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The most common symptom of Lyme disease is a pink or red rash.

The rash spreads from the part of the body where you have been bitten by an infected tick. But not everyone gets this rash.

The rash is often the first and most obvious sign of infection. It is pink or red and usually appears about one or two weeks after being bitten by an infected tick.¹ The rash can clear in the middle, making it look like a "bull's eye." It can become very large (about the size of a dinner plate) and it may spread for months if it isn't treated.

Not everyone who is infected gets a rash.²

Early on in the infection, you may also get one or more flu-like symptoms, such as:^{2 3 4}

• Tiredness
• Headaches
• Fever or chills
• Muscle pains.

If you get any of these symptoms and you think you may have been bitten by a tick, see your doctor. If you have been infected with Lyme disease, then it's best to start treatment as soon as possible.

Your doctor will ask about your symptoms and check how likely it is that you have been near animals infected with ticks. People often don't realize they have been bitten by a tick, so sometimes it can be difficult to diagnose, especially if you don't have the rash.

If you have no obvious symptoms you may not realize you have an infection. After a few weeks or months, the infection can spread to other parts of your body, including the nerves and joints.

If your doctor thinks you have the later stages of Lyme disease, you may need blood tests or other tests to check that you have Lyme disease.⁵

You may get facial palsy.¹ This means you lose control of some muscles in your face. It usually clears up, even without treatment.

You may get pain, numbness and difficulties with movement in some parts of your body. Doctors call it radiculopathy. It's caused by inflamed nerves and can last for months if you don't get treatment. The pain goes away quickly once you are treated.

A few people with Lyme disease get meningitis. In meningitis, the linings covering your brain and spinal column become inflamed. But the meningitis you get with Lyme disease is a mild form of the disease. It isn't dangerous and doesn't lead to any serious long-term problems. Lyme meningitis isn't common. One study found that about 1 in 100 children who get Lyme disease get meningitis.³

If the infection affects your joints it can be painful. It's most likely to affect your knee joints.⁴ In a small number of people, this pain doesn't go away, and the joints become swollen and inflamed. Doctors call this Lyme arthritis.

Lyme disease can cause problems with your heart and your liver. But these problems are rare.^{2 4}

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment. ©BMJ Publishing Group Limited 2008. All rights reserved.