Diagnose and treat Lyme disease if bull’s eye rash is present, says NICE

10 Jul 2019 01:47 PM

People presenting erythema migrans, the characteristic skin rash associated with Lyme disease, can be diagnosed and treated without the need for blood tests, NICE has said in a final quality standard published yesterday.

Lyme disease is a bacterial infection transmitted by the bite of a tick. Symptoms range from headaches and fever to joint pain and lethargy. Although most tick bites are harmless, they must be removed quickly and safely to reduce the risk of infection.

The updated quality standard emphasises the importance of a quick diagnosis and immediate treatment where appropriate. It’s important that patients begin their treatment as soon as possible in order to reduce the risk of infection spreading and causing lasting damage to the body.

Laboratory tests, such as the enzyme-linked immunosorbent assay (ELISA), check for antibodies in the blood. However, Lyme disease antibodies may first appear 6 to 8 weeks after a person has been bitten, so an early ELISA test (one performed within 4 weeks of symptoms starting) may not detect the disease.

If the ELISA is positive or symptoms continue for 12 weeks of more, a more specific test called an immunoblot test should be used to confirm Lyme disease. People who do not have the rash and had a negative result from an early ELISA should have an ELISA repeated at the 4- to 6-week mark if Lyme disease is still suspected.

After a diagnosis of Lyme disease, a person will receive an appropriate course of antibiotics based on their symptoms.

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

Professor Gillian Leng, deputy chief executive and director of health and social care at NICE, yesterday 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.”

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.

These activities could include displaying leaflets with advice on tick prevention and removal in local GP practices, for example.

Promotional activities organised to coincide with periods associated with a higher risk of tick exposure and with other local public health events can help communities become more aware of the risks associated with tick bites and prevent and treat infection promptly.

Veronica Hughes, CEO, Caudwell LymeCo Charity, yesterday said:

"I hope the new quality standard will increase the number of doctors who feel confident diagnosing a Lyme disease rash on sight and treating the infection right away.

“Caudwell LymeCo Charity hears regularly from people whose doctors have diagnosed an erythema migrans but decide to check with a blood test, not realising that the rash is the more reliable of the two. Waiting for blood test results always delays treatment; when a patient has the rash, this delay is unnecessary and reduces the likelihood of total cure."

Saul Faust, Professor of paediatric immunology and infectious diseases at the University of Southampton and chair of the guideline committee, yesterday said:

“Lab tests are necessary when a person’s symptoms are unclear, but they are not needed if a person presents the characteristic red rash, erythema migrans. Doctors should feel confident to prescribe antibiotics immediately for those with erythema migrans.”