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Lyme Disease

Checked: 28-05-2024 by Rob Adams Next Review: 28-05-2026

Overview

Lyme disease is transmitted by the bite of an infected tick and most commonly appears as a rash around the bite area (erythema migrans). In the UK, about a third of cases do not have a rash and may present with fever, headache or neurological symptoms.

Diagnosis

For more information about diagnosis and treatment then please see the UK Health Security Agency website - quick summary below:

1. Patients seen by a general practitioner with an erythema migrans rash at the time of consultation should be treated with antibiotics.

2. Patients without a rash but with symptoms suggestive of Lyme disease and a credible risk of tick exposure should have serum taken and sent to an NHS laboratory for Lyme disease antibody testing (Borrelia burgdorferi). Serology is only tested 4 weeks after a known exposure as it can result in a falsely negative result. The decision to treat on clinical suspicion should be based on exposure history and the presenting symptoms. Note that up to a third of cases of Lyme disease do NOT have a classical rash, if any at all, and absence of rash or any recollection of a tick bite does not exclude the diagnosis. The most common early symptoms in adults are flu-like symptoms of aching, fever, headache, fatigue, sweating, joint pain, light and sound sensitivity, abnormal skin sensations (tingling, numbness, itching), stiff neck. Facial palsy, headache and fever in tick season (April to October) has been shown to predict Lyme disease in children.

3. Patients with tests that are positive from an NHS laboratory should be treated if presenting symptoms and signs are compatible with active Lyme disease.

4. If an initial serological test is negative, but symptoms persist it is worth sending a repeat sample 3-4 weeks after the initial test as the antibody response to Lyme can take time to develop and fluctuates in early disease. Patients with positive results who have not already been treated should be treated with antibiotics.

Treatment

Adults

For people with erythema migrans who have no evidence of focal symptoms (for example, neurological, cardiac, or joint involvement), start treatment with oral antibiotics.

See the BNSSG Antimicrobial Guidelines for Primary Care (page 22) for further advice on antibiotic treatment.

Children

Discuss the diagnosis and management of Lyme disease in children and young people aged under 18 years with a paediatric infectious diseases specialist, unless they have a single erythema migrans lesion and no other symptoms.

Referral

The majority of patients can be treated in primary care. Referral can be considered if there are complicated symptoms or diagnostic uncertainty.

The NICE Lyme Disease guidelines are summarised in CKS (1) and include advice on management of patients with persisting symptoms after treatment for Lyme disease and when to consider referral.

Adults

Consider requesting Advice and Guidance via eRS or General Infectious Diseases / Tropical Medicine RAS via eRS.

Advice can also be obtained from the Rare and Imported Pathogens Laboratory (RIPL) staff in working hours on 01980 612348.

Children

Advice can be obtained from the paediatric infectious diseases team. Please see the Bristol Royal Hospital for Children - Paediatric Immunology & Infectious Diseases page for contact details or bleep via hospital switchboard.

There is also a paediatric infectious disease clinic for routine referrals which can be accessed via eRS.

Resources

(1) Lyme disease | Health topics A to Z | CKS | NICE

Patient Information

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