With or without a rash, patients experience some flu-like symptoms, including muscle soreness and aches, fatigue, enlarged lymph nodes, headache, neck pain, fever and chills, and joint pain. These symptoms can last a few hours to months, and be constant or intermittent, and change over time. Fatigue is generally longer lasting than the other symptoms. A cluster of these signs during the summer in an area with a lot of Lyme disease and ticks, even without a rash, should be treated for Lyme disease.
About 15% of untreated patients develop problems with their nervous system within weeks to months of the flu-like illness. These can include symptoms of meningitis (head and neck pain, light sensitivity, headache), and Bell’s palsy (loss of movement on one side of the face) or nerve pain. This can last months but generally resolves completely. In addition, 8% of patients can develop problems with the heart, including electrical problems called arrhythmias which can be dangerous. Finally, 60% of untreated patients will get arthritis, often of the knee, in one or more joints with swelling and fatigue.
Now that we have scared you all, why don’t we just perform a blood test when someone is bitten by a tick? Unfortunately, the available tests are not extremely reliable, particularly in the early stage of the disease. It takes weeks for the tests to become positive, and even then not everyone who has Lyme disease, even with the classic enlarging bullseye rash of erythema migrans, has a positive result.