Symptoms of Lyme disease

 Erythema migrans rash (EM) - Contrary to popular belief, the characteristic "bull's-eye" rash with central clearing is not the most common form. Rashes that are homogeneously red (throughout) are seen more frequently. Multiple painless EM rashes may occur, indicating disseminated infection.  Less than 50% of those infected recall a rash.  Most often a rash is not seen or recalled.  A rash is not likely to be seen when the tick bite occurs in an area of the body not easily inspected. LD rashes appear in wide variation and can also mimic other common presentations including a spider bite, ringworm, or cellulitis.

Other early symptoms of Lyme disease may include flu-like symptoms, fever, chills, fatigue, headache, and weakness.  Heart palpitations, kidney, and intestinal pain may also occur.   Early objective (visible) signs which may be present include meningitis, facial paralysis such as Bell's palsy, and heart block. 

The amount of time from infection to the onset of symptoms is usually 1–2 weeks, but can be much shorter (a couple of days), or even months.   Most individuals with early Lyme disease respond well to appropriate antibiotics.

The most important method for preventing chronic Lyme disease is recognition of the early manifestations of the disease combined with prompt treatment. 

Late Stage (Tertiary) Symptoms that may occur:

Neurological complications most often occur in the disseminated stage of Lyme disease, with numbness, pain, weakness, Bell's palsy (paralysis of the facial muscles), visual disturbances, and meningitis symptoms such as fever, stiff neck, and severe headache. Other symptoms, which may not appear until weeks, months, or even years after a tick bite, include decreased concentration, irritability, memory and sleep disorders, and nerve damage in the arms and legs.

• Headache, stiff neck, sleep disturbance, fatigue, and problems with memory and concentration are frequent findings in neurological Lyme disease.
   

• Other clues to Lyme disease have been identified, although these have not been consistently present in all patients:
   

  • numbness and tingling, muscle twitching, sensitivity to light and sound, ringing of the ears, lightheadedness and depression.
     

• See the detailed symptom list at the left for more info.

Symptoms are cyclic in nature and fluctuate in intensity.  Symptoms may be present on some days and not on others.  Symptom "flares" or cycles may be noted approximately every 4 weeks.

Sorting It All Out:

1.  Did you have a potential tick exposure?

2.  Do you remember being bitten by a tick?

3.  Do you work or play in a Lyme endemic area?  (Many areas in Iowa and the Midwest are now considered endemic.)

4.  What are your outdoor activities that put you at risk of tick exposure— gardening, mowing or clearing brush or leaves from wooded areas of property, hiking, camping, golfing, playing in the grass, etc.?

5.  Have your symptoms evolved or changed over time consistent with Lyme disease?

6.  Do you have signs and symptoms consistent with Lyme disease?

7.  Do you recall having the Erythema Migrans (bullseye) rash or similar rash?

8.  Have other household members or neighbors been diagnosed with a tick-borne illness?

9.  Do you have pets which may increase your risk of exposure to ticks?

10.  Did your physician check to rule out other diseases and conditions?

11.  Have you been tested for Lyme disease?  Was it a Western Blot test?  Do you have copies of the results from the lab?

12.  Do your symptoms come and go, sometimes affecting a different body system or part of your body?

13.  If you tried an antibiotic, did you improve or worsen?  Worsening of symptoms or flare may be caused due to lysis of the spirochetes and their release of antigenic material and bacterial toxins. This is referred to as a Jarisch Herxheimer-like reaction.