UK Guidelines Quiz: Do You Know The Latest on Managing Lyme Disease?

Tim Locke


February 12, 2019

Diagnosis of Lyme disease can be challenging as it shares symptoms with other conditions, and patients may not remember having a tick bite.

New NICE guidance (Feb 2019) on diagnosing and managing Lyme disease says the presence of the erythema migrans rash means a diagnosis of Lyme disease can be made without need for blood tests. This rash usually appears 1 to 4 weeks after the tick bite, and usually at the site of the bite. However, it can appear as early as 3 days, and as long as 3 months later.

It may have a central clearing giving a 'bull's eye' appearance, and may have increased in size.

This rash is not usually itchy, hot, or painful.

Other possible physical symptoms include:

  • Fever and sweats

  • Swollen glands

  • Malaise

  • Fatigue

  • Neck pain, or stiffness

  • Migratory joint or muscle aches and pain

  • Cognitive impairment, including memory and concentration problems, sometimes described as 'brain fog'

  • Headache

  • Paraesthesia

The NICE guidance asks clinicians to consider the possibility of symptoms affecting one or more organ systems (focal symptoms), including:

  • Neurological symptoms, including facial palsy or other unexplained cranial nerve palsies, meningitis, mononeuritis multiplex or other unexplained radiculopathy, encephalitis, neuropsychiatric presentations, or unexplained white matter changes seen on brain imaging

  • Inflammatory arthritis that may be fluctuating and migratory, and affecting one or more joints

  • Cardiac problems, including heart block and pericarditis

  • Eye symptoms, including uveitis and keratitis

  • Skin rashes, including acrodermatitis chronica atrophicans, and lymphocytoma


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