Doctors need accredited information on Lyme borreliosis

The recent focus on Lyme borreliosis helps raise awareness at a time of year when incidence is highest and there is increased need for vigilance.1 However, there appears to be a missed opportunity in terms of the quality and bias of information provided.

The true incidence of Lyme disease in the UK is unknown but is certainly higher than thought. On the basis of a clinical diagnosis of erythema migrans rash, an audit at a highly aware GP practice in Scotland found an incidence of 370 per 100 000 population compared with the laboratory confirmed 17 per 100 000 in the surrounding area (personal communication). Although this was a small sample, it is possible that 95% of cases do not enter official statistics.

Duncan and colleagues quote the British Infection Association (BIA) position paper and recommend it as useful reading2: “Erythema migrans occurs in 90% of symptomatic Lyme borreliosis 2-40 days after exposure.” This misleading statement is based on unreferenced surveys in continental Europe, where doctors and the public are more aware of the importance of the rash. Notably, two studies of UK patients treated for Lyme disease found that 77% and 65% reported an erythema migrans rash.3 4

This is not the only important point where the BIA statement misleads. A full comment on the BIA paper, written at the request of the BIA president so it could be put before the BIA council for consideration, can be read on the Lyme Disease Action website.5

It is a pity that the resources recommended to doctors are unaccredited (BIA paper, Health Protection Agency website) or geared towards the US (Wolters Kluwer Health). Doctors could more usefully be directed to the Lyme Disease Action website, which is accredited to the Department of Health’s Information Standard.