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CPD: Key questions on Lyme disease

Key points

  • Lyme disease can be contracted anywhere in the UK 
  • Identifying the characteristic erythema migrans rash is enough to diagnose Lyme disease
  • Erythema migrans can appear between three days and 12 weeks after a tick bite, whereas other insect bite rashes usually develop and recede within two days
  • Without the rash, diagnosis requires a combination of a careful history, clinical presentation and supporting laboratory tests
  • Other potential short-term clinical features include flu-like symptoms, ‘brain fog’, neurological symptoms, inflammatory arthritis, cardiac issues, eye or skin symptoms and lymphocytoma 
  • Not all ticks carry Lyme disease-causing bacteria; a simple tick bite requires no treatment other than removal of the tick and cleaning the area

Dr Caroline Rayment is a GP in West Yorkshire with an interest in research and NHS development in Lyme disease

Q How common is Lyme disease? Is the disease restricted to certain locations?

A Lyme disease can be contracted anywhere in the UK. However, in some places there is a higher chance of contracting the infection. The areas of highest incidence are the south of England and the Scottish Highlands. It is also common in North America, Canada, Scandinavia and much of Europe. 

Remember to ask the key question from medical school when taking a history – ‘where have you been and what have you been doing?’. This focuses us on the important aspects of a good travel, social and occupational history. Lyme disease is more common among certain groups who spend a lot of time in the open countryside such as walkers, campers, forestry workers and vets. Nevertheless, it can be contracted in residential gardens and city parks – a high profile case was that of the England rugby player Matt Dawson, who was thought to have contracted Lyme disease in a London park.

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