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Lyme disease: diagnosis and management
  1. Amy L Ross Russell1,
  2. Matthew S Dryden2,
  3. Ashwin A Pinto1,
  4. Joanna K Lovett1
  1. 1 Neurology Department, Wessex Neurosciences Centre, Southampton General Hospital, Tremona Road, Southampton, UK
  2. 2 Department of Microbiology and Infection, Hampshire Hospitals NHS Foundation Trust & Rare and Imported Pathogens Department, PHE, Porton, Salisbury, UK
  1. Correspondence to Dr Amy L Ross Russell, Neurology Department, Wessex Neurosciences Centre, Southampton General Hospital, Southampton SO16 6YD, UK; amy.rossrussell{at}


Lyme disease (borreliosis) is a tick-borne bacterial infection caused by the spirochaete Borrelia burgdoferi, transmitted by hard-backed Ixodes ticks. Actual numbers of cases are increasing and it appears that the distribution across the UK is widening; however, it occurs most frequently in area of woodland, with temperate climate. It typically presents in mid to late summer. Lyme disease is a multisystem disease. The nervous system is the second most commonly affected system after the skin. Other systemic manifestations, such as carditis, keratitis, uveitis and inflammatory arthritis, rarely occur in European Lyme disease. In 2018, the National Institute for Health and Care Excellence has updated its guidelines on the diagnosis and management of Lyme disease. Here, we highlight important aspects of this guidance and provide a more detailed review of the clinical spectrum of neuroborreliosis, illustrated by cases we have seen.

  • lyme disease
  • neuroborreliosis

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  • Correction notice This article has been corrected since it was

    published Online First. The references and citations were not correctly matched.

  • Contributors ALRR prepared the manuscript with contributions from JL and MD, and with review and revisions by all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Commissioned; externally peer reviewed by John Halperin, New Jersey, USA.

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