Treat suspected Lyme disease without delay

PATIENTS presenting with erythema migrans or the characteristic bull’s eye rash associated with Lyme disease should be diagnosed and treated with antibiotics without delay, says NICE.

An updated quality standard published by NICE emphasises the importance of a quick diagnosis and immediate treatment to reduce the risk of infection spreading and causing lasting damage.

The NICE standard reminds clinicians that laboratory tests, such as the enzyme-linked immunosorbent assay (ELISA), will check for antibodies in the blood but Lyme disease antibodies may first appear six to eight weeks after a person has been bitten, so an early ELISA test (one performed within four weeks of symptoms starting) may not detect the disease.

It recommends that patients with a positive ELISA or symptoms continuing for 12 weeks or more should undergo an immunoblot test to confirm Lyme disease. People without the rash and a negative result from an early ELISA should have an ELISA repeated at the four- to six-week mark if Lyme disease is still suspected.

NICE are also encouraging local authorities to work with other organisations (including outdoor and recreational organisations) in their area to help raise awareness of how to prevent Lyme disease. This could include displaying leaflets with advice on tick prevention and removal in local GP practices. Promotional activities are best organised to coincide with periods of higher risk of tick exposure.

Professor Gillian Leng, deputy chief executive and director of health and social care at NICE, said: "For most people with Lyme disease, a course of antibiotics will be effective, so it is important we diagnose and treat people as soon as possible.

"A person with Lyme disease may present with a wide range of symptoms, so we have clear advice for professionals about the use of lab tests for diagnosis and the most appropriate antibiotic treatments. If a characteristic bull’s eye rash is present, healthcare professionals should feel confident in diagnosing and treating Lyme disease."

Link: Lyme disease quality standard

NICE have also published a visual aid that details the different routes to diagnosis.