Acute (early) Lyme disease symptoms:


An expanding rash called an erythema migrans (EM) may occur at the site of the tick bite; 70% of cases reported to the CDC had an EM. The rash usually appears 2 to 30 days after the bite. Roughly 80% of all EMs are solid red ovals. The “bull’s-eye” or target-like rash is the easiest EM to recognize, but it’s not commonly seen. On dark skin an EM can look like a bruise. Some patients have more than one EM. Take a photo of any rash and have it checked by a doctor as soon as possible.

Fever, malaise, fatigue, headache, muscle and joint aches

The incubation period from tick bite to the onset of early Lyme disease symptoms is usually 2-30 days. It is possible for an infected person to have no symptoms or display only one or two symptoms; this can make obtaining a correct diagnosis difficult.

Blood tests will likely be negative during this stage of Lyme disease.

Persistent (late) Lyme disease symptoms

Fatigue, muscle and joint aches, Bell’s palsy, pain, numbness, tingling or burning sensations, meningitis, tremor, muscle twitches short-term memory loss, depression, anxiety, panic attacks, hallucinations and many others. The symptoms of late Lyme disease can appear months to years from infection. Left untreated, Lyme disease can cause chronic disability, but it is rarely fatal. Cases of persistent infection have been known to linger for 20 years before being correctly diagnosed.

 Printable Symptom-Checklist-with-References to bring along with you to your doctors appointment.


The most reliable method for diagnosing Lyme disease is a thorough medical history and physical exam. The history includes details about possible tick exposure, current medical problems and a complete review of all symptoms. The physical exam includes a good general exam plus detailed dermatologic, neurologic and joint exams. The laboratory tests used to assist in the diagnosis of Lyme disease include the ELISA and Western blots. The ELISA is done first; if it is positive then Western blots are done. Unfortunately, neither test is a reliable indicator of illness; test results vary between labs and within the same lab and false positives and false negatives are common. A 2003 study by CDC researchers demonstrated that the C6 ELISA, a commonly used test for Lyme disease, performed well for patients with arthritis but missed patients with acute disease and many with early or late neurologic Lyme disease. Because of these sorts of testing problems, Lyme disease must be diagnosed on clinical grounds. Lab tests may confirm a clinical diagnosis but by themselves they cannot rule the disease in or out.


The two tier testing system endorsed by the Centers for Disease Control and Prevention (CDC) has a high specificity (99%) and yields few false positives. But the tests have a uniformly miserable sensitivity (56%)—they miss 88 of every 200 patients with Lyme disease. NIH

  Read Serologic Testing in Lyme Disease by Dr. Elizabeth Maloney

Other Resources

Mosquitoes and fleas are not vectors of the Lyme disease agent. Some blood-feeding insects could theoretically pick up the organism if they feed on an infected small mammal host. However, they have not been shown to be able to efficiently maintain the bacteria over time or transmit the bacteria in subsequent feedings. The same holds true for American dog ticks.

Neuropsychiatric Lyme Disease



Most patients will not develop chronic Lyme disease, but for those who do it can have a huge impact on their quality of life.