Frequently asked questions
We have compiled some frequently asked questions and offered a brief response. Where possible, we also give links to other web sites, which discuss the topic in further detail.
- What is Borreliosis?
- Is a rash always the first symptom?
- Does the EM rash always look like a bull's-eye?
- Are the symptoms the same in everyone who is infected?
- Is there a vaccine for Lyme disease?
- Can humans be infected with more than one tick-borne disease at a time?
- Are there any safe areas where infected ticks are not present?
- Are incidences of Lyme disease recorded?
Q.1 - What is the difference between Lyme disease and Borreliosis?
A.1 - Lyme disease (not Lymes) is a bacterial infection. The cause of Lyme disease is a spirochaete (a long, thin spiral shaped bacterium) called Borrelia. The true Lyme disease pathogen is called Borrelia burgdorferi (Bb) sensu stricto (i.e. meaning Bb in the strict sense). Bb was the cause of a sudden cluster of cases in Old Lyme, Connecticut, where Lyme disease gets its name from. Later other species (or sub-species) were found in Europe and other areas and these were given different names. They all come under the umbrella term of Borrelia burgdorferi sensu lato (meaning Bb in the broad sense).
In the UK and most of Europe the most commonly found species of Borrelia include Borrelia burgdorferi, B garinii, B afzelii and B valaisiana. Of these species hundreds of subtypes of differing strains are known to exist. The various strains can produce differing symptoms. Bb sensu stricto is known to result predominately in rheumatological complications, while other strains can have more predominant neurological and dermatological complications. Some physicians prefer to use the term 'Borreliosis' as an umbrella term for an infection of any strain. Antibiotics would generally be the treatment of choice for most physicians no matter which strain of infection.
Q.1 - References and further reading
Micro biology resource from Kenyon College, Ohio
Q.2 - Is a rash always the first symptom?
A.2 - No. The rash, which is called Erythema Migrans, may appear at any time during early or late/chronic infection and can appear before, or after, the onset of other symptoms.
Studies have shown that less than 50% of infected people develop an Erythema Migrans rash and some strains of Borrelia do not present with any skin involvement. Flu-like symptoms and excessive fatigue are often the first noticeable indications of infection. Progression of the illness can lead on to symptoms including cranial-nerve facial palsy, meningitis and heart problems, arthritis and encephalitis (inflammation of the brain) to name but a few. The onset of symptoms and presentation can differ for each individual.
Q.2- References and further reading
ILADS: Basic Information about Lyme disease
Q.3 - Does the EM rash always look like a bull's-eye?
A.3 - No. More often the rash is atypical (not like the bull's-eye) and can vary greatly in shape. The bull's-eye rash is circular in shape with a clearing from the centre. However many EM rash examples can be irregular in shape, colour and size. They can appear on any part of the body including the scalp where they are often not observed when under the hair. Multiple rashes can appear in multiple locations and not necessarily on the part of the body where the bite is thought to have occurred.
Q.3 - References and illustration
A classic "bull's-eye" EM rash
An atypical EM rash
The Lyme Disease Foundation: has a picture gallery of several different types of rash.
Q.4 - Are the symptoms the same in everyone who is infected?
A.4 - No. Borrelia, also known as 'the new great imitator', can resemble many well recognised conditions such as Glandular Fever (Epstein-Barr Virus), Chronic Fatigue Syndrome/ME, Multiple Sclerosis, Motor Neurone Disease/ALS, Alzheimer's, Parkinson's Disease, Lupus, Meningitis, depression, Bell's palsy, sleep disorder, psychiatric illness, ADHD, arthritis, rheumatism and many more. Symptoms can be widespread and intermittent. Treatment can often make the patient worse before they get better. This is called a Jarisch-Herxheimer reaction.
Q.4- References and further reading
Jarisch-Herxheimer (J-H) Reaction and Lyme Disease.
Lyme disease: Symptoms and Characteristics 
size 1.13MB, from the 12th International Conference on Lyme disease and Other Spirochetal and Tick-Borne Disorders.
Q.5 - Is there a vaccine for Lyme disease?
A.5 - No. Currently there is not enough known about the disease to allow the creation of a vaccine in the UK. The US vaccine LYMErix was used but subsequently withdrawn.
Q.5- References and further reading
Information on Human Vaccine for Lyme disease.
Q.6 - Can humans be infected with more than one tick-borne disease at a time?
A.6 - Yes. The most common co-infections are Bartonella, Babesia and Ehrlichia, all of which require specialised treatment. Other opportunistic infections can also result from the immune system being depressed by a Borrelia infection.
Q.6- References and further reading
Paper in PubMed : Coinfecting deer-associated zoonoses: Lyme disease, babesiosis, and ehrlichiosis
Q.7 - Are there any safe areas where infected ticks are not present?
A.7 - No. Infected ticks have been collected from the remote Scottish isles to the London parks. Ticks are known to feed on, and be transported by, all manner of wildlife, farm animals, birds, rodents, reptiles, and domestic pets. It is generally accepted that infected ticks will be present wherever there is wildlife. However, taking simple precautions will help to prevent tick-attachment, and knowing how to correctly remove a tick can help prevent disease transmission.
Q7- References and further reading
National Farmers' Union - Countryside Online.
Paper in PubMed - Evidence for Lyme disease in urban park workers: a potential new health hazard for city inhabitants.
Paper in Blackwell Synergy - Distribution of Borrelia burgdorferi s.l. spirochaete DNA in British ticks (Argasidae and Ixodidae) since the 19th century, assessed by PCR..
Q.8 - Are incidences of Lyme disease recorded?
A.8 - In Scotland, Lyme disease is classed as a notifiable disease. This requires that notification should take place on the basis of clinical suspicion; a diagnosis does not have to be laboratory confirmed. In the British Armed Forces, Lyme disease is likewise a reportable condition. For those employed as zookeepers, forestry workers, or in certain other types of employment, notification to the Health & Safety Executive is required. Throughout the rest of the UK a voluntary monitoring scheme is in place by which The Health Protection Agency's Lyme Reference Section reports only laboratory confirmed cases of Lyme disease directly to the Zoonoses Surveillance Unit.
Q.8- References and further reading
Health Protection Scotland - Lyme disease: Surveillance.