ResearcH Filter by Authors Select Authors arrow&v Filter by Journal Select Journal arrow&v Filter by Keywords Select Keywords arrow&v 4 November 2021 Title: The New Human Babesia sp. FR1 Is a European Member of the Babesia sp. MO1 Clade Journal: MDPI - Multidisciplinary Digital Publishing Institute Authors: Bonsergent C, de Carne M, de la Cotte N, Moussel F, Perronne V, Malandrin L View 18 August 2021 Title: Recent Progress in Lyme Disease and Remaining Challenges Journal: Frontiers in Medicine Authors: Bobe JR, Jutras BL, Horn EJ, Embers ME, Bailey A, Moritz RL, Zhang Y, Soloski MJ, Ostfeld RS, Marconi RT, Aucott J, Ma'ayan A, Keesing F, Lewis K, Mamoun CB, Rebman AW, McClune ME, Breitschwerdt EB, Reddy PJ, Maggi R, Yang F, Nemser B, Ozcan A, Garner O, Di Carlo D, Ballard Z, Joung H-A, Garcia-Romeu A, Griffiths RR, Baumgarth N, Fallon BA View 28 July 2021 Title: Lyme Borreliosis and Associations With Mental Disorders and Suicidal Behavior: A Nationwide Danish Cohort Study Journal: American Journal of Psychiatry Authors: Fallon BA, Madsen T, Erlangsen A, Benros ME View 27 July 2021 Title: Borrelia mayonii - A cause of Lyme borreliosis that can be visualized by microscopy of thin blood films Journal: Clinical Microbiology and Infection Authors: Pritt BS, Fernholz EC, Replogle AJ, Kingry LC, Sciotto MP, Petersen JM View 6 July 2021 Title: In vitro efficacy of antibiotics against different Borrelia isolates Journal: Acta Microbiologica Immunologica Hungarica Authors: Veinovic G, Cakic S, Mihaljica D, Sukara R, Ruzic-Sabljic E, Tomanovic S View 11 June 2021 Title: Examining prevalence and diversity of tick-borne pathogens in questing Ixodes pacificus ticks in California Journal: Applied Environmental Microbiology Authors: Salkeld DJ, Lagana DM, Wachara J, Porter WT, Nieto NC View 8 June 2021 Title: Antibiotic Susceptibility of Bartonella Grown in Different Culture Conditions Journal: Pathogens Authors: Gadila SKG, Embers ME View 7 June 2021 Title: Lyme Neuroborreliosis in Children Journal: Brain Sciences Authors: Kozak S, Kaminiow K, Kozak K, Paprocka J View 7 June 2021 Title: Report of the Pathogenesis and Pathophysiology of Lyme Disease Subcommittee of the HHS Tick Borne Disease Working Group Journal: Frontiers in Medicine Authors: Donta ST, States LJ, Adams WA, Bankhead T, Baumgarth N, Embers ME, Lochhead RB, Stevenson B View 13 May 2021 Title: The peptidoglycan-associated protein NapA plays an important role in the envelope integrity and in the pathogenesis of the lyme disease spirochete Journal: PLoS Pathogen Authors: Davis MM, Brock AM, DeHart TG, Boribong BP, Lee K, McClune ME, Chang Y, Cramer N, Liu J, Jones CN, Jutras BL View 10 May 2021 Title: Detecting Borrelia Spirochetes: A Case Study With Validation Among Autopsy Specimens Journal: Frontiers in Neurology Authors: Gadila SKG, Rosoklija G, Dwork AJ, Fallon BA, Embers ME View 6 May 2021 Title: Dermatological and Genital Manifestations of Lyme Disease Including Morgellons Disease Journal: Clinical Cosmetic and Investigational Dermotology Authors: Middelveen MJ, Haggblad JS, Lewis J, Robichaud GA, Martinez RM, Shah JS, Du Cruz I, Fesler MC, Stricker RB View

Who We Are The Lyme Resource Centre (or LRC as commonly known) is a Scottish Registered charity. This unique Lyme disease charity is run by a team of trustees, volunteers and clinical advisers who give their time freely and voluntarily to help the charity meet its aims. It benefits from a highly skilled team of medical advisers, pharmacists, educationalists, engineers and other business professionals who guide and advise on policy, projects and collaborative partnerships. Our registered office is in Kinghorn, Fife, but we operate virtually so no donations or funds raised are spent on buildings or workspaces. At present, only a small proportion of staff are employed to undertake part time roles; but we look forward to growing the organisation. The charity was founded in 2019 by Prof Jack Lambert, alongside founding trustees Janey Cringean, Arlene Brailey and James Davies. Norman Lannigan OBE then joined as a trustee in 2021. Our Team Prof. John (Jack) Lambert Founder of LRC and lead trustee Read more As founder of LRC and lead trustee, Prof. John (Jack) Lambert, is a Professor in Medicine and Infectious Diseases at Mater Misericordiae University Hospital and UCD School of Medicine, Dublin, with both extensive clinical and research expertise. He has been director of the National Isolation Unit for Highly Infectious Diseases at the Mater Misericordiae University Hospital and a member of the National Viral Hemorrhagic Fever Committee of the HSE. He has also been involved in the Sexual Health Strategy group in Ireland and teaching GPs in Ireland on the subject of STDs. He has been Fellow of the Royal College of Paediatrics and Child Health since 2000 and Fellow of the Royal College of Physicians since 2005. Prof Lambert has presented widely in the field of Lyme and co-infections since 2016 through EU and USA conferences supported by the International Lyme and Associated Diseases Society (ILADS). He has undertaken specialist training through ILADS and has significant experience of treating Lyme Disease and co-infections. He organises and runs Global Crypto-Infections Conferences, looking at the science behind Lyme Disease and co-infections. Three conferences have now been held in 2019, 2020 and 2023. Recorded presentations can be viewed here: https://www.lymeresourcecentre.com/educational Arlene Brailey Trustee Read more Arlene is a registered pharmacist who worked as Assistant Director of NHS Education for Scotland (Pharmacy) for over 20 years. In 2020 she was designated as a Fellow of the Royal Pharmaceutical Society. Arlene also developed and led an award-winning patient support programme from 2019-2023 for a national antibiotic research charity. She now provides educational consultancy work to the NHS. She uses her educational experience and expertise to guide the charity’s education programme for health professionals. Arlene also provides oversight of a variety of activities, programmes, and development campaigns for LRC as a trustee. She works with many of the volunteers to help deliver the plans and wide-ranging projects which raise awareness of Lyme disease and other tick-borne infections. Arlene was a carer for her son for over ten years, after he was bitten