Clinical assessment alone is sufficient for the diagnosis of Lyme disease in patients presenting with erythema migrans, NICE has advised.
In new draft quality standards, NICE advises that, in the absence of erythema migrans and other symptoms, an enzyme-linked immunosorbent assay (ELISA) laboratory test can be used. People with an initial negative ELISA test result for Lyme disease who were tested within 4 weeks of onset of symptoms and who continue to have symptoms, should have a repeat ELISA test 4-6 weeks after the first test. If the ELISA is positive or symptoms continue, an immunoblot test can be used to confirm Lyme disease.
Commenting on the latest guidance, Saul Faust, professor of paediatric immunology and infectious diseases at the University of Southampton and chair of the guideline committee, said: “Prompt diagnosis of Lyme disease is essential for effective management of the condition. This draft quality standard highlights key areas to help health care professionals and people affected by Lyme disease.
“Lab tests are necessary when a person’s symptoms are unclear, but they are not needed if a person presents the characteristic red rash, erythema migrans. Doctors should feel confident to prescribe antibiotics immediately for those with erythema migrans,” he said.
The draft quality standards are now open for consultation until 12 March 2019. The final version is expected to publish in July 2019.