What are the symptoms of Lyme disease (Lyme borreliosis)?

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Last updated: April 6, 2025View editorial policy

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From the Guidelines

Lyme disease symptoms typically begin with a characteristic rash called erythema migrans, accompanied by nonspecific symptoms such as fever, malaise, fatigue, headache, myalgia, and arthralgia, usually developing 7-14 days after infection, as reported by 1. The symptoms of Lyme disease can be divided into several stages, with the early stage characterized by the appearance of erythema migrans, a bull's-eye rash, in about 70-80% of infected individuals.

  • Early symptoms resemble flu-like illness, including fever, chills, fatigue, body aches, headache, neck stiffness, and swollen lymph nodes.
  • If left untreated, the infection can spread to joints, causing severe arthritis with joint pain and swelling, particularly in the knees.
  • Neurological problems may develop weeks or months later, including meningitis, temporary facial paralysis (Bell's palsy), numbness or weakness in limbs, and impaired muscle movement. The incubation period from infection to onset of erythema migrans is typically 7-14 days but can be as short as 3 days or as long as 30 days, as noted in 1. Some infected persons have no recognized illness or manifest only nonspecific symptoms, such as fever, headache, fatigue, and myalgia, as stated in 1. Prompt recognition of symptoms is crucial, as early antibiotic treatment is most effective at preventing disease progression, according to 1.

From the Research

Lyme Disease Symptoms

  • The disease typically begins with a characteristic skin rash, erythema migrans, and associated flulike symptoms 2
  • Weeks to months later, untreated individuals may experience one or more manifestations of disseminated Lyme disease, including:
    • Nervous system involvement
    • Heart problems
    • Joint issues
  • The initial symptoms usually occur in the summer, as this is when the ticks that transmit the disease are most active 2

Diagnosis and Treatment

  • Diagnosis is based on recognition of the appropriate signs and symptoms, as well as serological testing and a history of travel to or residence in an endemic area 2
  • All stages of the illness are responsive to antibiotics, with early treatment being more efficacious 2

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Lyme disease: clinical manifestations, diagnosis, and treatment.

Seminars in arthritis and rheumatism, 1991

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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