by a tick while hillwalking in the Scottish Highlands as a teenager. He subsequently suffered with undiagnosed Lyme disease and other tick-borne infections. You can read more about Arlene's experience here: https://pharmaceutical-journal.com/article/opinion/would-my-son-have-his-lyme-disease-diagnosis-without-my-mothers-instinct-its-time-we-trusted-our-patients Norman Lannigan Trustee Read more Norman is a retired pharmacist who has served the NHS in Scotland for forty years. He is a Fellow of the Royal Pharmaceutical Society and was awarded an OBE for services to pharmacy and pharmaceutical care in October 2018. His last position was as Head of Pharmacy and Prescribing Support for Scotland’s largest NHS Health Board, NHS Greater Glasgow and Clyde. Norman had responsibility for all aspects of pharmacy service delivery in hospitals, in community pharmacy and within GP surgeries and for safe and effective use of medicines within the Health Board. He led the redesign of pharmacy services which involved the establishment of the world’s largest robotic pharmacy. Norman held Visiting Professor positions within the Strathclyde Institute of Pharmacy and Biomedical Sciences and within the School of Pharmacy at Robert Gordon University in Aberdeen. Norman has taken on responsibility for coordinating and developing LRC outdoor initiatives and partnerships. He is using his experience, leadership skills and knowledge of healthcare and management to help LRC to grow and achieve its aims of raising awareness of tick-borne infection amongst the public and healthcare professionals. He lives in West Calder and is now enjoying global travel once again! Pauline Bowie Ambassador and team member Read more A schoolteacher for 33 years, Pauline is a curricular leader of technologies with a focus on engineering subjects in the West of Scotland. She has personal experience of Lyme disease undiagnosed for 29 years. You can read more about Pauline’s story here.( will add links to media stories here) As a Patient Ambassador, Pauline is actively involved in promoting and coordinating many outreach activities within LRC. She works with media and with Scottish MSPs to highlight the issues and is currently developing a Lyme disease education programme for schools across Scotland. She actively engages her Young Enterprise Group of senior school students in Lyme disease community outreach. Pauline also participates in our outdoor awareness programme, educating the public at events across the country, and raising awareness of ticks and Lyme disease with those leading scout groups, Duke of Edinburgh expeditions and outdoor events. Each year, she coordinates the global ‘Light up for Lyme’ campaign across Scotland, asking public and private organisations to light up their buildings with green light throughout May. This helps focus and raise public awareness during May Lyme Awareness Month. Rico Franchi Ambassador Read more A singer/songwriter from Glasgow, Scotland, Rico raises awareness and funding for LRC through his talent as a singer and songwriter. Having battled Lyme disease for over ten years now, he says “I have been fortunate enough to use my music as a vehicle to create awareness and raise funds for Lyme charities. Being such a misunderstood illness, means that people rarely receive the support they need and deserve. It’s a very lonely journey, with many friends and family members often forgetting how ill we are on the inside, because we look well on the outside. We’re forced to smile and push through pain, fatigue and other sinister symptoms because there’s no alternative solution. The unpredictability of flare ups leaves us living in constant fear over what might arise next. We need a voice, and I’m happy and honoured to be part of that voice. Let’s raise more awareness and push harder for answers to help a growing community whose questions need answers.” You can find out more about Rico here. https://www.youtube.com/RicoFranchimusic https://www.instagram.com/ricotheunknown https://www.facebook.com/ricotheunknown Angus (Gus) Walker Team Member Read more Angus has a background in engineering and presently works as a Maintenance Supervisor in the oil and gas industry, with extensive experience in mechanical engineering and project management disciplines. Angus runs our Social Media programme and campaigns. He also helps deliver our outdoor awareness projects. This includes the production of the LRC outdoor signs and liaison with councils and outdoor volunteers such as The Conservationist Volunteers (TCV). He is a keen cyclist and was first involved with the charity in 2021, taking inspiration from a family member affected by tick borne illness, undertaking a huge cycling challenge to mark his 40th birthday – cycling more than 4040km and raising over £4000 for Lyme Resource Centre. Dr Anne Cruikshank GP Advisor Read more Anne is a general practitioner, based in Oxfordshire, England. She has had a long standing interest in Lyme disease - ever since a close family member was hospitalised with Lyme carditis in 2007. She has experience of managing patients with Lyme disease within both primary care and a consultant-led Lyme disease Clinic. In 2018, the Royal College of General Practitioners (RCGP) appointed Anne as the Clinical Champion for Lyme disease, tasked with leading the RCGP Lyme disease Spotlight Project to raise awareness of Lyme disease within primary care. She is a co-author of the RCGP Lyme Disease Toolkit - a user-friendly, open access, guide for health care professionals. patients and the general public. Whilst acknowledging the complexities of diagnosis and treatment of Lyme disease, Anne recognises that well informed healthcare professionals hold the key to early diagnosis and the prevention of long term complications. Lisa Crossley Team Member Read more Lisa joined the charity as Executive Officer, supporting the trustees and liaising with team members to help deliver the charity’s priorities. These include developing links with all councils in Scotland, fundraising and communications with media amongst others. Prior to retirement Lisa was the managing director of a group of engineering companies based in the north west and south east of England. Her early career was in international banking in the City of London. She brings financial and administrative experience to our cause and was