Lyme disease, the most common vector-borne disease in the United States, can cause a variety of non-specific symptoms that can make it tricky to diagnose – especially as the infection progresses. In the following article, learn the most and least common Lyme disease symptoms, how the disease can change over time, and more.
Lyme disease symptom basics
According to the Centers for Disease Control and Prevention (CDC), Lyme disease symptoms typically show up 3 to 30 days after a bite from an infected tick. These early-stage symptoms may include any of the following:
- Fever
- Chills
- Headache
- Fatigue
- Muscle and joint aches
- Swollen lymph nodes
- Bull’s eye rash, also known as erythema migrans, starting at the site of the tick bite and expanding gradually over several days
However, not all of these symptoms show up in all patients. For example, the bull’s eye rash only shows up in 25-50% of patients (PDF). When it does show up, it may not have the “classic” bull’s eye shape, or it may appear on a part of the body that is not easily seen. Yet some doctors dismiss a patient’s concerns of Lyme disease unless the patient presents with a bull’s eye rash.
Patients and physicians should be aware that the absence of any of the above symptoms does not mean a patient does not have a Lyme infection or other tick-borne disease. In fact, if a patient is aware that they’ve been bitten by a tick but does not have symptoms yet, the IGeneX T-cell test can be used to detect disease within the first month of infection.
Late-stage Lyme disease symptoms
As Lyme disease progresses, symptoms can worsen, change, and spread to different systems of the body. Some of the later signs and symptoms below can develop within days or weeks of a tick bite, while others may take months or years to appear:
- Severe headaches
- Neck stiffness
- New erythema migrans rashes on different parts of the body
- Bell’s palsy, a.k.a. facial palsy (loss of muscle tone or droop on one or both sides of the face)
- Arthritis with severe joint pain or swelling, especially in large joints such as the knees; one difference between Lyme arthritis and other types of arthritis is that with Lyme, the pain and swelling tends to appear only on one side of the body
- Intermittent pain in tendons, muscles, joints, and bones
- Lyme carditis: heart palpitations or irregular heartbeat, which can require hospitalization and even be fatal
- Dizziness
- Shortness of breath
- Inflammation of the brain or spinal cord
- Nerve pain
- Shooting pains, numbness, or tingling in the hands or feet
As mentioned, the longer Lyme disease goes untreated, the more likely it is for the above symptoms to appear and affect different body systems. In particular, late-stage Lyme is associated with the development of neurological and psychiatric symptoms that have both direct and indirect sources.
When Lyme disease affects the central nervous system (i.e., brain and spinal cord), a condition known as neurologic Lyme or Lyme neuroborreliosis can develop and lead to neurological symptoms such as progressive dementias, strokes, seizures, and more. An estimated 15-40% of patients with late-stage Lyme develop such symptoms (PDF). But late-stage or chronic Lyme disease can also affect a patient’s mental health indirectly, contributing to depression, anxiety, pain, cognitive problems, and other neurological and psychiatric symptoms by way of the debilitating nature of its other symptoms as well as the frustrating process of diagnosing and treating late-stage Lyme.
Note: Many of the late-stage Lyme disease symptoms described above have also been seen in the similar but distinct disease Tick-Borne Relapsing Fever. If your Lyme disease test results are negative but you continue to experience symptoms, you may be infected with TBRF or another tick-borne disease.
Chronic Lyme and PTLDS
Lyme disease symptoms can become chronic if the infection is not caught and treated in a timely manner. Some patients experience symptoms despite receiving antibiotic treatment – the CDC calls these cases Post-Treatment Lyme Disease Syndrome, or PTLDS – while for others, the disease has never been treated, leading to the development of a chronic condition. Either way, chronic symptoms can be serious and debilitating, and are much harder to treat than earlier-stage Lyme.
Chronic Lyme disease symptoms can include:
- Intermittent fevers, chills, and sweats
- Chronic inflammation
- Roving aches and stiffness
- Numbness and tingling in the limbs
- Dizziness and shortness of breath
- Tremors
- Respiratory infections
- Sore throats
- Stomach pains
- Heart palpitations and irregular heartbeat
- Anxiety and paranoia
- Rage
- Hallucinations
- Hearing sensitivity
- Dysphonia (vocal cord damage)
- New food allergies
- Multiple-chemical sensitivities
- Seizures
As with other Lyme disease cases, one patient’s chronic Lyme may look very different from another patient’s case. This makes chronic Lyme tricky to diagnose and treat, adding to the challenge for chronic Lyme patients, who tend to report a poorer quality of life than patients with other chronic illnesses.
Diagnosing your symptoms
The longer Lyme disease goes untreated, the more likely it is to affect multiple body systems and develop into a chronic condition that is much harder to detect and treat. Some symptoms associated with untreated, late-stage Lyme – such as Lyme carditis – can even be fatal. This is why the diagnostic process for Lyme and other tick-borne diseases is so important.
When a patient presents with Lyme-like symptoms, it is recommended that doctors consider their symptoms and exposure history alongside lab test results, typically blood tests. Unfortunately, the testing process for Lyme disease is prone to error and can lead to many mis- or missed diagnoses.
First, testing too early or too late can result in false negatives if the immune system has not produced enough antibodies to show up on the test. Second, many guideline-recommended tests, such as the ELISA and Western Blot, are not sensitive or specific enough to detect Lyme at multiple stages or to detect all the different species of Borrelia that cause Lyme.
Finally, many patients with Lyme disease also have co-infections, or other tick-borne disease infections alongside their Lyme infection. Co-infections will not show up on a Lyme test; they may need to be detected and treated separately for symptoms to fully resolve. What’s more, like with Lyme, many tick-borne diseases have non-specific or uncommon symptoms that patients or physicians may initially miss or dismiss.
This is why it’s important to get tested by a reputable lab using the most accurate testing possible. It can also help to work with a trusted physician who is familiar with the various ways Lyme can manifest at different stages.
Learn about the Lyme and tick-borne disease tests available at IGeneX. If you suspect you may be infected with a tick-borne disease, you can also evaluate your symptoms with the IGeneX Symptom Checker.
