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Draft guidance drawn up to ‘spot and treat’ Lyme disease

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Guidelines have been drawn up to provide “clear advice” to support clinicians in diagnosing and treating patients with Lyme disease, which is spread by ticks.

The National Institute for Health and Care Excellence said the new document, published today, would help healthcare professionals “spot and treat a potential diagnosis of Lyme disease” early.

“Our draft guidance makes a clear set of recommendations on when to diagnose Lyme disease”

Gillian Leng

The draft guidance said Lyme disease should be diagnosed in patients who presented with a circular red rash, known as erythema migraines, after a tick bite without the need for further tests.

In addition, NICE said clinicians should not rule out Lyme disease if a patient had symptoms consistent with the condition, but they were not sure if they had been bitten by a tick.

However, it cautioned that they should not diagnose Lyme disease simply if a person has been bitten by a tick but has no other symptoms.

Meanwhile, they should refer for tests if a patient without a rash has symptoms that could indicate Lyme disease. The draft guidance recommends using an enzyme-linked immunosorbent assay (ELISA) test if Lyme disease is suspected.

“People can have common and unspecific symptoms, like a headache or fever”

Saul Faust

This will look for specific antibodies, IgM and IgG. If the ELISA test is positive, an immunoblot test is recommended to confirm the diagnosis.

Clinicians should seek advice from a specialist if tests have come back negative, but unexplained symptoms persist, noted the guidance.

The draft recommended that antibiotics be used to treat Lyme disease, with most patients responding to one course and NICE recommending no more than two courses to treat the infection.

Lyme disease is a tick-borne infectious disease caused by a specific group of bacteria, called Borrelia burgdorferi. It spreads to humans through a bite from an infected tick.

According to Public Health England, no more than 10% of ticks carry the bacteria that causes Lyme disease in the UK, but there are between 2,000 and 3,000 new cases a year in England and Wales.

Ticks are mainly found in grassy and wooded areas, particularly areas that are overgrown, including gardens and parks.

There is a higher risk of getting Lyme disease in some areas such as South England and the Scottish Highlands, the draft NICE guidance noted.

Stakeholders and members of the public are invited to comment on the institute’s proposed recommendations until 6 November, with the guidance set to be finalised after that.

Professor Gillian Leng, NICE director of health and social care and deputy chief executive, said: “Lyme disease is easy to treat. However, if left undiagnosed, it can lead to more serious symptoms.


Gillian Leng

“This can include heart problems, arthritis and problems affecting the nervous system, for example, weakness on one side of the face,” she noted.

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

Professor Saul Faust, an expert in paediatric immunology and infectious diseases at Southampton University, who helped draw up the guidance, noted that Lyme disease can be difficult to diagnose.

“People can have common and unspecific symptoms, like a headache or fever, and they may not notice or remember a tick bite,” he said.

He added that the draft guidance would give health professionals “clear advice on how to diagnose if they think Lyme disease is a possibility”.

“We also recommend tests used for this illness meet certain laboratory criteria,” he said. “This is to make sure a potential diagnosis is based on clinically relevant and robust test results.”

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