Information and Guidelines for Diagnosis and Treatment
The following is a list of resources for healthcare professionals.
Lyme disease, caused by the bacteria Borrelia burgdorferi, is a global infection that is on the rise and is the most common tick-borne disease in the northern hemisphere. Although early diagnosis and treatment can lead to resolution for many patients, delayed or missed diagnosis can result in persistent and debilitating symptoms.
Recognising the often non-specific nature of Lyme disease symptoms can be challenging, emphasising the importance of raising awareness amongst primary care clinicians in order to facilitate early and effective treatment. Development of Lyme-aware practice teams, will ensure consistent advice and improved diagnostic skills Clinicians should be aware of the genuine scientific uncertainties and ongoing research regarding the diagnosis and treatment of this disease.
Lyme Disease Toolkit | RCGP Learning
The RCGP Lyme Disease Toolkit summarises the key aspects of diagnosing and treating Lyme disease, as well as prevention and ongoing management; it includes links to further key information and resources.
The toolkit can be accessed here and is open access for all. .
(Lyme Resource Centre is pleased to have worked with the Royal College of General Practitioners on these new learning materials for GPs, other health professionals and the public.)
Summary of Lyme Disease | RCGP Learning
Freely available to all registered healthcare professionals.
Both the RCGP toolkit and RCGP/LDA e learning module are endorsed by the Nice quality standard for Lyme disease. Lyme disease | Quality standards | NICE
Lyme disease | Guidance | NICE
Key statements:
1.2.11 Diagnose and treat Lyme disease without laboratory testing in people with erythema migrans.
1.2.12 Use a combination of clinical presentation and laboratory testing to guide diagnosis and treatment in people without erythema migrans. Do not rule out diagnosis if tests are negative but there is high clinical suspicion of Lyme disease.
1.2.13 If there is a clinical suspicion of Lyme disease in people without erythema migrans:
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offer and ELISA test for Lyme disease and
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consider starting treatment while waiting for the results if there is a high clinical suspicion
1.2.18 If Lyme disease is still suspected in people with a negative ELISA who have had symptoms for 12 weeks or more, perform and immunoblot
1.2.19 Diagnose Lyme disease in people with symptoms of Lyme disease and a positive immunoblot test.
1.2.3 Consider the possibility of Lyme disease in people presenting with several of the following symptoms , because Lyme disease is a possible but uncommon cause of :
fever and sweats,swollen glands, malaise, fatigue, neck pain or stiffness, migratory joint or muscle aches and pain, cognitive impairment, such as memory problems and difficulty concentrating (sometimes described as 'brain fog'), headache, paraesthesia.
1.2.4 Consider the possibility of Lyme disease in people presenting with symptoms and signs relating to 1 or more organ systems (focal symptoms) because Lyme disease is a possible but uncommon cause of
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neurological symptoms, such as facial palsy or other unexplained cranial nerve palsies, meningitis, mononeuritis multiplex or other unexplained radiculopathy; or rarely encephalitis, neuropsychiatric presentations or unexplained white matter changes on brain imaging
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inflammatory arthritis affecting 1 or more joints that may be fluctuating and migratory
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cardiac problems, such as heart block or pericarditis
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eye symptoms, such as uveitis or keratitis
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skin rashes such as acrodermatitis chronica atrophicans or lymphocytoma.
Antibiotic Treatment
Offer antibiotic treatment according to symptoms (see tables 1&2) https://www.nice.org.uk/guidance/ng95/chapter/recommendations#information-for-people-with-lyme-disease
BMJ Visual summary of antibiotic choices
Lyme disease: Antibiotic choices
The NICE guidance acknowledges it’s limitations including:
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There is a lack of robust epidemiological data on Lyme disease in the UK population.
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The guideline committee has noted the poor-quality evidence available on both diagnosis and treatment.
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The evidence on the effectiveness of antimicrobial treatment regimens used in different presentations of Lyme diseases is of poor quality, out-dated and often based on small studies.
See further information on: