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Abstract

Background

Borrelia burgdorferi, the micro-organism responsible for Lyme borreliosis, is known to be endemic in Scotland, with 4.2% sero-prevalence in Scottish blood donors. Facial nerve palsy can be a manifestation of the illness. The aim was to establish how often Lyme is considered as a potential cause in one Scottish health board.

Methods

Patients, aged four and above, presenting to secondary care with facial nerve palsy from 2016-2018 were identified using ICD-10 codes. A retrospective analysis of case notes and laboratory records was undertaken to establish whether a cause for nerve palsy had been found, whether a potential tick exposure history was taken, and if Lyme testing had been done. Microsoft Excel was used for analysis.

Results

173 patients with confirmed facial nerve palsy were identified. Consideration of Lyme disease was made in 9.2% (16/173). Of these, 43.8% (7/16), were asked about possible insect bites (four of whom were asked specifically about tick bites). 43.8% (7/16) were tested based on clinical presentation. 6.3% (1/16) had “no Lyme risks” documented and another 6.3% (1/16) had an occupational risk. Of the sixteen, 50% (8/16) had Lyme serology undertaken, although 2/8 had a confirmed alternative cause.

Conclusion

Possibility of Lyme disease is not commonly considered when individuals present with facial nerve palsy. This is despite endemnicity in Scotland, and opportunities for tick exposure being common, with outdoor activities and countryside trips. Educational initiatives are therefore required.

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/content/journal/acmi/10.1099/acmi.fis2019.po0021
2020-02-28
2020-06-04
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