drawn to joining LRC having witnessed the severe effects of Lyme disease on two close friends. Monica Wilde Team Member Read more Monica Wilde is a Research Herbalist (M.Sc. Herbal Medicine, University of Central Lancashire) with a special interest in concomitant prescribing of drugs, herbs and nutrients. Recognising the financial hardship that many Lyme patients find themselves in, she has run a low income Lyme clinic since 2015. Monica is helping the charity by documenting the use of herbs alongside prescription and OTC medicines to increase knowledge, assure safety, and develop understanding of best practice. She is also organising CPD training in Lyme protocols and support for herbal medicine practitioners Research has shown that some herbal products are effective against Lyme on a par with antibiotics. As many Lyme patients find that an integrated medicine approach gives them the best support and results, she is committed to working with clinical practitioners across disciplines. Liz Murray Team Member Read more Liz has a Masters in Business Administration and recent experience in marketing, customer experience and digital communications. She worked in NHS for 15 years as a Physiotherapist and Senior Manager before moving across to the commercial health sector, where she worked for a further 25 years until recently retiring. Liz now helps the charity with strategy, planning and communications strategy as well as some medium-longer term projects. She also has a deep understanding of the challenges of Lyme disease, having been diagnosed and treated with the condition after almost 6 years of symptoms. Gordana Avramovic Team Member Read more Gordana works as a research manager in infectious diseases at UCD and the Mater Hospital in Dublin and has had experience in managing a charity in London. Gordana organises LRC educational events and grant applications for the charity. Trevor Brailey Team Member Read more Trevor retired in 2016 as a Senior Engineering Associate within the petrochemical industry. He was appointed as treasurer for the charity, having recently completed seven years as treasurer for a medium-sized non-profit charitable company. Trevor brings his knowledge and experience of policies, practices, and good governance to ensure our finances are well managed. Christian Geoghegan Team Member Read more Christian currently works as a software and development service specialist, with over 10 years of professional experience in global multinationals. He joined the team in 2022 and is responsible for IT support and website development. Paula Denham Team Member Read more Paula currently works as a medical administrator in a hospital setting. She monitors and responds to the LRC email enquiries received. Paula can be reached at admin@lymeresourcecentre.com and will pass emails to the appropriate member of the LRC team. Margaret Miller Team Member Read more Prior to retirement, Margaret worked with NHS Education for Scotland as the Pharmacy Team Manager, alongside Arlene Brailey. She brings wide and varied administrative experience having worked in several Office Manager and Executive Assistant roles including Scottish Government and Ernst & Young. Margaret provides administrative support to LRC in several areas – including building the research publications facility on the website. Founder Trustees The Lyme Resource Centre is grateful for the work and support of those who helped to establish this unique charity in 2019. Dr Janey Cringean James Davies Trustee of LRC from 2019 - July 2021 Trustee of LRC from 2019 - May 2023

Printable Awareness Material Leaflet Signage Poster See More The Lyme Resource Centre is a charity with a mission to educate the public and healthcare professionals about Lyme disease and other tick-borne illnesses. May 2023 - Lyme Disease Awareness Month Information and Support Lyme Disease is an increasingly common bacterial infection that is acquired from the bite of an infected tick. This section contains a set of resources on how to protect yourself from tick bite and how to deal with them if you are bitten. Read More Resources for Health Professionals This section contains a set of resources for healthcare professionals, including learning materials. Read More Outdoor Initiatives The Lyme Resource Centre aims to raise awareness of the risk of tick borne disease whilst encouraging the public to enjoy the outdoor countryside. Read More Resources for Researchers This section contains a set of resources for researchers. Our body of papers, documents, and video conference presentations is being added to continually. Read More Events Stay up to date on the latest LRC awareness and educational events. Read More Support Us See what you can do to help spread awareness about lyme disease and co-infections. Read More Latest News

Outdoor Initiatives The Lyme Resource Centre aims to raise awareness of the risk of tick borne disease whilst encouraging the public to enjoy the outdoor countryside. Here are some of our recent and ongoing projects: ●Ticks & Lyme disease Awareness Signage Project ●What makes viruses tick? Project ●Tick Trail in West Lothian Country Parks (2022) ●Lyme Resource Centre Outdoors - face to face with the public LRC Ticks & Lyme disease Awareness Signage Project The Lyme Resource Centre has designed and funded an "Outdoor Awareness Signage Project" and partnered with the “What makes viruses tick? (WMVT)" project and "The Conservation Volunteers (TCV)" to install these signs in a variety of popular outdoor spaces in Scotland. The signs are carefully designed to help people recognise ticks and know how to prevent or detect tick bites. They describe how to safely remove an attached tick and how to recognise symptoms of Lyme disease. The signs make use of QR code technology to direct interested individuals to further information available on the LRC website and to enable reporting of sightings to the “What makes viruses tick” project tick map, building an understanding of tick density across Scotland. Working with a variety of outdoor partners such as local authorities, organisations with responsibility for managing outdoor spaces, the Scout Association and many other outdoor groups, the LRC is promoting placement of this unique signage in popular outdoor areas across Scotland - encouraging the public to continue to enjoy the outdoors