Guideline name: Lyme disease [NG95]
Update type: New guideline
Published: Apr 2018
Takehome
- Recommendations aim to create awareness among clinicians regarding when Lyme disease should be suspected.
- Clinicians need to ensure that all people have prompt and consistent diagnosis and treatment.
Awareness of Lyme disease
- Clinicians should be aware that Lyme disease is transmitted by bite (may not be noticeable) of an infected tick mainly found in grassy and wooded areas.
- Infected ticks are found throughout the United Kingdom and Ireland.
- South of England and Scottish Highlands are considered as high-risk areas, but infection can occur in many areas.
- Clinicians should advise people about Lyme Disease, use relevant information sources on Lyme disease such as Public Health England.
Diagnosis
- Clinicians should diagnose Lyme disease in people with erythema migrans, a red rash at the site of tick bite that:
- increases in size and may have a central clearing;
- not usually itchy, hot or painful;
- becomes visible within 1-4 weeks (can appear between 3 days to 3 months) after a tick bite and lasts for several weeks.
- 1 or several of the following symptoms could indicate Lyme disease:
- fever and sweats, swollen glands, malaise, fatigue, neck pain/stiffness, migratory joint/muscle aches and pain, cognitive impairment, headache, and paraesthesia.
- Possibility of Lyme disease should be considered in patients presenting with ≥1 organ system-related symptoms like neurological symptoms, inflammatory arthritis, cardiac problems, eye symptoms or skin rashes.
- Duration of symptoms and history of tick exposure should be considered in patients presenting with symptoms.
- Laboratory tests:
- Diagnosis and treatment should be started without laboratory testing in patients with erythema migrans;
- NICE has also produced a visual summary of the recommendations on testing for Lyme disease.
Management
- Patients with symptoms suggesting central nervous system infection, uveitis or cardiac complications should be considered for emergency referrals even if Lyme disease is suspected.
- Advice from a specialist should be considered for:
- children and young people aged ≤18 years unless they have a single erythema migrans lesion and no other symptoms;
- an adult with focal symptoms.
- Antibiotic treatment is appropriate for patients with focal and non-focal symptoms, please see tables for details
- Jarisch–Herxheimer reaction may exacerbate symptoms but does not usually warrant stopping treatment.
This summary is reviewed by Prof. Rishabh Prasad MBBS, MA, MSC, FRCGP FRSA
References
References