Doctors are being advised to consider the diagnosis of Lyme disease in patients with suggestive symptoms, as the disease can often be mistaken for other conditions, according to the Medical Defence Union (MDU).

Ixodes scapularis/CDC

Numbers of cases of Lyme disease, a bacterial condition spread by infected ticks, have risen in recent years, and it is estimated there are around 2,000 to 3,000 new cases in England and Wales each year. Earlier this week the government announced a review of the diagnosis, treatment and transmission of the condition, including new NICE guidelines.

Dr Nicola Lennard, MDU medico-legal adviser, said:

‘We know our members often worry about missing a diagnosis of an unusual condition or mistaking patients’ symptoms for something more run of the mill. One such example is Lyme disease, as initial symptoms may be non-specific and mistaken for other conditions.

‘Doctors may see increasing numbers of cases of Lyme disease in the future, so it’s advisable to consider the diagnosis if a patient presents with suggestive symptoms and history. This is particularly important at this time of year when people are more likely to be walking in areas such as Scotland and the New Forest, where the ticks that cause the disease are common. With appropriate diagnostic tests and antibiotic treatment, Lyme disease can be managed effectively.

‘Failure to diagnose Lyme disease is not necessarily negligent as this can be a difficult condition to spot, but it’s important to clearly document the consultation with the patient. Make sure you include the history taken, the examination performed, the differential diagnosis and management plan.’

In one typical case reported to the MDU, a patient complained to their practice that their condition had been missed despite several visits to the nurse practitioner and various GPs. Another patient with a tick bite initially tested negative for the infection but was later found to have the disease. The patient claimed the practice should have repeated the blood test in the light of the symptoms.

The MDU’s advice on avoiding a delay in diagnosis of Lyme disease includes:

  • Advise patients to take precautions against tick bites if they tell you they are visiting high risk areas, especially in spring and summer when ticks are most active.
  • Be aware that there are various clinical manifestations of Lyme disease.
  • Consider the diagnosis in patients with suggestive symptoms who have walked in areas where the disease is prevalent. NHS choices provides advice on preventing tick bites and a list of areas of known to have a high population of ticks.
  • If the diagnosis is considered, arrange appropriate tests and where the diagnosis remains unclear, consider obtaining a specialist opinion from an infectious diseases consultant.
  • Be aware of the relevant guidelines on treatment of the condition, such as those from the Health Protection Agency and Centres for Disease Control and Prevention.
  • Remember that Lyme disease is a notifiable disease in Scotland, but not in England and Wales.