NICE issues guidance on Lyme disease

Walking in woods

6 August 2018

Following consultation, NICE introduced its guidance on Lyme disease in April 2018.

With the arrival of warmer weather, more people will be venturing into grassy and woodland areas, where they may pick up infected tick bites with the risk of developing Lyme disease.

Lyme disease is not common in the UK but cases confirmed by laboratory testing rose from 346 in 2003 to about 1700 in 2015. Public Health England estimates there could be up to 3000 new cases of Lyme disease in England and Wales each year, although this figure is disputed by patient groups, who suggest the number of patients affected is higher.

The guidance aims to raise the profile of the disease among general practitioners, encouraging them to consider the disease among their list of potential diagnoses, when relevant.

The guidance recommends that patients who present with a characteristic rash, erythema migrans, should be treated for Lyme disease without the need to resort to laboratory testing. An algorithm sets out what testing is recommended for individuals who present with more non-specific symptoms in whom Lyme disease is suspected. Guidance is also given on what antibiotic treatment is advised.

The diagnosis of Lyme disease can be difficult and its non-specific symptoms, such as fever and sweats, swollen glands, neck, joint or muscle pain and paraesthesia, can be missed – yet with appropriate antibiotic treatment it can be managed effectively. If cases continue to rise, doctors may worry about the risk of missing the diagnosis.

An alleged failure to diagnose the disease is the most common reason for complaints and claims about Lyme disease reported to the MDU.

In view of this, it may be worth considering the following risk management advice.

  • Advise patients to take precautions against tick bites if they're visiting high risk areas, especially in spring and summer when ticks are most active. NHS Choices provides advice on preventing tick bites.
  • Be aware that there are various clinical manifestations of Lyme disease.
  • Consider the diagnosis in patients with suggestive symptoms who have walked in areas where the disease is prevalent, such as Scotland, the New Forest and North America. Be aware that the patient may not recall the tick bite or notice a mark.
  • If the diagnosis is considered, arrange appropriate tests to try to exclude or confirm it. NICE guidance on laboratory testing and diagnosis states: 'If there is a high clinical suspicion of Lyme disease, consider starting treatment while waiting for tests results' and 'do not rule out Lyme disease even if results are negative.'
  • Be aware of the relevant guidelines, including from NICE Public Health England and the RCGP which offers an online learning module.
  • Consider obtaining a specialist opinion if the diagnosis is unclear.
  • As with all aspects of patient care, it's important to keep accurate records, taken at the time of the consultation, and to record both positive and negative findings.

This guidance was correct at publication 06/08/2018. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.