whilst raising awareness of ticks and Lyme disease. Submit your tick sighting If you have responsibility for the management of a popular outdoor space or just enjoy the outdoors and would wish to participate in, or sponsor, this project (signage is installed with the permission of the landowner) please contact LRC administration. What makes viruses tick? "What makes viruses tick? (WMVT)" is a project hosted within the MRC- University of Glasgow Centre for Virus Research (CVR) by the Brennan Lab. The Lyme Resource Centre and The Conservation Volunteers (TCV) have partnered with WMVT to promote public engagement and citizen science - encouraging the public to get involved by reporting tick sightings in order to build a tick map for Scotland. The LRC signs facilitate this by including a QR code which enables the public to easily contribute tick sightings. Submit your tick sighting For more information on this project click here Tick Trail in West Lothian Country Parks (2022) West Lothian Council Countryside Ranger Ben Dolphin had a particular interest in ticks and tick borne disease and worked in partnership with the Lyme Resource Centre to develop a “Tick trail”. The tick trail is a series of cartoon boards raising awareness of ticks and tick borne disease and how to avoid and deal with them should they be encountered. The public can access further information via QR codes which link to useful websites. The sequential boards were particularly aimed at engaging children and were sited in three country parks in the West Lothian area namely in Beecraigs, Polkemmet and Almondell and Calderwood country parks. The story boards were drawn up by Ben and the content was quality assured by LRC. The signs have proven popular with walkers and children in the West Lothian area. If you wish to replicate the Tick Trail in your area, please contact admin@lymeresourcecentre.com for further information Copyright © : WestLothianCouncil Lyme Resource Centre Outdoors - face to face with the public As part of our objective to raise awareness and to educate the public about ticks and tick borne diseases the Lyme Resource Centre develops a calendar of events which volunteers and trustees of the LRC endeavour to attend to talk with the public and to distribute material such as leaflets, posters and chocolate limes! Scoutfest - Fordell Firs, Fife. 18th March 2023 Our small team of trustees and volunteers spent a fantastic day talking to hundreds of Scout leaders and officials, raising awareness, answering questions and recruiting some amazing people to support our charity: • through raising awareness using our education material • by volunteering to continue our ‘tick and lyme disease’ awareness signage installation campaign across Scotland. A burning issue for the Scout leaders was an increasing concern about noticing ticks while their Scout groups were undertaking outdoor activity. LRC were delighted to be invited to the beautiful David Marshall Lodge in the heart of the Trossachs in Aberfoyle to raise awareness of how to protect yourself from Lyme Disease. This will be a regular event for LRC due to the success of the event. Plans are afoot for attendance at the Glasgow Science Festival in the Botanic Gardens in June and more events to follow. Duke of Edinburgh Scheme LRC have been working with Duke of Edinburgh groups on how to protect themselves from ticks and Lyme disease. ​ If you would like to invite the LRC to display a stand or to present at one of your events please contact us here .

Latest News Topics All arrow&v Filter by Title Select Title arrow&v 23 May 2023 Invisible publishes a HEALTH Risk Assessment Tool Read More ​ Topic Tag: Health 15 May 2023 How education can bend the curve in the tick-borne disease epidemic Read More ​ Topic Tag: Support 9 May 2023 Combatting Lyme Disease: Education, Prevention, and Awareness Efforts Read More Ticks are out in force, so we’ve assembled our best advice for preventing and diagnosing tick-borne diseases in this issue. We’re also celebrating an important milestone—Invisible now has 36 no-cost, accredited environmental and vector-borne disease courses available to all, anytime and anywhere. Topic Tag: Health 9 May 2023 Lyme TV documentary online and free for viewing Read More It is Lyme awareness month & in honor of that the LDF has placed its Lifetime TV Network award-winning documentary online for people to view. Topic Tag: Education 9 May 2023 Botanic Protect Article Read More Let’s get proactive about tick prevention! Topic Tag: Education 17 Apr 2023 Harvard Medical School Media Immersion: Boston, 8 - 9 June 2023 Read More AFTER COVID: Preparing for the pathogens of tomorrow Application Deadline: March 31 Harvard Medical School and the Massachusetts Consortium on Pathogen Readiness will host a two-day educational immersion for reporters June 8-9. The event will bring together a small group of medical and science journalists and preeminent researchers and physician-scientists for a two-day seminar on the Harvard Medical School campus in Boston. Topic Tag: Education 7 Apr 2023 Invisible International - New One Health Clinical Tool Read More ​ Topic Tag: Tools 4 Apr 2023 Invisible international - Education is the answer Read More Last week, the Invisible medical education team hit the road with our American Academy of Family Physicians (AAFP) accredited CME platform and clinical tools! We traveled to Scripps Health’s Primary Care Conference to meet with 300+ primary care clinicians from all over the US and Canada. Topic Tag: Education 30 Mar 2023 Invisible International News Read More ​ Topic Tag: Neuro-Lyme 5 Mar 2023 Paced recovery essential for Long Covid employees Read More Occupational health, HR, OSH professionals and managers require a greater understanding of how to support employees suffering with Long Covid, to enable them to recover at their own pace, and enhance the probability of a full return to work in the long term. Topic Tag: Covid 5 Mar 2023 ‘I felt like a fraud’, says Long Covid employee Read More A teacher who suffered from Long Covid describes her experience with the condition in her workplace. Topic Tag: Covid 27 Feb 2023 Long COVID from a Clinical Perspective Read More A presentation provided by: Professor John (Jack) S. Lambert Topic Tag: Covid 27 Feb 2023 ICD-11 and Lyme Borreliosis - New International Classification of