palsy may initially appear to be unrelated to Lyme disease. However, early recognition is important. Corticosteroids commonly used to treat facial nerve palsy may worsen outcomes in patients with Lyme disease.

Researchers in the United Kingdom advise clinicians to consider Lyme disease in children presenting with Bell’s palsy. In endemic areas, Lyme disease should remain high on the list of possible causes.

Lyme Disease Rash and Early Symptoms

Studies indicate that at least 50% of patients with Lyme disease do not develop the classic bull’s-eye rash. When present, the rash may appear anywhere on the body and not necessarily at the site of the tick bite.

The rash typically appears between 3 and 30 days after the bite. It is usually not painful or itchy, which may cause patients to overlook it.

Some rashes fade and reappear, and atypical rashes are also possible. When multiple rashes appear, it may indicate that the Borrelia burgdorferi bacteria have spread beyond the initial tick bite.

Neurologic and Cardiac Symptoms of Lyme Disease

Lyme disease can affect the nervous system and the heart.

Neurologic manifestations may include meningitis, encephalitis, neuropathy, or cognitive dysfunction. More commonly, patients report severe fatigue, headaches, joint pain, muscle aches, light sensitivity, sleep disturbance, mood changes, and difficulty concentrating.

Lyme disease may also affect the heart, causing Lyme carditis. Although rare, untreated Lyme carditis can lead to sudden death.

Researchers emphasize that early recognition and treatment are critical to prevent serious complications.

Lyme Disease and the Brain

Lyme disease can also affect the brain, producing a condition known as Lyme encephalopathy.

A study from Tufts University School of Medicine reported that 24 of 27 Lyme disease patients presented with mild encephalopathy characterized by memory problems, mood changes, and sleep disturbances.

Researchers have described the pain experienced by patients with Lyme encephalopathy as similar to postoperative pain, while the fatigue was comparable to that seen in patients with multiple sclerosis.

Children may also develop neurocognitive symptoms. In one study, 14% of children with Lyme disease experienced complications such as behavioral changes, headaches, declining school performance, or fatigue.

Why Lyme Disease Symptoms Are Often Misdiagnosed

Because Lyme disease symptoms affect multiple body systems, patients are sometimes misdiagnosed with conditions such as chronic fatigue syndrome, fibromyalgia, or psychiatric disorders.

Delayed diagnosis may lead to persistent symptoms.

Studies suggest that between 34% and 62% of patients experience ongoing symptoms despite treatment. In one study, 36% reported persistent fatigue, 20% widespread pain, and 45% neurocognitive difficulties at six months.

Lyme disease may also lead to autonomic nervous system dysfunction such as postural orthostatic tachycardia syndrome (POTS), which can cause fatigue, dizziness, palpitations, and cognitive impairment.

Psychiatric Symptoms in Lyme Disease

Psychiatric symptoms are common in patients with chronic neurologic Lyme disease.

One study estimates that approximately one-third of these patients experience depression in addition to fatigue, headaches, joint pain, and cognitive symptoms.

Dr. Robert Bransfield, a psychiatrist specializing in tick-borne illnesses, reports that depression is the most common psychiatric condition associated with late-stage Lyme disease.

Unfortunately, complex multisystem illnesses may sometimes be dismissed as psychiatric conditions, delaying appropriate diagnosis and treatment.

Signs of Lyme Disease in Children

Children with Lyme disease may present differently from adults.

Behavioral changes, headaches, fatigue, dizziness, declining school performance, or facial nerve palsy may be early signs.

Because many children do not recall a tick bite, clinicians often rely on evolving symptoms and clinical judgment.

Parents and clinicians should consider Lyme disease when new neurologic or cognitive symptoms appear during tick season in endemic areas.

See the Pediatric Lyme Disease guide for additional information.