Early Signs

One of the first signs of Lyme disease is usually a circular rash called erythema migrans (er-uh-THEE-muh MY- granz) or EM. An EM appears at the site of a tick bite after 3 to 30 days. This rash slowly expands over a period of several days and can reach up to 12 inches (30 centimeters) across. The center of the rash may clear as it gets larger, giving it a bull's-eye appearance. The rash may be warm but is not usually painful. A rash that occurs within hours at the site of the tick bite but goes away within a day or 2 is likely an allergic reaction to the tick and not an EM rash.

Early Symptoms

Other early symptoms of Lyme disease can include:

• Chills
• Fatigue (tiredness),
• Fever
• Headache
• Muscle and joint aches, and
• Swollen lymph nodes

Some people may get these general symptoms in addition to an EM rash, but in others, these general symptoms may be the only evidence of infection.

Some people get a small bump or redness at the site of a tick bite that goes away in 1 to 2 days, like a mosquito bite. This is not a sign that you have Lyme disease. However, ticks can spread other organisms that may cause a different type of rash. For example, Southern Tick-Associated Rash Illness (STARI) causes a rash with a very similar appearance.

Not Treating Lyme Disease

Untreated Lyme disease may spread to other parts of the body within a few days to weeks. Symptoms may include:

• Heart palpitations and dizziness
• Pain that moves from joint to joint
• Paralysis (puh-RAL-uh-sis) (inability to move the muscles) of the face, usually on one side or the other (Bell's palsy)
• Severe headaches and neck stiffness due to meningitis (men-in-JAHY-tis) (swelling around the brain)

After several months, about 60% of people with untreated infection will begin to have arthritis that comes and goes, with severe joint pain and swelling. A few untreated people may develop chronic neurological (brain and spine) problems months to years after infection. These include:

• Numbness or tingling in the hands or feet
• Problems with concentration and short-term memory
• Shooting pains