Diseases (ICD-11) codes Read More ​ Topic Tag: Education 21 Feb 2023 Why is it so hard to find a Lyme doctor? Here are some reasons. Read More ​ Topic Tag: Education 6 Feb 2023 Maine hospital ordered to pay $6.5 million for wrongful Lyme death Read More In 2017, 25-year-old Peter Smith, died of Lyme carditis in Portland, Maine. Now, a jury has ordered the hospital and doctor that failed to recognize that he had Lyme disease to pay $6.3 million in a wrongful death lawsuit. Topic Tag: Lyme 29 Jan 2023 New CME course on "Diagnostic Challenges in Lyme disease" Read More ​ Topic Tag: Education 16 Jan 2023 The tick-borne disease epidemic in Ireland: A call for more research Read More ​ Topic Tag: Education 28 Dec 2022 Invisible’s Big Wins of 2022 Read More ​ Topic Tag: Health 8 Nov 2022 Swamp Boy: A story about Bartonella and mental illness Read More ​ Topic Tag: Health 26 Oct 2022 Help us launch the Tick Bytes Clinical Data Repository Read More ​ Topic Tag: Tools

Our Partnerships The Lyme Resource Centre has formed partnerships with both the “What makes viruses tick” project and "The Conservation Volunteers (TCV)" to assist us in delivering our outdoor awareness objectives. Here is a little more information about our partners. What makes viruses tick? (WMVT) WMVT is a project hosted within the MRC- University of Glasgow Centre for Virus Research (CVR) by the Brennan Lab . CVR is a research institution with an international reputation for virus research. Relevant research interests include investigating how viruses interact with tick cells and how this interaction influences disease transmission and ultimately human health. The WMVT project is focused on raising awareness of ticks and tick-borne viruses across Scotland. Although Lyme disease is the most common tick borne disease in Scotland, ticks also carry a wide range of other diseases, including viruses. (Tick Borne Encephalitis Virus (TBEV) has recently been detected for the first time in certain areas of the UK.) The project shares LRC’s objective to encourage the public to enjoy the outdoors, but to be aware of the risks of tick-borne diseases. A major aspect of WMVT is public engagement and citizen science, encouraging the public to get involved by reporting tick sightings in order to build a tick map for Scotland. The LRC signs facilitate this by including a QR code which enables the public to easily contribute tick sightings. Submit your tick sighting Feedback from the project team so far: ​ “We're using the data from this map to understand where ticks are being spotted, with multiple actions being taken from this data. We've worked with landowners to cut back vegetation alongside paths, installed interpretation panels alongside our partners TCV Scotland and the Lyme Resource Centre, and shared data with academic partners who are able to use it for future research funding and evidence. Additionally, we are collecting people's stories of their experiences with ticks and tick-borne diseases to understand the level of impact ticks are having across the country.” The Conservation Volunteers (TCV) TCV is a charity which exists to connect people to green spaces to deliver lasting outcomes for both. It supports people to improve their physical and mental health and wellbeing by being outdoors, active and interacting with others through their volunteering and other project activity. TCV works closely with the “What makes viruses tick” project, in particular the development of the tick map for Scotland and are assisting the Lyme Resource Centre with the outdoor signage project - installing LRC signs in outdoor areas popular with the public and where ticks are expected at high density. Signage is installed with the permission of the landowner.

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Information and Guidelines for Diagnosis and Treatment The following is a list of resources useful for Scottish GPs, pharmacists, nurses and other 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. Recognizing the often non-specific nature of Lyme disease symptoms can be challenging, emphasising the importance of raising awareness among primary care clinicians 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. RCGP Lyme Disease Toolkit This toolkit was developed by a team of primary and secondary care physicians. It is a user-friendly guide to Lyme disease for general practitioners and other healthcare professionals covering epidemiology, diagnosis, and treatment guidelines. Patients and the general public may also find it helpful. The RCGP/Lyme Disease Action e-learning module Freely available to all registered clinicians. Both the RCGP toolkit and RCGP/LDA e learning module are endorsed by the Nice quality standard for Lyme disease. NICE Guidelines for Lyme Disease https://www.nice.org.uk/guidance/ng95 • Diagnose and treat Lyme disease without laboratory testing in people with erythema migrans. • Adults with an erythema migrans( EM) rash should be treated with oral doxycycline: 100 mg twice per day or 200 mg once per day for 21 days. More detail on treatment protocols for other symptoms is given in the Management Recommendations section. • Do not rule out the 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. (NICE acknowledges the limited evidence base upon which these guidelines are based.) NICE Quality Standard for Lyme disease https://www.nice.org.uk/guidance/qs186 Clinicians should note the following: Jarisch Herxheimer Reaction (JHR) Patients should be warned they might experience a worsening of symptoms on starting treatment though this does not usually warrant stopping treatment.The reaction may start soon after starting antibiotics but can also occur slightly later and may last for a few hours or several days. Psychiatric Manifestations Doctors should be aware that patients can develop Lyme related mood disorders such as depression and anxiety, psychoses, disturbed behaviour and cognitive difficulties. Doctors should be alert to the real risk of suicide. Lyme in Pregnancy The NICE guideline states :“Tell women with Lyme disease during pregnancy that they are unlikely to pass the infection to their baby and emphasise the importance of completing the full course of antibiotic treatment”. CDC in 2020 stated: 'Untreated Lyme disease during pregnancy can lead to infection of the placenta. Spread from mother to fetus