Important resources:
- LINK TO THE REMEDY LYME DISEASE PAGE
- LINK TO NICE GUIDANCE
- LINK TO BNSSG LOCAL TREATMENT ADVICE
Background:
Lyme disease is a bacterial infection transmitted by the Ixodes Ricinus tick. There is a prevalence in the South of England including Bristol.
It is important to remember that most ticks do not carry the infection and so having a tick bite does not necessarily result in infection.
Please see the Tick Aware Document which offers useful public health advice:
History:
When approaching Tick bites in the out of hours setting please check:
- Date of tick bite if known.
- Geographical location to assess risk.
- Symptoms since bite and now.
- Presence and description of a rash. Please use video/photographs as appropriate.
- Has the tick been fully removed? (done using a tick remover tool or fine tipped tweezers. THESE ARE AVAILBALE IN BASE however we are not a tick removal service.).
Symptoms and signs:
Rash:
- Erythema migrans – bulls eye rash. (images)
- Normally between 1-4 weeks following a rash.
- Not normally hot, itchy or painful.
Non-cutaneous manifestations:
- Cognitive impairment, such as memory problems and difficulty concentrating.
- Fatigue.
- Fever and sweats.
- Headache.
- Malaise.
- Migratory joint or muscle aches and pain.
- Neck pain or stiffness.
- Paraesthesia.
- Swollen glands.
Focal symptoms:
- neurological symptoms, such as facial palsy or other unexplained cranial nerve palsies, meningitis, mononeuritis multiplex or other unexplained radiculopathy; or rarely encephalitis, neuropsychiatric presentations or unexplained white matter changes on brain imaging
- inflammatory arthritis affecting 1 or more joints that may be fluctuating and migratory
- cardiac problems, such as heart block or pericarditis
- eye symptoms, such as uveitis or keratitis
- skin rashes such as acrodermatitis chronica atrophicans or lymphocytoma.
Treatment decisions:
- UNDER 18 yrs – unless single erythema migrans lesion and no other symptoms discuss with specialist.
- ADULTS - If erythema migrans and no other focal symptoms then start treatment with oral antibiotics.
- If Lyme disease is suspected in people without erythema migrans; offer a blood test for Lyme disease. This can be done in hours by their own GP unless needing immediate treatment and high suspicion. The lab will often not process this until 4 weeks after the event.
- If there is a high clinical suspicion of Lyme disease, consider starting treatment with antibiotics while waiting for the results.
DO NOT GIVE DOXYCYLINE TO CHILDREN UNDER 9 YEARS OLD.
Review Date: 01/09/2022
Owner: Dr J Parvin