The sun’s come out here in the UK and people are venturing into forests for picnics. Timely then for NICE to spoil the fun and publish its guideline on Lyme Disease (NG95, April 2018)

• Caused by a tick-borne spirochaete of the Borrelia species, which is spread by a bite from  an infected tick
• Ticks live in many woodland and grassy areas but only a small number carry the bacteria that causes Lyme disease
• 2,000 to 3,000 diagnoses each year in England and Wales.
• erythema migrans rash, examples here.
• Flu-like symptoms to start with. Other symptoms include migratory inflammatory arthritis, uveitis, pain or numbness, trouble with memory, heart block, pericarditis
• ELISA and immunospot testing are used for diagnosis but false negatives are possible especially in first 4 weeks
• Treated with doxycycline or amoxicillin