is possible but rare. Fortunately, with appropriate antibiotic treatment, there is no increased risk of adverse birth outcomes’. * There are no published studies assessing developmental outcomes of children whose mothers acquired Lyme disease during pregnancy. https://www.cdc.gov/lyme/resources/toolkit/factsheets/Pregnancy-and-Lyme-Disease-508.pdf Paediatric Lyme Disease Ticks can attach in the hairline and on the scalp of children and remain undetected for longer than on adults. Facial palsy with headache and fever has been shown to predict early Lyme disease in children during peak Lyme disease season in endemic areas (May – Oct). A UK study [8] concluded “In areas endemic with Lyme disease, Lyme disease should be considered as the likely cause of facial nerve palsy in children until proven otherwise. Other symptoms in children include fatigue and anxiety. Emotional disorders and difficulties with attention and learning may develop if Lyme disease goes undetected or untreated. Occupationally acquired Lyme disease This includes employees and the self employed. Cases should be notified to the Health and Safety Executive (HSE), under the RIDDOR regulations. Advice from The Medical Defence Union An alleged failure to diagnose the disease is the most common reason for complaints and claims about Lyme disease reported to the MDU https://www.themdu.com/guidance-and-advice/guides/nice-issues-guidance-on-lyme-disease Scottish Lyme Disease Resources The Scottish Lyme Disease and Tick-borne Infections Reference Laboratory User Manual. Health Protection Scotland general advice on Lyme disease , including surveillance data. Health Protection Scotland printable information sheet and poster. Community Pharmacy Scotland Ticks and Lyme Disease – Raising Public Awareness and Acting Fast! https://www.cps.scot/news/ticks-and-lyme-disease UK Lyme disease resource UK health Security Agency https://www.gov.uk/government/collections/lyme-disease-guidance-data-and-analysis Lyme Disease Incidence LD is seen in every region of the UK. Infected ticks can be transported by migrating birds, so patients can be infected with LD wherever the habitat is suitable for ticks that carry Borrelia. A BMJ paper by Cairns et al showed that the highest incidence of Lyme disease was in Scotland and the south of England. They estimated that the incidence of LD in the UK is about threefold higher than the official estimate of 2,000-3,000 cases per year.

Resources for HEALTH Professionals Information and Guidelines for Diagnosis and Treatment This section includes advice on the diagnosis and treatment of Lyme disease, including links to the RCGP Lyme disease toolkit and the NICE Guideline on Lyme disease. Educational Webinars and videos These webinars and short videos address the challenges primary care clinicians encounter when diagnosing and treating Lyme disease. They are specifically aimed at GPs, practice nurses, pharmacists, paramedics, and professionals in minor injury units throughout the UK and Ireland. Crypto Infection Conferences Recordings from previous conferences Congenital Lyme Disease Evidence of congenital Lyme disease Other Published Information Information in this section is not peer-reviewed.

About Lyme Disease Lyme disease, also known as Lyme borreliosis, is an infection caused by a spiral shaped bacteria (spirochaete) called Borrelia, which can be passed to humans by the bite of an infected tick. It is the most common tick borne infection in Europe and the USA. Its name comes from the town of Old Lyme in Connecticut, USA, although its symptoms and clinical picture were first recognised in Europe in the 1800s. Lyme disease is treatable with antibiotics. However, if the diagnosis and treatment are delayed or missed then it can potentially cause long term health problems. UK population studies indicate that the incidence is increasing and likely to be higher than official estimates. (Incidence of Lyme disease in the UK: BMJ Open ) Signs and symptoms of Lyme disease Early Lyme disease Symptoms of early Lyme disease usually appear within days or weeks of a tick bite. Though they can appear up to 3 months after the bite. These include an erythema migrans(EM) rash and flu-like symptoms (out of season). Erythema Migrans (EM) Rash An EM (bull’s eye) rash is diagnostic of Lyme disease but may not be present, or may go unnoticed in at least 30% of cases. It usually develops within 3-30 days of a tick bite. If an EM rash is present then treatment with antibiotics should be started as soon as possible. A blood test is not required to confirm the diagnosis. The EM rash may look like an area of uniform redness rather than a ‘bull’s eye’; it is usually painless and not itchy and typically greater than 5cm in diameter. It will usually appear at the site of the bite, though not always. Multiple EM rashes sometimes appear on other areas of the body. Some EM rashes are very faint and difficult to see, and may look different in pigmented skin compared to the photos in textbooks. The rash may become more obvious after a bath or shower. You should take photos of the rash ( and share with your GP). An EM rash may disappear spontaneously without antibiotic treatment. However, this does not mean the infection itself has resolved. A course of antibiotics is still required. If left untreated the disease may spread around the body. A small (less than 2cm) localised area of redness may occur in response to a tick bite but this usually resolves in 3-5 days and is probably not necessarily an indication of Lyme disease. An EM rash may be misdiagnosed as ringworm, another insect bite or a skin infection - particularly if the patient does not recall a previous tick bite. ​ Lyme-disease-rash-images Dermnetnz.erythema-migrans-images Erythema migrans (Source: DermNetNZ.org)​​​​ Flu-like symptoms These may be mild or severe and may be misdiagnosed as a viral infection or ‘summer-flu’. Symptoms may occur with or without an EM rash and may include: · fatigue · neck pain · joint pain · muscle pain . headaches · fevers and sweats · neurological problems like brain fog or poor concentration The possibility of Lyme disease may be underestimated if clinicians fail to consider, or patients forget to mention, the possibility of a tick bite or tick exposure. A negative blood test result does not exclude the diagnosis. The NICE Guideline