NICE provides advice on diagnosing Lyme disease

GPs should consider Lyme disease in patients presenting with flu-like symptoms alongside neck or joint pain, cognitive impairment and paraesthesia, according to NICE draft guidance.

Lyme disease should be diagnosed if a patient presents with a circular red rash following a tick bite (Photo: iStock)
Lyme disease should be diagnosed if a patient presents with a circular red rash following a tick bite (Photo: iStock)

Lyme disease should be diagnosed without conducting further tests if a patient presents with a circular red rash following a tick bite, NICE has said.

Its draft guidance, now open for consultation, recommends that patients should be sent for further tests if they do not have the characteristic rash but still have other symptoms consistent with the condition.

Lyme disease should not be ruled out if a patient with possible symptoms is not sure if they have had a tick bite, it warns.

It also cautions that doctors should not diagnose Lyme disease simply if a person has been bitten by a tick but has no other symptoms.

To treat the condition, patients should be prescribed one – or in some cases two – courses of antibiotics, it says. If symptoms persist beyond this, GPs should refer patients to a specialist.

Lyme disease

Lyme disease is a tick-borne infectious disease caused by the Borrelia burgdorferi bacteria. Ticks are mainly found in grassy and wooded areas, such as gardens and parks.

Around 10% of ticks are carriers of B.burgdorfeni, according to Public Health England (PHE). There is a higher risk of getting Lyme disease in south England and the Scottish Highlands.

Saul Faust, professor of paediatric immunology and infectious diseases at the University of Southampton and chair of the guidance committee, said: ‘Lyme disease may be difficult to diagnose as people can have common and unspecific symptoms, like a headache or fever, and they may not notice or remember a tick bite.

‘Our draft guidance will give GPs and hospital doctors clear advice on how to diagnose if they think Lyme disease is a possibility.’

Professor Gillian Leng, deputy chief executive of NICE, said: ‘Lyme disease is easy to treat. However, if left undiagnosed, it can lead to more serious symptoms. This can include heart problems, arthritis and problems affecting the nervous system, for example, weakness on one side of the face.

‘We want people to be diagnosed early so they get the right treatment as soon as possible. This is why our draft guidance makes a clear set of recommendations on when to diagnose Lyme disease, and when to rule it out.’

The guidance will be open for consultation until 6 November.

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