The following is a list of resources useful for Scottish GPs and pharmacists. This page can be referred to at
- The Royal College of GPs (RCGP) runs a Lyme Disease Spotlight Project with lots of resources.
- RCGP have created a very useful Lyme Disease Toolkit for GPs.
- The RCGP and Lyme Disease Action Lyme disease e-Learning module is endorsed by the NICE Quality Standard for Lyme disease and free to all registered clinicians.
- The NICE Guidelines for Lyme disease state:
- "Diagnose and treat Lyme disease without laboratory testing in people with erythema migrans".
- 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.
- "Do not rule out diagnosis if tests are negative but there is high clinical suspicion of Lyme disease".
- "Consider starting treatment with antibiotics while waiting for the results if there is a high clinical suspicion".
- "Consider a second course of antibiotics for people with ongoing symptoms if treatment may have failed".
- The NICE Quality Standard states: "People with Lyme disease have initial antibiotic treatment, with the antibiotic, dosage and duration determined by their symptoms."
- The RCGP says "Development of a Lyme-aware practice team, utilising the resources listed above, will ensure consistent advice and improved diagnostic skills, thereby increasing the likelihood of patients receiving early and effective treatment of this potentially devastating disease".
- The Medical Defence Union say "An alleged failure to diagnose the disease is the most common reason for complaints and claims about Lyme disease reported to the MDU". One reason is the lack of reliability of standard two-tier testing, as used in the NHS. Lyme Disease can be fatal and a fatal outcome because of over-reliance on such tests has resulted in legal action.
- It is now accepted that mother-to-child transmission is possible.
- Health Protection Scotland general advice on Lyme disease, including surveillance data.
- Health Protection Scotland printable information sheet and poster.
- NHS Education for Scotland practitioner education resources.
- The Scottish Lyme Disease and Tick-borne Infections Reference Laboratory User Manual.
- The Lyme disease test request form.
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.
A number of tick-borne co-infections are highly prevalent in animals in Scotland; however, no accredited tests are available in Scotland to test humans for Anaplasma, Babesia, Bartonella, etc. Scottish research has shown that:
- Babesia antibodies exist in sera from wild red deer across Scotland in proportions ranging from 22 to 100 per cent.
- A Glasgow University thesis reports Babesia venatorum has been detected in 9% of healthy sheep, Babesia divergens in 11% of wild red deer, and a Babesia odocoilei-like parasite in 15% of wild red deer. Anaplasma phagocytophilum was detected in 73% of healthy sheep and 40% of red deer. Sarcocystis sp. similar to S. tenella were also detected in 3 % of healthy sheep.
- Babesia has been detected in 59.6% of blood samples from Scottish badgers.
- 15.3% of cats were seropositive for Bartonella.
- Q-fever was found in 1% of cattle and in 30% of one flock of sheep tested.
- Ticks with Borrelia miyamotoi, which causes relapsing fever, were found feeding on competitors of a Scottish mountain marathon.
Accumulating scientific evidence shows humans are bitten by ticks that carry Borrelia and a number of co-infections, and these infections cause illness in humans. According to the current ISO accreditation certificate and User Manual, The Scottish Lyme Disease and Tick-borne Infections Reference Laboratory has unaccredited tests for Anaplasma and Borrelia miyamotoi in the first 4 weeks of infection but does not yet have accredited tests for any of these tick-borne co-infections. A French study has shown the extent to which co-infections occur and concluded that multiple "co-infections are the rule rather than the exception".