advises starting treatment if there is a high clinical suspicion of Lyme disease. Lyme disease | Guidance | NICE In some cases, the infection spreads around the body at an early stage (within weeks to months of an infected tick bite) causing more specific symptoms such as facial palsy and cardiac symptoms. High frequency of paediatric facial nerve palsy due to Lyme disease in a geographically endemic region - ScienceDirect Late stage Lyme disease If the early symptoms of Lyme disease are missed, misdiagnosed or inadequately treated then the infection may spread to infect multiple areas within the body such as the nervous system, joints, skin, heart and eyes. This may occur weeks, months or years after the initial infection - when the original tick bite or infection may be long forgotten. Diagnosis at this stage may be difficult. In some cases, symptoms may come and go and migrate around the body. A negative blood test result does not necessarily rule out a diagnosis of Lyme disease. Recommendations | Lyme disease | Guidance | NICE Neurological symptoms: Facial palsy, unexplained nerve pain, weakness, tremor, dizziness Unexplained neurological symptoms - sometimes misdiagnosed as other conditions Headaches Encephalitis Meningitis Dysautonomia ( dysfunction of the autonomic nervous system) LDA leaflet on neuroborreliosis lymediseaseaction Neuropsychiatric symptoms: Anxiety Depression Altered cognitive function - poor concentration, difficulty with numeracy and word finding Brain fog Fatigue Musculoskeletal symptoms: Inflammation in joints, muscles and tendons - often comes and goes and migrates around the body. Fibromyalgia Dermatological symptoms: Recurrent EM rashes Lymphocytoma - a painless bluish-red nodule which can occur on the ear lobe in children Acrodermatitis chronica atrophicans (ACA) Dermnetnz.acrodermatitis-chronica-atrophicans Cardiac conditions: Inflammation of the heart - myocarditis, pericarditis Arrhythmias ( irregular heart beat ) Sudden cardiac death has sometimes been reported Eye conditions: Inflammation - Uveitis or Keratitis Visual disturbance Diagnosing and Testing for Lyme disease In many cases the diagnosis may need to be based upon clinical symptoms alone. Laboratory investigations may help to support the diagnosis. The NICE Guideline on Lyme disease includes the following statements: Diagnose and treat Lyme disease without laboratory testing in people with erythema migrans. 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. If there is a clinical suspicion of Lyme disease in people without erythema migrans: 1)Offer an ELISA test for Lyme disease and 2)Consider starting treatment with antibiotics while waiting for the results if there is a high clinical suspicion The blood test for Lyme disease ( ELISA) looks for antibodies to the bacteria that cause Lyme disease, but not the bacteria itself. If the test is done at an early stage in the disease, or the patient has a suppressed immune system, then antibodies may not have developed sufficiently and the test may be negative despite active infection. Antibodies can sometimes persist for years even after a patient has been treated and has no active disease. Both false-negative and false-positive results can occur. Recommendations | Lyme disease NICE Treating Lyme disease If Lyme disease is diagnosed or suspected then antibiotic treatment should be started a soon as possible. Type and dosage of antibiotic will depend on the age of the patient and the severity of the infection. The dosages used are higher than for many other infections and should usually continue for at least 3 weeks. NICE has developed a treatment protocol: Recommendations | Lyme disease NICE Optimal treatment regimes for EM rashes and disseminated Lyme disease have not yet been determined. Some protocols advocate limited courses of antibiotic treatment. Others consider that persistent symptoms are the result of persistent infection and require individualised treatment regimes. Many doctors and patients report benefit from combined and extended antibiotic treatment regimes. Research is ongoing. Jarisch-Herxheimer reaction This is a reaction that can occur within the first few days of starting antibiotics for Lyme disease. Symptoms may include a worsening of fever, chills, muscle pains and headache. The reaction may last for a few hours or several days. It is usually self-limiting and resolves spontaneously. Persistent symptoms after treatment Many patients report ongoing symptoms following treatment for Lyme disease. In many cases these symptoms resolve over time, but others (around 10-20% of cases) report persistent, often severe symptoms. These are often referred to as either Post Treatment Lyme disease (PTLD) or chronic Lyme. There is no international consensus on the causes or management of these symptoms, research is ongoing into these genuine scientific uncertainties. Lyme Disease Treatment | Prognosis for Lyme Patients after Treatment Advice for patients who suspect they have or may have Lyme disease 1) Seek medical advice as soon as possible if you notice a rash or feel unwell following a tick bite or tick exposure. Be sure to mention your concerns, including any recent travel. 2) Remember that ticks may be present in parks and gardens as well as rural and wooded areas. Tick bites are painless and may go unnoticed. 3) Take (and keep) clear photos of the rash 4) An erythema migrans rash may be ‘atypical’ and not necessarily a bull’s eye appearance. It can be uniform in colour, and may have hues of pink, purple, red, or blue or deepening of the existing skin tone. It is diagnostic for Lyme disease and must be treated, without the need for a blood test. 5) If your health professional seems unsure about the diagnosis and treatment of Lyme disease then ask them to view the Royal College of GPs (RCGP) Lyme disease Toolkit which includes the NICE Guideline on Lyme disease. Lyme disease toolkit 6) If symptoms persist after three weeks of antibiotics then a second course of treatment may be required. Recommendations | Lyme disease| NICE 7) Remember: Early diagnosis and adequate treatment provide the best chance of cure. Late diagnosis and inadequate treatment may result in continuing health problems and on rare occasions life-threatening consequences. A negative Lyme disease test result does not necessarily exclude the diagnosis.

