Symptoms and Complications
The classic symptom of Lyme disease is a skin rash called erythema migrans (migrating rash). This characteristic skin rash starts out as a small red patch that gradually expands, often clearing in the center to form a bull's-eye pattern. A bite from a very young tick that is very small may not leave a rash or a bite mark.
Some of the symptoms of Lyme disease are common to other medical conditions such as influenza. "Flu-like" symptoms include fatigue, headache, chills and fever, muscle and joint pain, and swollen lymph nodes.
Other symptoms a person with Lyme disease may experience include:
- buzzing, ringing, or pain in the ear
- chest pain or rib soreness
- confusion
- difficulty concentrating or reading
- difficulty speaking or understanding speech
- difficulty walking
- dizziness, poor balance, increased motion sickness
- double or blurry vision, eye pain
- facial paralysis
- forgetfulness or poor short-term memory
- hand tremor
- heart palpitations, heart murmur, or skipping pulse
- joint pain, tenderness, or swelling - especially in the knee
- muscle twitching of the face or other areas
- neck creaks and stiffness
- stiffness of the joints, neck, or back
The most common complication of Lyme disease is arthritis, which affects about 60% of those who develop the rash. Unlike rheumatoid arthritis or osteoarthritis, many forms of infectious arthritis don't actually damage the bone. Most people with Lyme disease arthritis experience temporary swelling and pain, mainly in the large joints. The knees are most commonly affected, though sometimes several joints are inflamed together. Arthritic symptoms usually come and go. Some people feel brief flu-like symptoms in the days before a joint starts to swell. Though temporary, the arthritis can be severe and require crutches. Arthritic symptoms may appear within a few weeks of the rash, or they may appear several years later.
Cardiac (heart) and neurological (brain and nerves) symptoms may also appear within several weeks of the onset of the initial symptoms of Lyme disease. About 5% of the people who do not receive treatment for Lyme disease may have cardiac symptoms, most commonly arrhythmias (an irregular heart beat). Neurologic symptoms occur in about 15% of people who do not receive treatment for Lyme disease, most commonly due to inflammation of the lining of the brain (meningitis) or of the brain itself (encephalitis), although there may also be other problems. Some doctors may also request studies of the brain and spinal fluid.