Lyme disease

A bacterial infection from a tick bite. Treated early it usually resolves completely; missed, it becomes far harder.

What it is

Lyme disease is caused by bacteria carried by infected ticks. Estimates suggest a few thousand laboratory-confirmed cases a year in the UK, and probably substantially more in reality.

Ticks are found in grassland, woodland and heathland across the UK, including in urban parks. Risk is highest between spring and autumn.

Treated early with antibiotics, most people recover fully. Untreated, it can affect joints, the nervous system and the heart, and treatment at that stage is longer and less complete.

The erythema migrans rash, the expanding circular mark, is the one clinical sign that allows treatment without waiting for a blood test. Blood tests can be negative in the first few weeks, which is why a typical rash should be treated on sight.

Signs you might notice

A spreading circular or oval rash, often but not always with a clearer centre, appearing days to weeks after a bite. It is usually not itchy or painful, which is why people ignore it.

Flu-like symptoms: fever, headache, muscle and joint aches, fatigue, swollen glands.

Later: joint pain and swelling, nerve pain, facial weakness resembling Bell's palsy, and heart rhythm problems.

Not everybody remembers a tick bite. Nymphal ticks are the size of a poppy seed.

How it can affect day-to-day life

The bite itself is painless, and the tick may be tiny, so a great many people have no memory of one.

The rash appears in a majority but not all cases, and it does not always look like a bullseye.

Chronic symptoms after treated Lyme disease are contested territory clinically, and people caught in that debate often feel abandoned by services. Whatever the mechanism, the fatigue and pain are real and deserve management.

Supporting someone well

Check for ticks after being outdoors: behind knees, groin, armpits, waistband, hairline, and on children and dogs.

Remove a tick properly with fine-tipped tweezers or a tick tool, grasping close to the skin and pulling steadily upward. Do not burn it, smother it in petroleum jelly, or twist it.

Note the date, and watch the site for several weeks.

Get any expanding rash seen and treated. Do not wait for a blood test if the rash is typical.

Cover up and use repellent in tick habitat.

Persisting symptoms after treatment deserve assessment rather than dismissal, and also deserve other causes being excluded.

Where to get help

A GP can diagnose and treat. Take a photograph of the rash, since it may fade before the appointment.

Lyme Disease UK provide information and support.

Facial weakness, severe headache with neck stiffness, or heart rhythm symptoms need urgent assessment.