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expert reaction to draft NICE guidance on diagnosing Lyme disease

The National Institute for Care Excellence (Nice) has announced a new draft guideline on diagnosing and managing Lyme disease.


Prof. Sarah Randolph, Tick expert & retired Professor of Parasite Ecology, University of Oxford, said:

“I found this draft guidance to be a well balanced and pretty comprehensive set of guidelines – the best I’ve read.

“It’s worth remembering that different ‘strains’ (usually called genospecies for reasons I have never understood) of Borrelia burgdorferi are associated with different clinical symptoms.  Hence the wide range of symptoms that may occur as the ‘disease’ progresses.

“The large number of cases of Lyme disease diagnosed in certain parts of the UK is at least partly and probably mostly caused by high exposure of humans to infected ticks, i.e. large numbers of visitors to, for example, the New Forest and Exmoor.  This raises awareness amongst local GPs and so there is better diagnosis there.  The hazard per se (numbers of infected ticks) may be just as high for the individual human in many other parts of the UK, but with less exposure fewer cases occur.  People should self-protect and self-examine for tick bites even outside the so-called high-risk regions.   At the ‘low’ end of this spectrum is Richmond Park – very low numbers of ticks, but huge numbers of visitors (orders of magnitude higher even than the New Forest), hence there have been a number of reported cases (often amongst high-profile athletes training there).  The risk per individual visitor to Richmond Park is very low.

“Deer are a major risk factor – the huge increase in abundance and spread of deer, including into domestic settings, almost certainly increases tick populations and so the risk of Lyme disease.”




Declared interests

None received.

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