Signs and Symptoms of Lyme Disease
Symptoms that don’t add up?
Lyme disease may affect multiple systems.
Symptoms often fluctuate and evolve over time.
What are the signs and symptoms of Lyme disease—and why are they so often missed?
Lyme disease can affect the nervous system, joints, heart, sleep, cognition, and mood. While many people associate Lyme disease with a bull’s-eye rash or Bell’s palsy, symptoms may also include fatigue, dizziness, sensory changes, headaches, and cognitive dysfunction—even early in the illness.
Because symptoms often fluctuate and overlap with other conditions, Lyme disease may initially go unrecognized.
Learn more about delays in diagnosis in Delayed Lyme Disease Diagnosis.
Common Signs and Symptoms of Lyme Disease
Signs and symptoms of Lyme disease may vary significantly from person to person.
Common symptoms include:
- Bull’s-eye rash (erythema migrans)
- Bell’s palsy (facial nerve paralysis)
- Fatigue
- Joint pain or swelling
- Headaches
- Neck or back pain
- Sleep disturbance
- Memory and concentration problems
- Dizziness or lightheadedness
- Numbness or tingling
- Light or sound sensitivity
- Mood changes or irritability
Many patients experience symptoms that come and go or fluctuate in severity over time.
Lyme Disease Rash and Early Symptoms
Although the bull’s-eye rash is widely recognized, studies suggest that at least 50% of patients may not develop the classic rash.
When present, the rash may:
- Appear anywhere on the body
- Be painless and not itchy
- Fade and reappear
- Appear atypical rather than circular
- Occur in multiple locations
Multiple rashes may suggest dissemination of infection beyond the initial tick bite.
Some patients mistake the rash for a spider bite, skin irritation, or allergic reaction.
Bell’s Palsy and Lyme Disease
Bell’s palsy may be one of the earliest recognizable neurologic signs of Lyme disease.
However, Lyme-related facial palsy is sometimes initially labeled as idiopathic facial nerve palsy.
Early recognition matters because corticosteroids commonly used for Bell’s palsy may worsen outcomes in some Lyme disease patients.
Learn more in Steroids Harmful to Patients With Bell’s Palsy Caused by Lyme Disease.
Neurologic and Cardiac Symptoms of Lyme Disease
Lyme disease may affect both the nervous system and the heart.
Neurologic complications can include:
- Meningitis
- Neuropathy
- Encephalopathy
- Cognitive dysfunction
- Sensory abnormalities
- Headaches
- Brain fog
Patients may also experience fatigue, poor concentration, anxiety, mood changes, dizziness, and sleep disturbance.
These symptoms are explored further in Neurologic Lyme Disease.
Lyme disease may also affect the heart, causing Lyme carditis, rhythm abnormalities, chest discomfort, shortness of breath, or—in rare cases—sudden death.
Learn more in Lyme Carditis.
Lyme Disease and the Brain
Lyme disease may contribute to encephalopathy and neurocognitive dysfunction in some patients.
Symptoms may include:
- Memory problems
- Difficulty concentrating
- Mood changes
- Fatigue
- Sleep disturbance
- Slowed processing speed
Children may also develop behavioral changes, declining school performance, headaches, or cognitive difficulties.
Several imaging studies in patients with persistent Lyme symptoms have reported evidence of neuroinflammation, altered white matter structure, and glial activation, supporting ongoing investigation into the neurologic effects of Lyme disease.
Why Lyme Disease Symptoms Are Often Misdiagnosed
Because Lyme disease affects multiple systems, symptoms are often attributed to other conditions including:
- Chronic fatigue syndrome
- Fibromyalgia
- Anxiety disorders
- Depression
- Autoimmune disease
- Neurologic disorders
Patients with fluctuating multisystem symptoms are sometimes told there is nothing more that can be done, even when symptoms persist.
Learn more in When Medicine Says There’s Nothing More to Do.
Lyme disease may also contribute to autonomic dysfunction such as POTS, causing palpitations, dizziness, orthostatic intolerance, fatigue, and cognitive symptoms.
Learn more about autonomic complications in Autonomic Dysfunction in Lyme Disease.
Psychiatric Symptoms and Lyme Disease
Some patients with neurologic Lyme disease report depression, anxiety, irritability, panic symptoms, or emotional instability.
Dr. Robert Bransfield has described how complex multisystem illness is sometimes incorrectly attributed to psychiatric disease alone, delaying recognition of possible medical contributors.
This overlap between neurologic, inflammatory, and psychiatric symptoms can complicate diagnosis.
Signs of Lyme Disease in Children
Children may present differently from adults.
