Intended for healthcare professionals

Practice 10-Minute Consultation

Tick bite and early Lyme borreliosis

BMJ 2012; 344 doi: (Published 14 May 2012) Cite this as: BMJ 2012;344:e3124
  1. Christopher J A Duncan, research fellow12,
  2. George Carle, general practitioner3,
  3. R Andrew Seaton, consultant in infectious diseases and general (internal) medicine1
  1. 1Brownlee Centre for Infection, Tropical Medicine and Counselling, Gartnaval Hospital, Glasgow G12 0YN, UK
  2. 2Sir William Dunn School of Pathology, Oxford OX1 3RE, UK
  3. 3Kyles Medical Centre, Tighnabruaich, Argyll PA21 2BE, UK
  1. Correspondence to: C J A Duncan chrisduncan{at}
  • Accepted 6 February 2012

A 48 year old man removed two ticks attached to his leg while walking in the Scottish Highlands. A week later he develops a rash and consults you worried about Lyme disease.

What you should cover

Epidemiology—Lyme borreliosis is the commonest tick-borne infection in the northern hemisphere. It is relatively uncommon in the UK overall (about 1200 cases in 2009), but marked geographical variation is observed. Risk is highest in rural forested areas and heathland such as the Highlands (incidence 56.35/100 000 in 2009-101), Lake District, and New Forest. Some 15–20% of infections are acquired in Europe or the US. There has been a steady rise in cases diagnosed in the UK over the past decade.2 3

Risk assessment—Ask about duration of hard bodied (Ixodes) tick attachment, with or without engorgement (fig 1). Transmission of pathogenic Borrelia species is unlikely if ticks are attached for <24 hours and unengorged.2 4

Fig 1 Fully engorged female Ixodes ricinus (courtesy of Dr Alan S Bowman, University of Aberdeen)

Clinical features—Erythema migrans (fig 2 …

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