16th July 2026

Lyme Disease

Lyme disease is a tick-borne infection caused by the spirochete *Borrelia burgdorferi*, transmitted by Ixodes ticks. It is most prevalent in temperate woodland areas in Europe and North America. The condition has three stages: early localised, early disseminated, and late disease.

Clinical Features and Diagnosis

The classic hallmark of early localised Lyme disease is erythema migrans — an expanding, painless erythematous rash with central clearing (‘bull’s-eye’ appearance) occurring at the site of the tick bite. Systemic symptoms may include malaise, fatigue, headache, fever, and myalgia.

Early disseminated disease may involve multiple erythema migrans lesions, cranial nerve palsies (especially facial nerve), meningitis, or carditis. Late manifestations include arthritis (especially of the knees) and peripheral neuropathy.

Diagnosis is clinical in the presence of erythema migrans. Serological testing (ELISA followed by Western blot) is used for confirmation in later disease or atypical presentations. False negatives can occur in early disease due to low antibody titres.

Management

Treatment of early disease includes oral doxycycline for 14–21 days. Alternatives include amoxicillin or cefuroxime in pregnant women or children under 8. Neurological or cardiac involvement may require intravenous ceftriaxone. There is no current vaccine in the UK, so prevention relies on protective clothing and tick checks.