Stages of Lyme Disease

Lyme disease may progress in stages from mild symptoms to serious, long-term disabilities if left untreated. There are three stages of Lyme disease: early localized, early disseminated, and late persistent.


Stage 1: Early localized infection

In about 30% of the people infected with bacteria that cause Lyme disease, an expanding circular rash is accompanied by flulike symptoms such as:

• Fatigue or lack of energy, which is the most common symptom.
• Headache and stiff neck.
• Fever and chills.
• Muscle and joint pain.
• Swollen lymph nodes.

As many as 70% have only flulike symptoms (no rash) or have no symptoms at all.


Stage 2: Early disseminated infection

If Lyme disease is not detected and treated while early symptoms are present, or if you do not have early symptoms that trigger the need for treatment, the infection may spread to the skin, joints, nervous system, and heart within weeks to months after the initial infection.

Symptoms at this stage may include:

• Persistent fatigue.
• Additional skin rashes in several places on your body that develop as the infection spreads.
• Pain, weakness, or numbness in the arms or legs.
• Inability to control the muscles of the face (paralysis of the facial nerves).
• Recurring headaches or fainting.
• Poor memory and reduced ability to concentrate.
• Conjunctivitis (pinkeye) or sometimes damage to deep tissue in the eyes.
• Occasional rapid heartbeats (palpitations) or, in rare cases, serious heart problems.

Stage 3: Late persistent infections

If Lyme disease is not promptly or effectively treated, damage to the joints, nerves, and brain may develop months or years after you become infected (late Lyme disease). Symptoms at this stage may include:

• Swelling and pain (inflammation) in the joints, especially in the knees.
• Numbness and tingling in the hands, feet, or back.
• Severe fatigue.
• Partial facial nerve paralysis (Bell's palsy), which usually occurs within the first few months after the tick bite.
• Neurologic changes, including problems with memory, mood, or sleep and sometimes problems speaking.
• Chronic Lyme arthritis, which causes recurring episodes of swelling, redness, and fluid buildup in one or more joints.

Heart, nervous system, and joint symptoms may be the first signs of Lyme disease in people who did not have a rash or other symptoms of early infection.