Lyme Disease Symptoms

This page provides information about the symptoms of Lyme disease: the diversity, the stages of Lyme, and a Lyme symptoms checklist.

Diversity of Lyme disease symptoms

In case of an infection with the Borrelia bacteria (transmitted via a tick bite) a red rash can emerge at the tick bite location. This rash can emerge days to weeks after the tick bite; it gradually expands and often the center clears again so that a ringlike rash develops. This skin condition is called erythema migrans (EM). The EM doesn't always have the same shape, and in some cases people develope multiple EMs at different locations.

NOTE: not all those who get infected will have an EM.

Further some time after the tick bite flu-like symptoms, such as headache, stiff neck, fever, muscle pain and fatigue can appear. These symptoms may disappear also after a while. If the Lyme bacterium is spread through the body (disseminates), various symptoms may occur.

Lyme disease is a multi-system disease. It may lead to neurological (nervous system / brains), dermatological (skin), rheumatic (muscles and joints), cardiac (heart), opthalmologische (eyes) and psychiatric symptoms. That's why it can cause so many symptoms.

Lyme disease stages

Often Lyme disease is classified in 3 stages, with each stage having specific symptoms. This classification should be seen as a model, from which the reality often differs. Per person, the course of Lyme disease can vary a lot.

. with stage 1 people usually mean early lyme disease, with a local infection at the site of the bite (an erythema migrans), although in principle the spirochete can spread (disseminate) very quickly through the body.
. with stage 2 people mean the next stage, where the spirochetes have spread throughout the body. Therefore this second stage is also called: disseminated lyme disease.
. with stage 3 people usually mean chronic/late stage lyme disease. (It seems that some people view late stage lyme disease as untreated Lyme disease, and chronic Lyme disease as treated Lyme disease where the Borrelia bacterium has not been eradicated and is still causing symptoms).

Post lyme syndrome

Possibly a fourth stage could be added to the above stages: post Lyme syndrome. There is a theory that the Borrelia-bacterium can cause a kind of autoimmune disease. Post-Lyme disease as well as chronic Lyme disease are highly controversial, and both offer an explanation for continuing symptoms after a so-called "adequate" antibiotic treatment. The critical questions here is: what is an adequate treatment?

Lyme disease symptoms checklist

The following Lyme symptoms list is taken from Burrascano's Lyme Disease Guidelines. Take into account that different persons have difference in symptoms, the severity, sequence, etc. The course of Lyme disease is not the same for everybody.

Note that a lot of these symptoms are not specific for Lyme disease: they are common complaints, which also occur in other disorders. Having some of these general complaints, doesn't mean that much on itself, but in combination with other evidence they can support the diagnosis. Therefore other information is neccesary as well, like test results, history of a tick bite, history of a rash after the tick bite, etc.

-Persistent swollen glands
-Sore throat
-Sore soles, esp. in the AM
-Joint pain
-Joint swelling
-Unexplained back pain
-Stiffness of the joints or back
-Muscle pain or cramps
-Obvious muscle weakness
-Twitching of the face or other muscles
-Confusion, difficulty thinking
-Difficulty with concentration, reading, problem absorbing new information
-Word search, name block
-Forgetfulness, poor short term memory, poor attention
-Disorientation: getting lost, going to wrong places
-Speech errors- wrong word, misspeaking
-Mood swings, irritability, depression
-Anxiety, panic attacks
-Psychosis (hallucinations, delusions, paranoia, bipolar)
-Light sensitivity
-Sound sensitivity
-Vision: double, blurry, floaters
-Ear pain
-Hearing: buzzing, ringing, decreased hearing
-Increased motion sickness, vertigo, spinning
-Off balance, “tippy” feeling
-Lightheadedness, wooziness, unavoidable need to sit or lie
-Tingling, numbness, burning or stabbing sensations, shooting pains, skin -hypersensitivity
-Facial paralysis-Bell's Palsy
-Dental pain
-Neck creaks and cracks, stiffness, neck pain
-Fatigue, tired, poor stamina
-Insomnia, fractionated sleep, early awakening
-Excessive night time sleep
-Napping during the day
-Unexplained weight gain
-Unexplained weight loss
-Unexplained hair loss
-Pain in genital area
-Unexplained menstrual irregularity
-Unexplained milk production; breast pain
-Irritable bladder or bladder dysfunction
-Erectile dysfunction
-Loss of libido
-Queasy stomach or nausea
-Heartburn, stomach pain
-Low abdominal pain, cramps
-Heart murmur or valve prolapse?
-Heart palpitations or skips
-“Heart block” on EKG
-Chest wall pain or ribs sore
-Head congestion
-Breathlessness, “air hunger”, unexplained chronic cough
-Night sweats
-Exaggerated symptoms or worse hangover from alcohol
-Symptom flares every 4 wks.



For medical literature documenting the symptoms of Lyme disease, go to and choose the PDF "Symptoms".

Feder, Johnson, et al. A Critical Appraisal of "Chronic Lyme Disease". N Engl J Med. 2007 Oct 4;357(14):1422-30.