Context

Lyme disease is a zoonotic disease transmitted by ticks.

In 2020, there were 1262 laboratory confirmed cases of Lyme disease reported in England and Wales by Public Health England, of which only approximately 15% are acquired overseas⁵. It has been estimated that, in addition to the laboratory-confirmed cases, there are also between 1,000 and 2,000 additional cases of Lyme disease each year in England and Wales that are not laboratory-confirmed⁵. However, as Lyme disease can’t be diagnosed clinically and does go undiagnosed, the true incidence of Lyme disease is unknown. People of all ages can be affected and both sexes are equally susceptible.

It is most often diagnosed during August to September. This coincides with a tick bite in late Spring, arguably because of increased outdoor activity during this period.

Lyme disease can present with a wide spectrum of clinical signs and symptoms (besides that of the characteristic rash) which can take months or even years to resolve, even with appropriate treatment.

NICE published guidance on the diagnosis and management of Lyme disease in April 2018 (updated in October 2018) on which this Learning Session is based. Their guideline aims to raise awareness of when Lyme disease should be suspected and to ensure that people with suspected Lyme disease are given early and consistent treatment. The guideline committee acknowledged that poor-quality evidence is available on both diagnosis and treatment and has developed a series of research recommendations to improve basic epidemiology, understanding of the natural history of Lyme disease, and to develop diagnostic tests appropriate for UK infections.