GPAtlas🧭 When to suspect
Lyme disease is a tick-borne infection caused by Borrelia burgdorferi (sensu lato), transmitted by the bite of an infected Ixodes ricinus tick. It can be acquired anywhere in the UK but is most common in the South of England and the Scottish Highlands. Most tick bites do not transmit infection, and prompt, correct tick removal reduces the risk.
The hallmark is erythema migrans (EM) – an expanding red rash, sometimes with central clearing (the classic "bull's-eye"), that is not usually itchy, hot or painful, appears 1–4 weeks after a bite (range 3 days to 3 months) and lasts several weeks. EM is a clinical diagnosis: treat it on sight and do not wait for blood tests.
Around one-third of UK cases have no rash, and many patients recall neither a rash nor a bite. Consider Lyme disease in someone with plausible exposure (grassy or wooded areas, gardening, hiking, forestry, deer management) who presents with non-focal symptoms (fever, fatigue, headache, migratory arthralgia, "brain fog") or focal organ involvement (neurological, cardiac, joint or eye). The two key skills are to recognise and treat EM clinically and to never miss disseminated disease – while avoiding over-diagnosis in those without a supportive history or positive serology.
| Stage | Typical timing | Characteristic features |
|---|---|---|
| Early localised | Days to weeks | Erythema migrans at the bite site, often with flu-like symptoms |
| Early disseminated | Weeks to months | Multiple EM lesions; neuroborreliosis (facial palsy, Bannwarth's syndrome); Lyme carditis (heart block); uveitis |
| Late | Months to years | Lyme arthritis (large joints, especially the knee); acrodermatitis chronica atrophicans; late neuroborreliosis |
Source: NICE NG95 · UK Health Security Agency
🔒 Sign up free to read the full topic
You're viewing a free preview. Create a free account to unlock the rest.
Sign up free →Sample topics are open to everyone in the Free Sample Bundle.