Symptoms in children may include:
- Fatigue
- Headaches
- Dizziness
- Behavioral changes
- Cognitive decline
- Sleep disturbance
- School difficulties
Diagnosis in children often depends on recognizing evolving symptom patterns rather than relying on a single symptom or laboratory finding.
Learn more in the Pediatric Lyme Disease Guide.
Frequently Asked Questions
What are the most common symptoms of Lyme disease?
Common symptoms include fatigue, headaches, joint pain, Bell’s palsy, dizziness, sleep problems, and cognitive difficulties.
Does everyone with Lyme disease get a bull’s-eye rash?
No. Many patients do not develop the classic erythema migrans rash.
Can Lyme disease affect the brain?
Yes. Lyme disease may contribute to memory problems, cognitive dysfunction, mood changes, and encephalopathy.
Can Lyme disease affect the heart?
Yes. Lyme carditis may cause rhythm abnormalities, chest discomfort, shortness of breath, and—in rare cases—serious complications.
Why are Lyme disease symptoms often missed?
Symptoms may fluctuate, overlap with other illnesses, and involve multiple body systems, complicating diagnosis.
Clinical Takeaway
Signs and symptoms of Lyme disease often extend far beyond the classic bull’s-eye rash.
When symptoms fluctuate, involve multiple systems, or evolve over time, Lyme disease may remain part of the differential diagnosis—even when early testing is inconclusive.
Related Articles
Review diagnostic complexity in Lyme Disease Misdiagnosis.
Explore overlapping infections in Lyme Coinfections.
Learn more about prevention strategies in Prevention of Lyme Disease.
Learn more about persistent symptoms in Post-Treatment Lyme Disease Syndrome.
Explore recovery challenges in Recovery From Lyme Disease.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
After more than a year on abx for babesia Duncani, my neuroologists is claiming that its really stenosis of the cervical spine that is the root cause of my body wide joint pain and tightness, testicle pain, sfn nephropathy, neck pain, insomnia, sensitivity to noise etc etc. I just feel like giving up, as there is really no way for me to sort this out.
Is there a way to figure out what is really the cause when the MRI does show stenosis and disk degeneration while at the same time getting positive B. Duncani tests?
That is the challenge in medicine. I also check for other tick borne infections. I have patients that I follow who have disc disease. You could have both issues.
I was bitten about 6 weeks ago I reached around my back and smashed t before I realized what it ws. Had blood ov er my fingers. Could not get any of the body. I have been very depressed the last two weeks, but with this quaranteen I thought it was the cause. I am also that as 86 years old. I don’t venture out.much. I contracted lyme 40 years ago and it was awful. Dr Burranscan after many trips from FL to Long Island asked me to come to Colgate Pres hospital for tests and found I had Babesia in the brain, for which he and Dr. Phalen treated me and I have survived with many surgeries to remove organs. It actually ruined my life. I have been handicapped for 40 years.
I am glad Dr. Burrascano was able to help. I have patients who don’t forget how difficult it has been. I hope you get your health back. Call my office at 914 666 4665 if you have any questions.
Well Explain about the Lyme Diseases, You Explained very well. Now a days this diseases is Increases and people get misunderstood by the symptoms. Wrong diagnosis and delay in treatment can lead more consequences for Lyme disease person People must have to connect to the doctors soon if any of the symptom is showing.
I have chronic cystic Lyme disease that was Di 1 1/2 years ago by my Naturopathic Doctor. Canadian test were negative fir Lyme but tge German test was positive. Since then I have been treated with natural substances and I can report I am starting to feel much better. It has been a long and expensive ride.
If Canadian test is negative,There is no option of treatment.
My question is- has anyone had skin problems where the area becomes so sore that only a hot water bottle receives the pain. Usually three or four days later the area comes to a head. I can, using a fingernail, lift very painfully a small carrot like “thing” out and the pain is gone. Until, it starts again. These areas are where I experience a past injury. Burn, blunt force injury from a baseball, vaccines, Epidurals first childbirth and tick bites.
I have taken pictures of these things and put a few in a small bottle of gin. Just in case anyone ever shows any interest in them.
This site will not let me post the picture but I would share with anyone interested. Suitable for framing.
There are some individuals with Morgellons.
Physicians are likely to misidentify premature Lyme disease on behalf of flu, and later on, they experience a few non-specific symptoms together with a variety of difficulties with different body organs. This is just a partial listing of Lyme disease symptoms, because there are additional than three hundred signs in the medical glossary implying Lyme disease infection.
I just got the bullseye a few days ago. Patient First gave me Doxycycline 100mg so I take that twice a day. This article is absolutely horrifying.