About Ticks Ticks are small blood-sucking arthropods present throughout the world in many different environments. There are over 900 species split between either hard or soft bodied ticks. In the UK, the Lyme disease bacteria (borrelia) can be transmitted to humans by at least three species of hard-bodied tick belonging to the Ixodes complex: Ixodes ricinus or sheep tick Ixodes hexagonus or hedgehog tick, which may inhabit urban areas Ixodes canisuga: the fox tick, also known as the dog tick N.B. Ixodes scapularis is the deer tick, a native American species, not found in the UK Where are ticks found? Ticks are present across the UK and are mostly found in woods, fields and moorland, though can also survive in some parks and gardens. Ticks cannot jump or fly. Instead they climb a piece of vegetation and wait for a passing human or animal to catch hold of. They are carried on deer as well as small mammals and birds. They may even be carried into the home on domestic pets. The prevalence of ticks is known to be particularly high in the Scottish highlands. Ticks are more active from April to October but may still be found throughout the year in warmer parts of the UK. The incidence of Lyme disease peaks in June, with a smaller peak in September. Studies have indicated that between 0-12% of UK ticks may be infected with the Lyme bacteria, with some variation between different locations across the country. The Centre for Tick Virus Research is mapping ticks sightings by the public and working with the Lyme Resource Centre (LRC) to improve awareness. Find out more here: What makes viruses tick? How do ticks spread Lyme disease? Ticks pass through three life stages: larva, nymph and adult, and require a blood meal in each stage. The tick may become infected during one blood meal before then transmitting borrelia and other infections during its next blood meal. How ticks spread disease | Ticks | CDC There is no proven minimum time needed for transmission of infection from the tick to an animal or human, however the longer the attachment ( which can be several days) the greater the risk. Since tick bites are painless, they can easily go unnoticed - particularly nymph ticks which measure less than 2mm in size and may therefore remain attached for longer than the larger adult ticks, increasing the likelihood of transmission of Lyme disease and other tick-borne infections. (Transmission | Lyme Disease | CDC ) Ticks outside the UK An increased prevalence of ticks and higher tick infection rates are known to occur in mainland Europe and parts of North America, as compared to the UK. The recorded incidence of Lyme disease is particularly high in Central and Eastern Europe and North-eastern States of the USA. Ticks may carry a range of other bacteria, viruses and parasites; though very few cases of other tick-borne diseases have been recorded in the UK. A case of tick-borne encephalitis was reported in the UK in Spring 2023. Tick-borne encephalitis detection in England - GOV.UK . It is important to mention your travel history, within or outside the UK, if being assessed for the risk of Lyme disease. Tick Awareness Tick awareness is an essential part of Lyme disease prevention. Advice on avoidance and prevention of tick bites includes: Stick to paths Avoid brushing against vegetation Wear long trousers and tuck them into socks Wear light coloured clothing so that ticks are more easily noticed Carry a tick remover or fine toothed tweezers and carry out tick checks, both during and after time outdoors - especially on children and domestic animals Prompt correct tick removal is key to primary prevention of Lyme disease. Insect repellents containing DEET and picardine are effective against ticks. Pet owners are one and a half times more likely to be bitten by a tick than non-pet owners. (Animals may carry ticks into the home.) Tick awareness A5 leaflet for printing Preventing tick-borne disease through awareness Tick bite management It is estimated that only one in three people notice a tick bite. Nymph ticks may be as small as a poppy seed. Ticks may remain firmly attached for up to five days. The bite may not be itchy or painful. Adults tend to be bitten on the lower body such as behind the knee, the groin or the navel, whereas children are more likely to be bitten above the waist, especially around the hairline. The likelihood of a person developing Lyme disease from a tick bite in the UK is thought to be low. However, there is no proven minimum time of attachment required for transmission of infection. Ticks should be removed promptly and carefully using a tick removal tool or fine tipped tweezers. Do not use oil or nail varnish, and avoid squashing or traumatising the tick as this increases the risk of transmission of infection. Tick Twister Video Following a tick bite, a person should watch for signs of skin rashes, flu-like symptoms or other unusual symptoms for at least 30 days following the bite. ​ Tick bite prevention and management Be tick aware toolkit.pdf (UKHSA tick aware toolkit)

Scottish government and MSP s Working with Scottish Government (SG) Infection Dept The Lyme Resource Centre has been working with the Scottish Government (SG) Infection Department to highlight the importance of raising awareness of ticks and tick borne-diseases. Resulting in: ​ A Public Health Poster Campaign on ticks and Lyme disease - displayed in all 1280 Community Pharmacies across Scotland in 2022 and 2023. https://images.squarespace-cdn.com/content/v1/601d44b7e8475c7d8be2ea36/c3dfca61-8c21-4f7b-9e85-69a0c5c09990/Lyme+Disease+PHS+Poster.jpg Helping to develop an SG social media campaign in 2022 and 2023. Working with the SG Chief Medical Officer team to improve education of healthcare professionals about tick-borne infection across the NHS. Ticks and Lyme Disease – Raising Public Awareness ​ Working with Fife and West Lothian local authorities The Lyme Resource Centre has partnered with Fife and West Lothian local authorities on signage projects and are seeking to establish further partnerships with local authorities in Scotland to increase the spread of the signs across local authority managed parks which are popular with the public. Efforts continue to encourage local authorities to engage with this initiative, however there are varying priorities for resources among local authorities at this time. We are seeking to influence Scottish Government Policy by engaging with MSP’s to encourage local authorities in Scotland to make this signage initiative a priority. Position paper A position paper by the Lyme Resource Centre