Lyme disease: Doctors told not to wait for blood tests where patients have ‘bull’s eye’ rash

‘When a patient has the rash, this delay is unnecessary and reduces the likelihood of total cure,’ Lyme disease charity warns

Doctors have been told to diagnose Lyme disease without waiting for blood test results if patients have the characteristic “bull’s eye” rash.

Blood tests for the tick-borne infections may miss the condition in the early weeks, according to new draft guidance published by the National Institute for Health and Care Excellence (Nice).

This could reduce the chances of a full recovery, the NHS treatment watchdog said. As a result, it said patients should be offered antibiotics where they show the characteristic ringed rash, known as erythema migrans.

The bull’s eye rash appears in around two thirds of cases usually within a month of a bite from an infected tick.

“For most people with Lyme disease, a course of antibiotics will be effective, so it is important we diagnose and treat people as soon as possible,” Professor Gillian Leng, director of health and social care at Nice, said. “A person with Lyme disease may present with a wide range of symptoms, so we have clear advice for professionals about the use of lab tests for diagnosis and the most appropriate antibiotic treatments.”If a characteristic bull’s eye rash is present, healthcare professionals should feel confident in diagnosing Lyme disease.”

Tests can check for antibodies in the blood, however these may not appear until up to eight weeks after the patient is bitten.

It is hoped the new draft guidance will increase the number of early diagnoses and allow patients to receive treatment immediately, reducing the risk of further symptoms developing.

When there is no rash present and symptoms are unclear, doctors will be advised to carry out blood tests.

Professor Saul Faust, chairman of the guideline committee, said: “Lab tests are necessary when a person’s symptoms are unclear, but they are not needed if a person presents the characteristic red rash, erythema migrans. Doctors should feel confident to prescribe antibiotics immediately for those with erythema migrans.”

Veronica Hughes, chief executive of Caudwell LymeCo, a UK charity for patients with Lyme disease, said: “Waiting for blood test results always delays treatment. When a patient has the rash, this delay is unnecessary and reduces the likelihood of total cure.”

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