About Lyme Disease
Lyme disease, also known as Lyme borreliosis, is an infection caused by the bacteria Borrelia. It is usually transmitted to humans via the bite of an infected tick; however, transplacental transmission at childbirth has also been documented. The disease is multisystemic and the affected organs are the skin, nervous system, eyes, heart and joints.
Lyme disease exists all over Scotland. A BMJ paper reported that Scotland has a high incidence of Lyme disease with over 1/4 of the 8000 UK cases per year.
Health Protection Scotland advice is at:
Lyme Disease Symptoms
Early Lyme Disease Symptoms
Most people who become infected with Lyme disease do not recall a tick-bite. Symptoms of early Lyme disease are likely to appear between 2 and 30 days after a tick bite.
The best known symptom of early disease is the erythema migrans (EM) rash, which can occur at the site of the tick bite. Less than 20% of all EM rashes have the classic "bull's-eye" appearance. Individual EM rashes may have a different appearance. Photographing suspicious rashes can help doctors determine if Lyme disease is likely.
It is unclear how many people with Lyme disease develop an identifiable EM rash. In the USA, CDC surveillance case data documents that about 30% of confirmed cases lack a reported rash. An EM rash is diagnostic of Lyme disease, meaning that people who have the rash have Lyme disease.
Because blood tests may be falsely negative in early Lyme Disease, testing is not recommended. Antibiotic treatment should begin as soon as an EM rash is identified.
Early Lyme Disease symptoms may present as a "summertime flu", producing fever, fatigue, muscle or joint pain and headache, with or without EM rash. Some people may notice areas of numbness or tingling that can move from one area to another.
Late Stage Lyme Disease Symptoms
A Lyme infection can affect any system of the body, causing a wide array of symptoms. The infection can produce debilitating fatigue, headaches, muscle pain, arthritis in any joint, neurological symptoms such as numbness, tingling, nerve pain and weakness, heart problems, psychiatric disorders, difficulty with thinking, memory, language and math skills, ad well as problems with vision and hearing. Given the variety of potential problems, it is not surprising that cases of Lyme disease don't all look exactly alike.
While the infection is often mild, some people may have a severe illness and associated disabilities. Left untreated, or under-treated, Lyme Disease can persist for years. Although rarely fatal, deaths have occurred, especially if the heart is involved.
The best known symptom of early disease is the erythema migrans or EM rash, which can occur at the site of the tick bite. Sometimes multiple rashes are present. Untreated EM rashes expand and clear over days to weeks though some have been known to last over a year. EM rashes are usually solid coloured, ranging from faint pink to deep red. Less than 20% of all EM rashes have the classic "bull's-eye" appearance.
Lyme Disease Rash
Erythema migrans (Source: DermNetNZ.org)​​​​
Photos from NICE and DermnetNZ show examples of EM rashes. Individual EM rashes may have a different appearance. Photographing suspicious rashes can help doctors determine if Lyme disease is likely.
It is often said that the rash should be over 5cm across, but a smaller rashes have been documented.
It is unclear how many people with Lyme disease develop an identifiable EM rash. In the USA, CDC surveillance case data documents that about 30% of confirmed cases lack a reported rash. An EM rash is diagnostic of Lyme disease, meaning that people who have the rash have Lyme disease. Because blood tests may be falsely negative in early Lyme Disease, testing is not recommended. Antibiotic treatment should begin as soon as an EM rash is identified.
Lyme Disease Diagnosis
Lyme Disease is often a clinical diagnosis, based on a person's exposure to ticks, their symptoms, and their physical examination findings. Because symptoms and findings may differ from patient to patient, making the diagnosis can be difficult.
Commercial laboratory tests for Lyme Disease are unreliable and insensitive, missing a substantial number of actual cases. Negative test results do not rule out Lyme disease.
Antibody tests detect the body's adaptive immune response to the infection caused by the pathogen rather than detecting the pathogen itself. For example, in the case of COVID-19, both the US CDC, FDA, and other bodies cautioned against the use of antibody tests because of their accuracy as a diagnostic tool:
Negative Lyme antibody tests should not be used to deny treatment to patients with Lyme disease. There is an urgent need for more accurate testing. In the meantime, Lyme disease often requires a clinical diagnosis.
Lyme Disease Treatment
Antibiotics are used to treat Lyme Disease.
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NICE Guidelines for Lyme disease state:
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"Diagnose and treat Lyme disease without laboratory testing in people with erythema migrans".
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Adults with an erythema migrans rash should be treated with "oral doxycycline: 100 mg twice per day or 200 mg once per day for 21 days". More details on treatment for other symptoms is given in their Management Recommendations section.
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"Do not rule out diagnosis if tests are negative but there is high clinical suspicion of Lyme disease".
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"Consider starting treatment with antibiotics while waiting for the results if there is a high clinical suspicion".
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"Consider a second course of antibiotics for people with ongoing symptoms if treatment may have failed".
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The NICE Quality Standard states:
"People with Lyme disease have initial antibiotic treatment, with the antibiotic, dosage and duration determined by their symptoms."
A summary of the NICE Guideline treatment section can be found here:
https://www.nice.org.uk/guidance/ng95/chapter/Recommendations#management
If not treated promptly and sufficiently, Lyme Disease may become persistent and longer courses of antibiotics may be necessary. Treatment failures have been documented even in the best circumstances.
It is important for treatment to be individualised and carefully monitored. Symptoms that change over time or do not resolve should be reported to the treating physician, who may need to consider other treatment regimes and diagnoses.