Tick bite
BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3029 (Published 13 August 2020) Cite this as: BMJ 2020;370:m3029
- Mohammad S Razai, academic clinical fellow in primary care1,
- Katja Doerholt, consultant in paediatric infectious diseases2,
- Eva Galiza, clinical research fellow in paediatric infectious diseases3,
- Pippa Oakeshott, professor of general practice1
- 1Population Health Research Institute, St George’s University of London, London, UK
- 2St George’s University Hospital NHS Foundation Trust, London, UK
- 3Institute for Infection and Immunity, St George’s University of London, London, UK
- Correspondence to M S Razai mrazai{at}sgul.ac.uk
What you need to know
Most tick bites do not cause Lyme disease
A “bull’s eye” red rash of erythema migrans is diagnostic for Lyme disease
An antibiotic course of doxycycline for three weeks is first line treatment in patients with erythema migrans rash to prevent disseminated disease
A 14 year old boy presents with a one week history of a rash behind his knee. He has recently been on a hiking holiday to the Scottish Highlands, where he had a tick bite. His mother is worried about Lyme disease.
Lyme disease (Lyme borreliosis) is caused by Borrelia burgdorferi bacteria transmitted through bites from infected ticks.1 It is common in Europe and North America.123 More than 1500 people receive a laboratory confirmed diagnosis of Lyme disease each year in the UK,4 and 300 000 in the US.5 A study in UK primary care estimated an incidence of 12.1 (95% confidence interval 11.1 to 13.2) per 100 000 individuals per year.6
An accurate diagnosis can facilitate early treatment and prevent complications affecting the central nervous system, joints, skin, and/or heart.7 Further, general practitioners can allay patients’ concerns about the disease and provide referral when necessary.
This article offers a guide to assessing and managing tick bites in primary care.
What you should cover
History
Take a detailed history of exposure to tick bite and symptoms.
Risk assessment
Ask about
• Recreational or occupational activities that risk exposure to ticks, such as outdoor sports, camping, hiking, forestry, and farming.
• Travel, particularly over the past month, to areas where Lyme disease is common. In the UK, Scotland has the highest incidence, followed by southwest and southern …
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