110 signs/symptoms table
| # | Sign or Symptom | Typical Frequency | Reference |
|---|---|---|---|
| 1 | Erythema migrans rash | Common | Steere AC, et al. N Engl J Med. 2001;345(2):115-125. |
| 2 | Expanding rash | Common | Wormser GP, et al. Clin Infect Dis. 2006;43(9):1089-1134. |
| 3 | Central clearing rash | Common | Hu L. Ann Intern Med. 2016;164(9):ITC65-ITC80. |
| 4 | Warmth at rash site | Common | CDC. Signs and Symptoms of Untreated Lyme Disease. |
| 5 | Tender rash site | Less common | CDC. Signs and Symptoms of Untreated Lyme Disease. |
| 6 | Fatigue | Common | Steere AC, et al. N Engl J Med. 2001;345(2):115-125. |
| 7 | Malaise | Common | Hu L. Ann Intern Med. 2016;164(9):ITC65-ITC80. |
| 8 | Fever | Common | Wormser GP, et al. Clin Infect Dis. 2006;43(9):1089-1134. |
| 9 | Chills | Common | CDC. Signs and Symptoms of Untreated Lyme Disease. |
| 10 | Sweats | Less common | CDC. Signs and Symptoms of Untreated Lyme Disease. |
| 11 | Headache | Common | Hu L. Ann Intern Med. 2016;164(9):ITC65-ITC80. |
| 12 | Neck stiffness | Less common | Steere AC, et al. N Engl J Med. 2001;345(2):115-125. |
| 13 | Myalgias | Common | Wormser GP, et al. Clin Infect Dis. 2006;43(9):1089-1134. |
| 14 | Arthralgias | Common | Steere AC, et al. N Engl J Med. 2001;345(2):115-125. |
| 15 | Swollen lymph nodes | Less common | CDC. Signs and Symptoms of Untreated Lyme Disease. |
| 16 | Flu-like symptoms | Common | Hu L. Ann Intern Med. 2016;164(9):ITC65-ITC80. |
| 17 | Multiple erythema migrans lesions | Less common | Wormser GP, et al. Clin Infect Dis. 2006;43(9):1089-1134. |
| 18 | Facial palsy | Less common | Marques A. Continuum. 2015;21(6):1737-1750. |
| 19 | Bell’s palsy-like weakness | Less common | CDC. Lyme Disease Symptoms and Signs. |
| 20 | Meningitis | Uncommon/Rare | Steere AC, et al. N Engl J Med. 2001;345(2):115-125. |
| 21 | Lymphocytic meningitis | Uncommon/Rare | Marques A. Continuum. 2015;21(6):1737-1750. |
| 22 | Radicular pain | Less common | Wormser GP, et al. Clin Infect Dis. 2006;43(9):1089-1134. |
| 23 | Radiculoneuritis | Uncommon/Rare | Hu L. Ann Intern Med. 2016;164(9):ITC65-ITC80. |
| 24 | Peripheral neuropathy | Uncommon/Rare | Steere AC, et al. N Engl J Med. 2001;345(2):115-125. |
| 25 | Numbness | Less common | CDC. Lyme Disease Symptoms and Signs. |
| 26 | Tingling | Less common | Hu L. Ann Intern Med. 2016;164(9):ITC65-ITC80. |
| 27 | Burning pain | Less common | Marques A. Continuum. 2015;21(6):1737-1750. |
| 28 | Shooting nerve pain | Less common | Steere AC, et al. N Engl J Med. 2001;345(2):115-125. |
| 29 | Brain fog | Less common | CDC. Lyme Disease Symptoms and Signs. |
| 30 | Difficulty concentrating | Less common | Hu L. Ann Intern Med. 2016;164(9):ITC65-ITC80. |
| 31 | Memory problems | Less common | Steere AC, et al. N Engl J Med. 2001;345(2):115-125. |
| 32 | Cognitive slowing | Less common | Marques A. Continuum. 2015;21(6):1737-1750. |
| 33 | Sleep disturbance | Common | Hu L. Ann Intern Med. 2016;164(9):ITC65-ITC80. |
| 34 | Insomnia | Less common | CDC. Lyme Disease Symptoms and Signs. |
| 35 | Excessive sleepiness | Less common | Hu L. Ann Intern Med. 2016;164(9):ITC65-ITC80. |
| 36 | Irritability | Less common | Marques A. Continuum. 2015;21(6):1737-1750. |
| 37 | Depression | Less common | Steere AC, et al. N Engl J Med. 2001;345(2):115-125. |
| 38 | Anxiety | Less common | Hu L. Ann Intern Med. 2016;164(9):ITC65-ITC80. |
| 39 | Mood swings | Less common | Marques A. Continuum. 2015;21(6):1737-1750. |
