Early localized Lyme infection

Alternative names
Lyme disease - primary; Lyme borreliosis; Stage 1 Lyme disease

An inflammatory disease characterized by a skin rash (or rashes) and flu-like symptoms caused by the bacterium Borrelia burgdorferi and transmitted by the deer tick.

Causes, incidence, and risk factors

Primary Lyme disease, a flu-like illness with fever, chills, and muscle aches, occurs in about 50% of those infected with Lyme disease. If untreated, the disease may progress to secondary Lyme disease and tertiary Lyme disease.

Risk factors include recent tick bite or recent outdoor activities in endemic (high risk) areas. Approximately 16,000 people are affected annually in the United States. See also Lyme disease.


Deer ticks can be so small that they are almost impossible to see. Therefore, many people with Lyme disease never even saw a tick. These people are more likely to develop symptoms because the tick remained on their body longer.

The symptoms of Lyme disease include:

  • a flat or slightly raised red lesion at the site of the tick bite  
  • expansion of the red lesion (rash) to several inches over several days. The rash usually will clear in the center, creating an annular rash, looking somewhat like a bull’s eye.  
  • fever  
  • headache  
  • lethargy  
  • muscle pains and aches  
  • joint aches  
  • swollen glands, either near the rash or all over the body

Signs and tests

  • An ELISA or Western blot may show antibodies to Borrelia burgdorferi. This test is usually not positive in the first few weeks after the tick bite, so it is often not accurate early in the disease.  
  • A skin biopsy can sometimes identify the organism.


The goal is to eliminate the infection with antibiotics, and prevent secondary or tertiary infection. Antibiotics include doxycycline, tetracycline, cefuroxime, or amoxicillin in children.

Note: Oral tetracycline is usually not prescribed for children until after all the permanent teeth have erupted. It can permanently discolor teeth that are still forming.

Expectations (prognosis)

The signs and symptoms usually resolve in 3 to 4 weeks, even without treatment. With treatment, all signs and symptoms should resolve completely. The secondary or tertiary form of the disease may develop if the initial infection is not treated.

Neurological or cardiac symptoms may develop in the second stage of the disease, followed by arthritis and brain or nerve damage in the third stage of the disease.


Calling your health care provider

Call for an appointment with your health care provider if you exhibit symptoms of Lyme disease, particularly if you could have been exposed to ticks.

Call your health care provider if sensory or muscular weakness, numbness or tingling, or heart irregularities develop.


When walking or hiking in wooded or grassy areas, tuck long pants into socks to protect the legs, and wear shoes and long-sleeved shirts. Ticks will show up on white or light colors better than dark colors, making them easier to remove from your clothing. Spray your clothes with insect repellant.

Check yourself and your pets frequently. If you find ticks, remove them immediately by using tweezers, pulling carefully and steadily.

Ticks can be fairly large - about the size of a pencil eraser - or so small that they are almost impossible to see. After returning home, remove your clothes and thoroughly inspect all skin surface areas, including your scalp. Ticks can quickly climb up the length of your body. Some ticks are large and easy to locate. Other ticks can be quite small, so carefully evaluate all spots on the skin.

Johns Hopkins patient information

Last revised: December 2, 2012
by Arthur A. Poghosian, M.D.

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.