Lyme disease — tick-borne Borrelia infection
Lyme disease ( Lyme borreliosis ) — Borrelia burgdorferi sensu lato transmitted by Ixodes ricinus ticks — sheep/deer ticks.
UK hotspots: Scottish Highlands, New Forest, South Downs, Yorkshire Moors — anywhere ticks present.
Incidence rising — awareness + climate — still treatable early.
Lifecycle
- Tick attaches — feeds 48–72h for efficient transmission
- Borrelia spreads locally → erythema migrans
- Haematogenous dissemination if untreated
Stage 1 — Early localised
3–30 days post bite:
- Erythema migrans (EM) — expanding red rash — central clearing “bullseye” — not always bullseye
- ≥5cm diameter typically
- not painful/pruritic usually
- flu-like — fatigue, myalgia, fever
EM alone — start antibiotics — no test wait
Stage 2 — Early disseminated
Weeks–months:
- multiple EM lesions
- cranial nerve palsy — facial palsy (Bell’s)
- lymphocytic meningitis
- radiculopathy — Bannwarth syndrome
- carditis — AV block — may need pacing
- migratory arthralgia
Stage 3 — Late
Months–years untreated:
- Lyme arthritis — large joint, knee
- acrodermatitis chronica atrophicans — skin
Rare in UK with modern treatment
Diagnosis
Clinical EM — sufficient
Serology:
- ELISA → immunoblot if positive/equivocal
- false negatives early
Do not test asymptomatic tick bite
Treatment (NICE)
| Stage | Regimen |
|---|---|
| Early | Doxycycline 21 days OR amoxicillin OR azithromycin |
| Neuro/cardiac | IV ceftriaxone — specialist |
| Arthritis | Oral or IV per severity |
Pregnancy — amoxicillin — avoid doxycycline
Prevention
- long trousers, tucked socks walking
- stick to paths
- insect repellent DEET
- check skin after outdoors — prompt removal
- shower within 2 hours
No UK Lyme vaccine currently licensed
Post-treatment symptoms
Fatigue after adequate antibiotics — common — usually resolves months
Chronic Lyme term controversial — NICE — no long-term antibiotics without active infection evidence
Specialist infectious diseases if persistent objective signs
Tick attached — remove correctly, watch rash 4 weeks — bullseye = GP same week antibiotics.
Common questions about Lyme disease
- What are the symptoms of Lyme disease?
- Early localised — erytheema migrans rash (expanding red ring), fatigue, fever, headache, muscle aches. Disseminated weeks later — multiple rashes, facial nerve palsy (Bell's palsy), meningitis symptoms, joint swelling (often knee), heart block. Late — Lyme arthritis, neurological symptoms months later if untreated.
- How do you remove a tick?
- Use tick removal tool or fine tweezers close to skin — pull steadily upward without twisting or squeezing body. Clean skin and hands. Do not use petroleum jelly, heat, or nail polish — increases infection risk. Monitor bite site 4 weeks.
- How is Lyme disease diagnosed?
- Erythema migrans rash — clinical diagnosis — start antibiotics immediately. Blood tests (ELISA then immunoblot) detect antibodies — often negative early — repeat if suspicion persists. PCR on joint fluid or CSF selected cases.
- What antibiotics treat Lyme disease?
- Early Lyme — doxycycline 100mg twice daily 21 days (not pregnancy/under 12), or amoxicillin, or azithromycin alternatives. Neurological or cardiac Lyme — IV ceftriaxone — specialist. Most people recover fully with prompt treatment.
- Can Lyme disease be chronic?
- Some report fatigue, pain, cognitive symptoms after treated Lyme — post-infectious syndrome may occur — not proven persistent infection in most. NICE advises against long-term antibiotics without objective evidence of active Lyme. Specialist referral if ongoing symptoms.
Sources
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