Lyme disease diagnosis

The Medical Defence Union (MDU), a UK doctors’ insurance body, has told its members to remain vigilant for possible cases of Lyme disease. Lyme disease, caused by the bacterium Borrelia burgdorferi and transmitted to humans by the bite of infected ticks, can be hard to spot as it has a variety of symptoms, and can easily be mistaken for something else. The most common symptom is a slowly expanding rash which spreads out from a tick bite, usually after about five to 14 days. Typical symptoms also include fever, headache, fatigue, and a characteristic skin rash called erythema migrans. Most cases of Lyme disease can be treated successfully with a few weeks of antibiotics. But if left untreated, infection can spread to joints, the heart, and the nervous system. In England and Wales 684 cases were reported last year, and Scotland has seen a tenfold increase in numbers over the last decade, with 177 cases reported last year. The MDU has issued guidance for doctors advising them to:

• Tell patients to take precautions against tick bites if they are visiting woods, heathland and parklands in high risk areas
• Make themselves aware of the various clinical manifestations of the disease
• Consider the diagnosis in patients with possible symptoms who have walked in areas where the disease is prevalent
• Remember that only about 20% of patients are likely to recall being bitten by a tick

In the United States, Lyme disease is the most common vector-borne disease with approximately 20,000 new cases reported each year (MMWR Lyme Disease - United States, 2003-2005). Cases peak during summer months, reflecting transmission by nymphal vector ticks during May and June. In the USA from 2003-2005, 64,382 Lyme disease cases reported to CDC, of which 93% were reported from the 10 states (Connecticut, Delaware, Maryland, Massachusetts, Minnesota, New Jersey, New York, Pennsylvania, Rhode Island, and Wisconsin) where the disease is endemic. Since Lyme disease became nationally notifiable in 1991, the annual number of reported cases has more than doubled, although Lyme disease surveillance is complicated by both underreporting and overdiagnosis of cases. A Lyme disease vaccine was licensed in the USA in 1999 but was withdrawn from the market in 2002, reportedly because of poor sales. Although no Lyme disease vaccine is currently available, CDC says people can lower their risk for the disease and other tickborne illnesses by avoiding tick-infested areas where possible, using insect repellents containing DEET (N,N-diethyl-m-toluamide), and performing daily self-examination for ticks. In North America, removing ticks within 24 hours of attachment reduces the likelihood of B. burgdorferi transmission. Tick populations around homes and in recreational areas can be reduced 50%–90% through simple landscaping practices such as removing brush and leaf litter or creating a buffer zone of wood chips or gravel between forest and lawn or recreational areas. For persons who are unfortunate enough to become infected, prompt diagnosis and treatment are important to prevent serious illness and long-term complications.
Related:

• Spirochetes: videos
• BBC Health: Lyme disease
• CDC: Lyme disease prevention

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