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Learn about the stages of Lyme disease, from early localized to late disseminated, and the potential complications that can arise if left untreated. Discover how to recognize the symptoms and the importance of early detection and treatment.

Lyme disease is the fastest-growing vector-borne disease with more than 476,000 new cases each year. Spread by the bite of an infected black-legged (deer) tick, Lyme disease is in all fifty states in the U.S. and is most prevalent on the coasts and in the Upper Midwest. Anyone who spends time outdoors is at risk for Lyme disease and should take preventions against tick bites. If diagnosed and treated during the earliest stage (early localized Lyme disease), it can often be cured with a course of antibiotics. However, Lyme disease is difficult to diagnose and many tick bites go unnoticed. Untreated Lyme disease can become very serious, progressing to later stages of disease that can become chronic. Understanding the progression of Lyme disease and its potential complications is crucial to understanding the importance of early detection and treatment.

What Are the Stages of Lyme Disease?

Lyme disease occurs in three stages: early localized, early disseminated, and late disseminated disease. However, the stages can overlap, and not all patients go through all three. An erythema migrans (EM) rash is an early sign of infection. Sometimes called a bulls-eye rash because it often presents in a target-like shape, an EM rash can also be a different shape or even color. Moreover, not everyone with Lyme disease gets or notices an EM rash. In most cases, Lyme symptoms can start with a flu-like illness. Untreated Lyme disease can spread throughout the body to places like the heart and joints, and can cross the blood-brain barrier into the central nervous system. It can turn into a long-lived debilitating illness affecting the neurologic, cardiac, and immune systems of patients.

When Do Symptoms of Lyme Disease Appear?

Stage 1: Early Localized Lyme Disease Early symptoms with localized (or acute) Lyme disease may begin hours, a few days, or even weeks after a black-legged tick (deer tick) bite. At the point of initial infection, the Lyme disease bacterium, a spirochete called Borrelia burgdorferi, has not yet spread throughout the body. Lyme is the easiest to cure at this stage with antibiotics.

Early Stage symptoms may include:

● Erythema Migrans skin rash (EM rash), which may or may not look like a bulls-eye

● flu-like illness, including chills and fever

● fatigue

● headache and stiff neck

● muscle soreness and joint pain

● swollen lymph nodes

● sore throat

Stage 2: Early Disseminated Lyme Disease

Early disseminated Lyme may occur several weeks or months after the black-legged tick bite. The bacterium Borrelia burgdorferi is beginning to spread throughout the body. In addition to flu-like symptoms, this stage is often characterized by an increase in typical symptoms such as:

● chills

● fever

● headaches

● fatigue

It can also be marked by symptoms that demonstrate disease progression to the heart or nervous system, including:

● pain, weakness, or numbness in the arms and legs

● vision changes ● Lyme carditis, heart problems, such as palpitations or chest pain

● Multiple EM rashes ● facial paralysis or facial palsy

Stage 3: Late Disseminated Lyme Disease

Many have asked, do you ever get rid of Lyme disease or other tick-borne illnesses? Do I have chronic Lyme disease? Can Lyme disease return? If Lyme disease isn’t promptly or effectively treated in the first two stages, late disseminated (post-treatment, chronic, or neurological) Lyme occurs weeks, months, or even years after the infected tick bite. The bacterial infection has spread throughout the body and nervous system, and many untreated patients develop chronic Lyme arthritis as well as an increase in neurological and cardiac symptoms. In later stages of infection, more severe Lyme disease symptoms may include:

● arthritis in large joints or near the point of infection

● severe headaches or migraines

● vertigo, dizziness

● migrating pains that come and go in joints/tendons

● stiff, aching neck

● chronic fatigue syndrome

● sleep disturbances, insomnia

● disturbances in heart rhythm

● mental fogginess, concentration issues

● numbness in the arms, legs, hands or feet

● problems following conversations and processing information

● severe fatigue

How is Lyme Disease Diagnosed?

At any stage, Lyme disease is a clinical diagnosis, meaning a medical professional makes a diagnosis based on a person’s symptoms and risk factors (including a known or suspected tick bite or time spent in a tick-endemic area). Blood tests can help a doctor confirm a diagnosis, but they are not always accurate and should not be used alone to determine if someone has Lyme disease. If you suspect you may have Lyme disease, it’s important to see a Lyme Literate Medical Doctor (LLMD) to get an accurate diagnosis.

How is Lyme Disease Treated?

Lyme disease is treated with antibiotics. Depending on the stage of disease and severity of symptoms, oral or intravenous antibiotics may be used. Treatment will vary from patient to patient. In addition to stage and severity of Lyme disease symptoms, other factors such as co-infections (other tick-borne diseases), age, and other clinical factors determine the best treatment course for an individual.


Lyme disease presents itself in three stages, with symptoms varying in severity. However, the best approach to Lyme disease should focus on prevention rather than treatment. To minimize the risk of infection, especially in wooded areas or during outdoor activities, it is essential to prioritize protective measures. This includes wearing long-sleeved shirts and light-colored clothing and using insect repellent containing DEET or picaridin to deter ticks. By focusing on disease control through awareness and prevention, we can effectively reduce the chances of Lyme disease and its debilitating consequences.


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