This presentation by Dr Dave Ashcroft of Aberfeldy illustrates many useful lessons learned in a Scottish GP practice. Five clicks will take you through the Aberfeldy experience: you can assimilate it in less than 5 minutes.

Occupationally acquired cases should be notified to the Health and Safety Executive (HSE), under the RIDDOR regulations. This also applies to self employed individuals who may need to have this drawn to their attention.

None of the existing guidelines incorporates all the published knowledge on Lyme disease. The best official UK sources of information are

See also the About Lyme menu for sections on differential diagnosis, tests etc.

Jarisch-Herxheimer Reaction

Patients should be warned they might experience a worsening of symptoms on starting treatment. CKS [2] only mentions this with respect to pregnant women, but it applies to all patients.

CKS states “People may mistake this for an allergic reaction and stop their antibiotics. Provided the symptoms are not severe and there is no evidence of an allergic reaction (such as urticaria), they can be advised to continue.”

Psychiatric Manifestations

Doctors should be aware that patients can develop Lyme related psychoses, violent behaviour, depression, confusion etc. For more detail see the page on Neurology & Psychiatry on the About Lyme section of this website.

Doctors should be alert to the real risk of suicide.

Paediatric Lyme disease

Although >50% tick bites on adults are below the waist, 60% of bites on children are above the waist [4]. Ticks can attach in the hairline and on the scalp of children and remain undetected for longer than on adults.

LDA recognises the additional problems that occur in paediatric Lyme Disease.

The presentation on Pediatric Lyme Disease (PDF) by Dr Ann F Corson supports this statement.

Lyme in Pregnancy

There is some evidence that congenital Lyme disease exists [1] but no international consensus.

For treatment in Pregnancy, see CKS [2] but note that this only covers patients with erythema migrans and without neurological, cardiac or joint symptoms.

A recent study in Hungary [3] concluded that “an untreated maternal Borrelia burgdorferi s.l. infection may be associated with an adverse outcome, although bacterial invasion of the fetus cannot be proven.”

References

1) For a 2008 review of literature on Lyme disease in pregnancy click here

2) Clinical Knowledge Summaries CKS

3) Lakos & Solymosi Maternal Lyme Borreliosis and pregnancy outcome Int J Infect Dis. 2010 Jun;14(6):e494-8

4) Robertson, J N, J S Gray, and P Stewart. 2000. Tick bite and Lyme borreliosis risk at a recreational site in England. European Journal of Epidemiologypidemiology 16, no. 7: 647-652.

Doctor patients

Lyme borreliosis: perspective of a scientist–patient. Hamlen R. Lancet Infect Dis 2004; 4: 603–4.

My Years with Lyme Disease

 

Be Aware!

Because of the lack of quality European clinical trials, there is significant disagreement across European guidelines on both diagnosis and treatment. Although tests can help to confirm Lyme disease, no blood test can rule it out: diagnosis should be on the basis of clinical symptoms and the elimination of other conditions.