SPICe has recently received a number of enquiries about Lyme disease. This blog post provides background information on Lyme disease and also answers some of the most common questions received.
What is Lyme disease?
Lyme disease, or Lyme borreliosis, is a bacterial infection spread to humans by infected ticks. Ticks are tiny spider-like creatures found in woodland and heath areas. They feed on the blood of birds and mammals, including humans.
How do you catch Lyme disease?
A tick bite can only cause Lyme disease in humans if the tick has already bitten an infected animal. Ticks can be found in any areas with deep or overgrown vegetation where they have access to animals to feed on.
Only a small number of ticks are infected with the bacteria that cause Lyme disease. Generally, you’re more likely to become infected if the tick remains attached to your skin for more than 24 hours.
Some people with Lyme disease will develop more severe symptoms months or years later. This is more likely if treatment is delayed.
Are there any areas in Scotland where the risk of catching Lyme disease is particularly high?
The Scottish Highlands are known to have a particularly high population of ticks. The conclusions from a study on distribution and presentation of the disease, which was published in 2015, were that:
“The incidence of Lyme borreliosis may be stabilising in Scotland but NHS Highland remains an area of high incidence. Lyme borreliosis should be considered in symptomatic patients that have had exposure to ticks and not just those with a definite tick bite.”Journal of the Royal College of Physicians Edinburgh, 2015
A new project launched in the Highlands in August 2019. The project will use satellite data to help highlight where ticks are and where the disease has been detected. LymeApp will combine the satellite information with data from the Scottish Lyme Disease and Tick-borne Infections Reference Laboratory in Inverness, as well as information from general medical practitioners and those exposed to ticks through work or recreation.
What are the symptoms of Lyme disease?
Many people with early symptoms of Lyme disease develop a circular red skin rash around a tick bite. The rash can appear up to three months after being bitten by a tick and usually lasts for several weeks. The rash is often described as looking like a bull’s-eye on a dartboard.
Most rashes appear within the first four weeks. Not everyone with Lyme disease gets the rash. Some people also have flu-like symptoms in the early stages
How is Lyme disease diagnosed?
There are no Scottish Intercollegiate Guidance Network (SIGN) guidelines at present, but the UK National Institute for Health and Care Excellence (NICE) has produced a Clinical Knowledge Summary (CKS) for the management of Lyme Disease.
NICE guidance states that a clinical diagnosis of Lyme disease should be made in people with the circular red skin rash, which is known as erythema migrans. In addition, the possibility of Lyme disease should also be considered in other people with a range of symptoms including fever, fatigue and migratory joint or muscle aches and pains.
For people without the red rash, clinical presentation and laboratory testing is used to guide diagnosis and treatment.
If the person may have been bitten by a tick whilst abroad, NICE says that doctors should consider the possibility of other tick-borne diseases (or possible co-infection), particularly if the person has symptoms atypical of Lyme disease.
A link to information on the current testing procedures for Lyme Disease can be found via Lab-tests online. There are a number of tests used in the diagnosis of Lyme Disease including antibody tests or tests to detect the presence of the bacterial DNA.
In 2018 the Scottish Lyme Disease and Tick-borne Infections Laboratory at Raigmore Hospital in Inverness was granted Reference Laboratory status which will provide additional funding for research and development into new tests for tick borne diseases.
What is the treatment for Lyme disease?
If someone develops symptoms of Lyme disease, they will normally be given a course of antibiotic tablets, capsules or liquid. Most people will require a two- to four-week course, depending on the stage of the condition.
Lyme disease can often be treated effectively if it’s detected early on, but if it’s not treated or treatment is delayed, there’s a risk of developing severe and long-lasting symptoms.
According to the NHS Inform website the term “post-infectious Lyme disease” is used to describe persistent symptoms after a confirmed and treated infection. The term “chronic Lyme disease” has been used by some people to describe persistent symptoms such as tiredness, aches and pains, usually in the absence of a confirmed Lyme disease infection.
Is there a way to reduce the risk of getting Lyme disease?
There is currently no vaccine available to prevent Lyme disease. The best way to prevent the condition is to take precautions, such as covering skin which might come into contact with plants and using an insect repellent containing DEET, when visiting areas where ticks are found to try to avoid being bitten.
Removing all ticks quickly will prevent infection with Lyme disease. They can be removed using a specially designed tick removal device or fine tipped tweezers.
NHS Scotland has an infosheet which shows different ways of removing ticks.
Lyme Disease UK warns that:
“Incorrect removal will also increase the chances of disease transmission. So whilst it is important to remove the tick as soon as possible, it is equally as important that the tick is removed correctly.”Lyme Disease UK
Is any further research being done on Lyme disease?
The NorthTick Project is a research project into tick-borne diseases which started in October 2019. NHS Highland is one of ten partners from seven countries working together. The project will run for three and a half years.
What action is being taken by the Scottish Government to tackle Lyme disease?
Petition PE01662: Improve Treatment for Patients with Lyme Disease and Associated Tick-borne Diseases, was lodged on 28 June 2017, and is still under consideration by the Public Petitions Committee. In a submission dated 2 June 2020, the Scottish Government stated that:
“the Scottish Government takes Lyme disease very seriously and is committed to working with a range of partners to raise awareness of and support those affected by this complex disease and other related conditions.”
On 20 June 2019 a question on Lyme disease was asked at First Minister’s question time. The First Minister’s response outlines some of the Scottish Government’s actions (S5F-03459)
“We are committed to raising awareness of Lyme disease and to supporting those who are affected by what is a complex infection. We have a multidisciplinary expert group dedicated to Lyme disease that is part of the Scottish health protection network.
Last week, the chief medical officer wrote to all NHS Scotland health boards and general practitioner practices to highlight the important role that they play, not only in the early diagnosis and management of Lyme disease cases, but in promoting awareness among their patients of ticks and tick-borne infections.”
Miranda Jackson, Enquiries Officer