Table 1. A summary of clinical cases presented to GPs (for full details see Supplementary Appendix S1)
CaseFurther details
1: Classic erythema migrans (EM) rashInitial presentation of EM. A photo used by multiple organisations, so GPs likely to be familiar with. Then patient revealed to have been bitten by a tick
2: Borrelial lymphocytomaBorrelial lymphocytoma of the ear lobe
3: Acrodermatitis chronica atrophicans (ACA)With associated peripheral neuropathy
4: Bell’s palsyLater revealed to have insect bite on scalp
5: Recurrent synovitis of kneesNone
6: Multiple EM rashesPatient had been walking in Dartmoor
7: Heart rhythm abnormalitiesNone
8: Fatigue, post-exertional malaise, anxiety, headaches, and memory issuesLater patient reveals an international lab report saying she has Lyme disease, and she demands long-term antibiotics
9: Fatigue, arthralgia, poor ability to concentrate, myalgia, mood swingsNone
10: Non-engorged tick attached to scalpNone
11: Poor fine motor movements, rash 2 months previously at scout camp. This had been treated with erythromycin.None