Stages of Lyme disease

Lyme disease can develop in several stages. It may cause different symptoms, depending on how long you have been infected and where in your body the infection has spread.

Early localized Lyme disease develops days to weeks after you become infected. An expanding, circular red rash (erythema migrans) is the most common sign of early Lyme disease. Flu-like symptoms such as fever, chills, and headache may also occur at this stage.

Early disseminated Lyme disease is the second stage. It may develop several weeks or months after you become infected and can cause:

• Skin problems, such as an expanding, circular rash at the site of the bite. Additional rashes can then appear on other parts of your body as the infection spreads. More serious skin problems from Lyme disease are rare in the United States but can include swelling in the earlobes and near the nipples, and severe thinning of the skin on the hands and feet.
• Joint problems, which are common and include brief episodes of pain, redness, and swelling in one or more large joints—most often the knee. Joint symptoms usually improve with antibiotic treatment.
• Early nervous system problems, such as pain and weakness in the arms and legs caused by nerve inflammation.
• Heart problems, most commonly a slow or irregular heartbeat (arrhythmia). Heart problems caused by Lyme disease are rare and are even rarer if you did not already have a weakened heart before you got Lyme disease.

Late persistent Lyme disease is the last and often the most serious stage of the disease. It may develop weeks, months, or (rarely) years after the initial infection and can cause:

• Joint problems, such as early arthritis that most often affects the knee. A small number of people eventually get chronic Lyme arthritis, which usually improves with antibiotic treatment. However, joints that have been badly damaged may take a long time to heal or may not respond to antibiotics. Joint surgery is sometimes tried in these cases.
• Late nervous system problems, such as pain, weakness, or numbness in the arms or legs that can occur when the bacterial infection has spread to the nerves or spinal cord. Bad headaches, fatigue, or problems with vision, hearing, memory, concentration, and thinking can also arise. Serious nervous system problems can cause severe headache and stiff neck due to swollen tissues surrounding the brain and spinal cord (meningitis); paralysis of the nerves that control the muscles in the face (Bell's palsy); and inflammation of the brain (encephalitis). However, these problems sometimes go away on their own; if not, they usually improve after antibiotic treatment.
• Heart problems, which are rare but can occur months to even years after being bitten by an infected tick. The most serious heart problems—such as inflammation of the structures surrounding the heart (pericarditis)—usually resolve without any lifelong damage. Unfortunately, heart problems can be the first sign of Lyme disease in a small number of people who did not have early symptoms.