Lyme disease in the BMJ

The June 23rd edition of the BMJ had a large tick on the cover heralding a couple of articles inside in this week’s Practice section:

  • Tick bite and early Lyme Borreliosis: a 10 minute consultation
  • Lyme neuroborreliosis: a patient’s journey.

The 10 minute consultation discussed what steps a doctor should take in investigating a rash following a tick bite. The article had some good points, including the fact that an erythema migrans does not require serological testing. Unfortunately, the oft quoted “EM appears in 90%” was used and LDA thought this point, and some others, were worth countering. Our rapid response followed.

The related article, Lyme neuroborreliosis, is a patient journey through her early symptoms, diagnosis, treatment and partial recovery. The doctors concerned tried their best with diagnosis and eventually a young registrar hit on the possible cause and the diagnosis of Lyme disease was confirmed with a blood test. What struck us in LDA was that this patient, treated according to guidelines with 4 weeks of antibiotics, is still not well. This stoical lady of 80 feels she is fortunate. She was “interested to discover” that she can no longer swim because of lack of coordination, and that is not her only remaining symptom.

We do not know what each person’s remaining symptoms are due to. In some cases they are due to active disease still present and in some there will be nerve damage. We do badly need a way of telling this because at the moment few doctors will prescribe beyond 4 weeks. With most other infections, if your symptoms do not resolve you will have another course of treatment, but not usually with Lyme disease, despite the unpleasant symptoms.

A rapid response to this article demonstrates that some people benefit from more treatment: Dr Caroline Rayment describes her journey and concludes that guidelines are just that, and not always applicable to every patient.