A Report into the Requesting of Lyme Disease Tests in the Immunoserology Department at Nobles Hospital, Isle of Man

Abstract

Introduction: Lyme disease is caused by a spirochete infection of the genus Borrelia, transmitted through bites of the sheep tick Ixodes Ricinus on the Isle of Man. This can lead to a number of short-term non-specific symptoms, and longer-term debilitating effects. Objective: This study analyzed the requesting of Lyme disease serology at the Immunoserology laboratory at Noble’s Hospital in order to look for money saving opportunities. Materials and Methods: A data grab was performed on the LIMS system in use at Noble’s Hospital, Isle of Man, for Lyme disease testing requested over a five-year period, with results transferred to an Excel spreadsheet. This data was then sorted into various categories, including year-by-year and month-by-month totals, percentage of requests honored, source of requests, in-depth investigations of GP requests, and results of tests. Results: Findings indicated that Lyme disease requesting had doubled over this five-year period, with over twothirds of requests being from General Practitioners. Several surgeries were found to be requesting significantly more than the proportion of the population served indicated was appropriate. Discussion: In order to ensure that clinicians made suitable judgments, and therefore the best use of resources, this report makes three recommendations: 1. Communication sent to GP practices reminding them of the importance of testing only in the event of clinical suspicion, characteristic rash, and evidence of a tick bite. Limitations of testing and details of specialist advice from Rare and Imported Pathogens Laboratory (RIPL) also included. 2. RIPL contact information also added to the comment automatically applied to a negative sample. Comment added to positive samples regarding the limitations of the test, and RIPL contact details. 3. Information disseminated to the public regarding the Public Health England (PHE) Tick Surveillance Scheme in order to maintain epidemiological data.