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29-07-2012 | Article

Always learning

Some time ago, I came across a patient in whom the differential diagnosis included the possibility that she may have Lyme disease. As it turned out, she did not, but if I am honest this was not a disease I knew much about - partly because I work in an urban area but also, I assumed, because it is relatively uncommon.

I decided to read up on it and initially found a good article in the Merck Manual (click here to read more). However, sometimes what we need is more practical, front-line advice rather than textbook information. Finally I have come across a BMJ article that fits the bill (click here).

This is part of the excellent 10-minute consultation series (click here to read further), which I find very useful and practical. In this particular article, "Tick bite and early Lyme borreliosis", I learned a few gems that I am sure will help me in future diagnosis and management. In addition, I realised it is more common than I had previously thought - there were about 1200 cases in this country just 3 years ago. Some people contract their infection abroad but sources of infection are also found in the New Forest, Highlands and the Lake District.

One diagnostic pearl that I picked up was that "transmission of pathogenic Borrelia species is unlikely if ticks are attached for less than 24 hours and unengorged". Another was that "erythema migrans is a clinical diagnosis and does not require serological confirmation".

The article itself is short, readable and practical and - I hope - memorable. In the hurly burly of everyday life it is all too easy to put off reading because of a lack of time, fatigue or simply having no interest. Yet it is essential to set aside some protected time for reading and keeping up to date. We all have different ways of learning - I prefer reading as do many people, while others prefer lectures or a mixture of resources.

As long as you have a commitment to regular and appropriate learning from good quality resources then you are fulfilling your professional duties as a doctor. Either way, you will not go wrong by reading this excellent and short article on Lyme disease from the BMJ and maybe one day it could help you and your patient.

Best wishes,


Dr Harry Brown, editor-in-chief univadis

By Dr Harry Brown