Lyme Disease Symptoms and Diagnosis

A review of the three stages of Lyme disease.

Infection following a tick bite causes three stages of disease. The early, localized infection (Stage 1) causes a rash  commonly called a “bull’s-eye rash.” Although diagnostic following a tick bite, the rash only occurs in about half of Lyme disease cases.

Signs of Stage 1 Lyme disease

Typically, symptoms that may arise 3 to 30 days after being bitten by an infected tick include:

  • Red, expanding rash at the site of the tick bite (develops in about 70% to 80% of cases). It is called erythema migrans. The rash gradually expands over several days. It can reach up to 12 inches or more across. Parts of the rash may clear in the center as it gets bigger, making it look like a bull’s-eye. The rash usually feels warm when you touch it. It is usually not itchy or painful.
  • Chills
  • Fatigue
  • Fever
  • Headache
  • Muscle and joint aches
  • Swollen lymph nodes

(Source: 123RF)

Signs of Stage 2 Lyme disease

Typically, symptoms that may arise days or weeks after being bitten by an infected tick include:

  • Additional bull’s-eye rashes on other parts of the body
  • Paralysis or weakness in one or both sides of the face, known as facial or Bell’s palsy
  • Pain and swelling in large joints, most often the knee
  • Severe headaches and neck stiffness, caused by meningitis (inflammation of the spinal cord)
  • Shooting pains, which may keep you awake
  • Heart problems such as skipped heartbeats (palpitations), dizziness, chest pain or shortness of breath

Signs of Stage 3 Lyme disease

Typically, symptoms that may arise months or years after being bitten by an infected tick are:

  • Bouts of arthritis, with severe joint pain and swelling, particularly in the knee (in about 60% of Lyme disease patients who have not been treated)
  • Abnormal muscle movement
  • Muscle weakness
  • Numbness and tingling
  • Speech problems
  • Thinking (cognitive) problems

The late, disseminated stage of infection is characterized by neurologic manifestations and severe arthritic pain in joints. There may be shooting pains, numbness or tingling in the hands or feet, insomnia, and problems with short-term memory.


Diagnosis of Lyme disease is based on your signs and symptoms, and whether you have possibly been exposed to infected ticks. The doctor may order a blood test to look for evidence of antibodies against the Lyme disease bacteria. The diagnosis of Lyme disease is usually confirmed by a blood test.

Because the bacteria that causes Lyme disease is hard to detect with current lab test, misdiagnosis of the disease is common. If you suspect you have Lyme disease, you should contact your physician for proper testing.

Updated on: 05/23/19
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