| 40 | Photophobia | Uncommon/Rare | Steere AC, et al. N Engl J Med. 2001;345(2):115-125. |
| 41 | Visual blurring | Less common | CDC. Lyme Disease Symptoms and Signs. |
| 42 | Eye pain | Uncommon/Rare | Hu L. Ann Intern Med. 2016;164(9):ITC65-ITC80. |
| 43 | Conjunctivitis | Uncommon/Rare | Steere AC, et al. N Engl J Med. 2001;345(2):115-125. |
| 44 | Double vision | Uncommon/Rare | Marques A. Continuum. 2015;21(6):1737-1750. |
| 45 | Ear pain | Uncommon/Rare | CDC. Lyme Disease Symptoms and Signs. |
| 46 | Tinnitus | Uncommon/Rare | Hu L. Ann Intern Med. 2016;164(9):ITC65-ITC80. |
| 47 | Vertigo | Uncommon/Rare | Marques A. Continuum. 2015;21(6):1737-1750. |
| 48 | Dizziness | Common | CDC. Lyme Disease Symptoms and Signs. |
| 49 | Lightheadedness | Less common | Wormser GP, et al. Clin Infect Dis. 2006;43(9):1089-1134. |
| 50 | Syncope | Uncommon/Rare | Hu L. Ann Intern Med. 2016;164(9):ITC65-ITC80. |
| 51 | Palpitations | Uncommon/Rare | Steere AC, et al. N Engl J Med. 2001;345(2):115-125. |
| 52 | Chest pain | Uncommon/Rare | Hu L. Ann Intern Med. 2016;164(9):ITC65-ITC80. |
| 53 | Shortness of breath | Uncommon/Rare | CDC. Lyme Disease Symptoms and Signs. |
| 54 | Exercise intolerance | Less common | Marques A. Continuum. 2015;21(6):1737-1750. |
| 55 | Lyme carditis | Uncommon/Rare | Besant G, et al. J Emerg Med. 2018;54(3):e31-e35. |
| 56 | Atrioventricular block | Uncommon/Rare | CDC. Lyme Carditis. |
| 57 | Bradycardia | Uncommon/Rare | Besant G, et al. J Emerg Med. 2018;54(3):e31-e35. |
| 58 | Heart block | Uncommon/Rare | CDC. Lyme Carditis. |
| 59 | Joint swelling | Common in arthritis stage | Steere AC, et al. Ann Intern Med. 1983;99(1):76-82. |
| 60 | Knee swelling | Common in arthritis stage | CDC. Lyme Arthritis. |
| 61 | Monoarthritis | Common in arthritis stage | Steere AC, et al. Ann Intern Med. 1983;99(1):76-82. |
| 62 | Recurrent arthritis | Common in late disease | Steere AC, et al. Ann Intern Med. 1983;99(1):76-82. |
| 63 | Migratory joint pain | Common | Wormser GP, et al. Clin Infect Dis. 2006;43(9):1089-1134. |
| 64 | Limited joint range of motion | Less common | Hu L. Ann Intern Med. 2016;164(9):ITC65-ITC80. |
| 65 | Tendon pain | Less common | CDC. Lyme Disease Symptoms and Signs. |
| 66 | Muscle weakness | Less common | Marques A. Continuum. 2015;21(6):1737-1750. |
| 67 | Muscle stiffness | Common | Steere AC, et al. N Engl J Med. 2001;345(2):115-125. |
| 68 | Back pain | Less common | Hu L. Ann Intern Med. 2016;164(9):ITC65-ITC80. |
| 69 | Jaw pain | Uncommon/Rare | CDC. Lyme Disease Symptoms and Signs. |
| 70 | Facial numbness | Uncommon/Rare | Marques A. Continuum. 2015;21(6):1737-1750. |
| 71 | Poor coordination | Uncommon/Rare | CDC. Lyme Disease Symptoms and Signs. |
| 72 | Gait instability | Uncommon/Rare | Marques A. Continuum. 2015;21(6):1737-1750. |
| 73 | Tremor | Uncommon/Rare | Hu L. Ann Intern Med. 2016;164(9):ITC65-ITC80. |
| 74 | Seizures | Rare | Steere AC, et al. N Engl J Med. 2001;345(2):115-125. |
| 75 | Hyperesthesia | Uncommon/Rare | Marques A. Continuum. 2015;21(6):1737-1750. |
| 76 | Paresthesias | Less common | Hu L. Ann Intern Med. 2016;164(9):ITC65-ITC80. |
| 77 | Sensitivity to touch | Uncommon/Rare | Steere AC, et al. N Engl J Med. 2001;345(2):115-125. |
| 78 | Loss of appetite | Common | Hu L. Ann Intern Med. 2016;164(9):ITC65-ITC80. |
| 79 | Nausea | Less common | CDC. Lyme Disease Symptoms and Signs. |
| 80 | Abdominal pain | Less common | Steere AC, et al. N Engl J Med. 2001;345(2):115-125. |
| 81 | Diarrhea | Uncommon/Rare | Hu L. Ann Intern Med. 2016;164(9):ITC65-ITC80. |
