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Clinical Summary

Awareness, diagnosis and management of Lyme disease: a summary of recommendations

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

This summary is reviewed by Prof. Rishabh Prasad MBBS, MA, MSC, FRCGP FRSA


References


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