Lyme disease: Face the next tick season with confidence

If the arrival of spring signals the return of good weather, rising temperatures also mean the return of ticks. Health professionals throughout the province need to be prepared to take charge of the disease. Drs. Alex Carignan, François Milord and Camille Guillot share their advice on the responsible management of tick-borne diseases. Read: New research identifies tick-borne pathogens spreading outside their normal range Ontario, Quebec The three clinical stages of Lyme disease 1. Localized stage This is the start of the infection. It is usually characterized by an isolated erythema migrans, which often appears between three and 30 days after the tick bite. However, this is not always present or noticed. 2. Early disseminated stage This stage usually occurs when the first phase has not been detected or treated. The clinical presentation may include systemic symptoms such as cutaneous, neurological, musculoskeletal, cardiac and ocular manifestations. Erythema migrans may still be present. 3. Late disseminated stage It usually corresponds to the complication of the early disseminated stage and begins a few weeks to a few months after infection. Lyme arthritis is the main manifestation. Read: Climate Changed: Canada's health system isn't ready for new reality, say doctors Treatment options Always think about the possibility of Lyme disease in high-risk areas In these areas, if a patient complains of symptoms that may mimic Lyme disease, they should be investigated. In addition, in 70% of cases of Lyme disease, the patient does not remember being bitten by a tick. “You have to go a little further when you question the patient and focus more on the places at risk than on the presence of the tick on the skin. Has he been to a place where there are ticks, such as woodlots? Does he garden? Does he play golf? These are all risky activities,” explains Dr. Milord. The earlier the disease is treated, the better chance to reduce possible complications “Certain clinical presentations should also elicit the search for the disease in a systematic way,” says Dr. Alex Carignan. “This is similar in the case of aseptic meningitis, Bell's palsy or inflammatory arthritis of unclear etiology.” Know when serology is indicated for diagnosis According to Dr. Carignan, serology is indicated when the patient has symptoms more related to the disseminated stages of Lyme disease, such as neurological and joint symptoms. However, serology is not indicated in a patient presenting to a healthcare professional with erythema migrans, since it is negative in 50% of cases. It can also be negative at the very beginning of the infection, he specifies. If the patient does have erythema migrans and has been in an area at risk for Lyme disease, it is best to simply treat the disease. Erythema migrans usually appears three days after the bite, appears as a spot or oval plaque, gradually expands and persists for more than three days, and is more than five centimeters in size. Contrary to popular belief, 80% of erythema migrans do not have the shape of a target, specifies Dr. Carignan. Follow up after treatment for persistent symptoms When the diagnosis is confirmed and the treatment is prescribed, it is important to follow up with the patient, says Dr. Milord. Indeed, in about 10% of cases, symptoms may persist even after treatment, mainly when the disease is treated in the disseminated phases. These symptoms usually include fatigue, headaches, myalgias and cognitive difficulties. “If this is the case, the patient must be reassured: the presence of these symptoms does not indicate that the treatment has not worked. They disappear on their own after a few months,” he says. Prolonged treatments should also be avoided, warns Dr. Carignan. “Prolonged antibiotic use does not relieve symptoms and instead risks causing adverse effects to the patient,” he says. However, the experts indicate that health professionals can direct their patients to the reference centers for post-Lyme syndrome in the health network, where they will benefit from multidisciplinary care. Be proactive with prophylaxis Since the entry into force of Bill 31, pharmacists in Quebec can prescribe post-exposure prophylaxis for Lyme disease to patients who have a tick bite but no symptoms. No more need for a collective prescription or to be in a risk zone as was the case before. Pharmacists in endemic areas are increasingly comfortable prescribing prophylaxis, a single dose of doxycycline, notes Dr. Carignan, but those in other areas should be too. "Pharmacists need to be aware of their role in prophylaxis. We can never raise enough awareness about its importance,” noting that patients need to be informed around prophylaxis as well. Urge patients to be cautious without causing them anxiety It is very important to remind patients to be careful when going outside, says Dr. Guillot. Suggest they do a body check after each outing where there is a risk of ticks. "You have to check certain hot areas of the body like behind the ears or under the arms," she shares. This check can be done in the shower, as small ticks are sometimes difficult to see, but will be easier to scope out when soaping up, for example. You can also ask someone to check on the back of the neck and in the hair. The doctor adds that care must be taken not to cause further anxiety in patients. “They should not avoid going outside because contact with nature brings a lot of health benefits. The key is simply to be careful and to develop the reflex of doing a good check after your activity.” Keep other tick-borne diseases in mind “With global warming, we are going to see more and more tick-borne diseases, and health professionals need to stay informed,” says Dr. Carignan. For example, the blacklegged tick is also responsible for human granulocytic anaplasmosis, a disease that has been increasingly common in Quebec over the past two years. Indeed, an aggregate of 25 cases was identified in Estrie and Montérégie in the summer of 2021, whereas before, only three cases had been reported, shows a clinical study1 conducted by Dr. Carignan. The disease is treated by taking doxycycline for seven to 10 days and usually responds very well to antibiotic treatment. Patients with the disease will have more general symptoms such as fever, headache, muscle aches and fatigue. Reference: 1. Campeau L, Roy V, Petit G, Baron G, Blouin J, Carignan A. Identification of an unusual cluster of human granulocytic anaplasmosis in the Estrie region, Quebec, Canada, in 2021. Communicable disease survey in Canada 2022;48(5):212-9. https://doi.org/10.14745/ccdr.v48i05a02f. This article has been translated from its original French and originally appeared on our sister site Profession Santé.

Lyme disease: Face the next tick season with confidence

Register for free access or login.

Related Topics