| 82 | Constipation | Uncommon/Rare | CDC. Lyme Disease Symptoms and Signs. |
| 83 | Weight loss | Less common | Wormser GP, et al. Clin Infect Dis. 2006;43(9):1089-1134. |
| 84 | Night sweats | Less common | CDC. Signs and Symptoms of Untreated Lyme Disease. |
| 85 | Low-grade fever | Common | CDC. Signs and Symptoms of Untreated Lyme Disease. |
| 86 | Recurrent fever | Uncommon/Rare | Wormser GP, et al. Clin Infect Dis. 2006;43(9):1089-1134. |
| 87 | Palpable lymphadenopathy | Less common | Hu L. Ann Intern Med. 2016;164(9):ITC65-ITC80. |
| 88 | Sore throat | Uncommon/Rare | CDC. Lyme Disease Symptoms and Signs. |
| 89 | Hoarseness | Uncommon/Rare | Marques A. Continuum. 2015;21(6):1737-1750. |
| 90 | Cough | Uncommon/Rare | CDC. Lyme Disease Symptoms and Signs. |
| 91 | Rash-like facial flushing | Uncommon/Rare | Steere AC, et al. N Engl J Med. 2001;345(2):115-125. |
| 92 | Red eyes | Uncommon/Rare | Hu L. Ann Intern Med. 2016;164(9):ITC65-ITC80. |
| 93 | Eye redness | Uncommon/Rare | CDC. Lyme Disease Symptoms and Signs. |
| 94 | Swollen eyelid | Uncommon/Rare | Marques A. Continuum. 2015;21(6):1737-1750. |
| 95 | Blurry near vision | Uncommon/Rare | CDC. Lyme Disease Symptoms and Signs. |
| 96 | Sound sensitivity | Uncommon/Rare | Hu L. Ann Intern Med. 2016;164(9):ITC65-ITC80. |
| 97 | Light sensitivity | Uncommon/Rare | Steere AC, et al. N Engl J Med. 2001;345(2):115-125. |
| 98 | Confusion | Uncommon/Rare | Marques A. Continuum. 2015;21(6):1737-1750. |
| 99 | Disorientation | Uncommon/Rare | Hu L. Ann Intern Med. 2016;164(9):ITC65-ITC80. |
| 100 | Word-finding difficulty | Uncommon/Rare | Marques A. Continuum. 2015;21(6):1737-1750. |
| 101 | Slowed thinking | Uncommon/Rare | Hu L. Ann Intern Med. 2016;164(9):ITC65-ITC80. |
| 102 | Reduced stamina | Less common | CDC. Lyme Disease Symptoms and Signs. |
| 103 | Post-exertional worsening | Uncommon/Rare | Marques A. Continuum. 2015;21(6):1737-1750. |
| 104 | Intermittent symptoms | Common | Steere AC, et al. N Engl J Med. 2001;345(2):115-125. |
| 105 | Persistent symptoms after treatment | Uncommon/Rare | Klempner MS, et al. N Engl J Med. 2001;345(2):85-92. |
| 106 | Post-treatment symptom syndrome | Uncommon/Rare | Marques A. Curr Allergy Asthma Rep. 2010;10(1):13-20. |
| 107 | Hand weakness | Uncommon/Rare | Hu L. Ann Intern Med. 2016;164(9):ITC65-ITC80. |
| 108 | Foot drop | Rare | Marques A. Continuum. 2015;21(6):1737-1750. |
| 109 | Bell’s palsy bilateral | Rare | CDC. Lyme Disease Symptoms and Signs. |
| 110 | Cranial neuropathy | Uncommon/Rare | Steere AC, et al. N Engl J Med. 2001;345(2):115-125. |
Important Notes
Erythema migrans is a specific early sign.
Lyme arthritis is often predominant among joints.
Neurologic and cardiac symptoms are clinically important.
Many symptoms are nonspecific, so Lyme disease will be missed.
Core References
Steere AC, Coburn J, Glickstein L. Lyme disease. N Engl J Med. 2001;345(2):115-125.
Wormser GP, et al. The clinical assessment, treatment, and prevention of Lyme disease. Clin Infect Dis. 2006;43(9):1089-1134.
Hu L. Lyme disease. Ann Intern Med. 2016;164(9):ITC65-ITC80.
Marques A. Lyme neuroborreliosis. Continuum (Minneap Minn). 2015;21(6):1737-1750.
Steere AC, et al. The clinical evolution of Lyme arthritis. Ann Intern Med. 1983;99(1):76-82.
Klempner MS, et al. Two controlled trials of antibiotic treatment in patients with persistent symptoms and a history of Lyme disease. N Engl J Med. 2001;345(2):85-92.
CDC Lyme disease clinical resources.