Lyme disease

Lyme disease is caused by Borrelia species, transmitted to humans via tick bite. It is not endemic in Australia but can occur in travellers returning from Europe or North America. The Overseas-acquired tick-borne diseases: Lyme disease document developed by the Australian Government Department of Health and Aged Care contains a map of the distribution of Lyme disease globally.

In general, Lyme disease in the United States produces skin, musculoskeletal and cardiac manifestations, while Borrelia species in Europe tend to cause skin and neurological manifestations. Early symptoms and signs (3 to 30 days after tick bite) are however similar, and can include fever, chills, headache, fatigue, arthralgia and erythema migrans ('bullseye') rash, especially near the site of the tick bite.

Note: If Lyme disease is suspected, seek advice on diagnosis and management from an infectious diseases physician or a clinical microbiologist.

If Lyme disease is suspected, seek advice on diagnosis and management from an infectious diseases physician or a clinical microbiologist. The Royal College of Pathologists of Australasia has a position statement about laboratory testing for Lyme disease Diagnostic Laboratory testing for Borreliosis (‘Lyme Disease’ or similar syndromes) in Australia and New Zealand.

International publications on the prevention, diagnosis and treatment of Lyme disease include:

Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease
National Institute for Health and Care Excellence (NICE): Lyme disease—Guidance
Review of European and American guidelines for the diagnosis of Lyme borreliosis.

Prolonged intravenous or oral antimicrobial therapy for Lyme disease did not significantly improve outcomes in studies performed in North America and Europe, and can be associated with significant adverse effects.

The Australian Government Department of Health has published a clinical pathway on debilitating symptom complexes attributed to ticks (DSCATT), available on their website. The pathway is intended to assist in the management of patients presenting in primary care with new onset (eg fever, rash) or unresolved debilitating symptoms that cannot be attributed to another condition, with or without a history of tick bite.